First-onset tics in patients with attention-deficit-hyperactivity disorder: impact of stimulants

Abstract

First‐onset tics during stimulant treatment of attention‐deficit‐hyperactivity disorder (ADHD) are clinically relevant and remain a matter of scientific debate. Because there are limited clinical trials analyzing the risk of first‐onset tics in stimulant‐treated ADHD, a comprehensive evaluation is required for evidence‐based clinical recommendations. An analysis of studies with high methodological quality (i.e. double‐blind placebo‐controlled) on first‐onset tics during stimulant treatment of ADHD revealed that there seems to be no elevated risk of first‐onset tics in children undergoing this treatment. Although a close temporal relationship might be seen in a few patients, the role of treatment duration, dose of stimulant, genetic vulnerability, and developmental aspects need to be further explored to clarify possible pathophysiological mechanisms of tic emergence under stimulant treatment. The results of high quality studies, in addition to specialized studies with methodological limitations, suggest that stimulants are the criterion standard for the safe and successful treatment of ADHD.

Developmental comorbidity in attention-deficit/hyperactivity disorder

“…Schneider et al (2009) reported that boys with ADHD and comorbid chronic multiple TD were more severely impaired due to increased levels of anxiety and lower social competence. In comorbid patients, the ADHD symptomatology has been found to interfere with the patient's functional capacities and overall quality of life more than the tics themselves (Spencer et al 1999(Spencer et al , 2001Peterson et al 2001;Hoekstra et al 2004;Roessner et al 2006Roessner et al , 2007. Using the Tourette Syndrome International Database Consortium (TIC) database containing 6,805 cases, Freeman et al (2007) reported an association of ADHD with an approx.…”

Update on Attention-Deficit/Hyperactivity Disorder and Tic Disorders: A Review of the Current Literature

“…Large-sample study data are also available that report no marked correlation among the emergence of tics, the severity and course of preexisting tics, and stimulant dosage [38,43,44]. Children with tic onset after beginning stimulant therapy were most commonly found to be within the age range when tics disorders had their onset spontaneously [38]. Roessner et al [38] suggest that the relationship between stimulant use and first onset of tics may be an early triggering of what would have been a later spontaneous tic onset.…”

“…Denckla and colleagues [42] reported the development of motor tics or an exacerbation of preexisting tics in approximately 1.3% of children (n= 1,520) receiving methylphenidate therapy for ADHD, suggesting that stimulant therapy does not significantly induce tics or exacerbate preexisting tics, and that this can be seen as a rare occurrence. Large-sample study data are also available that report no marked correlation among the emergence of tics, the severity and course of preexisting tics, and stimulant dosage [38,43,44]. Children with tic onset after beginning stimulant therapy were most commonly found to be within the age range when tics disorders had their onset spontaneously [38].…”

“…However, stimulants are not tolerated or efficacious in 10% to 20% of cases, possibly due to exacerbation of tics [33•]. The outcomes of some case reports and studies resulted in concerns that stimulants may induce tics in children without preexisting tics [38][39][40][41]. The suggested correlation between the development or exacerbation of tics and use of stimulants has been analyzed in several clinical trials.…”

“…Children with tic onset after beginning stimulant therapy were most commonly found to be within the age range when tics disorders had their onset spontaneously [38]. Roessner et al [38] suggest that the relationship between stimulant use and first onset of tics may be an early triggering of what would have been a later spontaneous tic onset.…”