European Child & Adolescent Psychiatry

, Volume 15, Issue 1, pp 1–11

Attention deficit hyperactivity disorder, tics and Tourette’s syndrome: the relationship and treatment implications. A commentary

REVIEW

Abstract

Tourette’s Syndrome (TS) is now recognised to be a common childhood onset neurodevelopmental disorder. Attention deficit hyperactivity disorder (ADHD) is also a common childhood disorder. There are many cases in which the two disorders are comorbid. The reasons for this are unclear, but the comorbidity does not necessarily point to one genetic cause. Sleep is also often disturbed in individuals with TS and ADHD. The treatment implications of ADHD in the setting of tics or TS are important. Clonidine is suggested as a first line treatment. It was once thought that stimulants were contraindicated in the treatment of ADHD in the setting of TS, whereas it is suggested that they may be safe, but should be used judiciously. In addition, it was once thought that the combination of stimulants and clonidine was contraindicated, but from a large study the combination does appear to be safe. A relatively new medication for ADHD is atomoxetine, and although not documented widely in the setting of tics and TS, it may prove useful in this setting; further research is required. This commentary briefly discusses the comorbidity between TS and ADHD and offers treatment suggestions.

Key words

Tourette’s syndrome tics attention deficit hyperactivity disorder comorbidity treatment 

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References

  1. 1.
    Adler LA,Spencer TJ,Milton DR,Moore RJ, Michelson D (2005) Long-term, open-label study of the safety and efficacy of atomoxetine in adults with attention-deficit/hyperactivity disorder: an interim analysis. J Clin Psychiatry 66(3):294–299PubMedGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition Text Revised) (DSM-IV-TR). Washington DC, American Psychiatric AssociationGoogle Scholar
  3. 3.
    American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition Text Revised) (DSM-IV-TR). Washington DC, American Psychiatric AssociationGoogle Scholar
  4. 4.
    Ayalon L, Hermesh D, Dagan Y (2002) Case study of circadian rhythm sleep disorder following haloperidol treatment: reversal by risperidone and delatonin. Chronobiol Int 19(5):947–959CrossRefPubMedGoogle Scholar
  5. 5.
    Banaschewski T, Roessner V, Dittmann RW, Santosh PJ, Rothenberger A (2004) Non-stimulant medications in the treatment of ADHD. Eur Child Adolesc Psychiatry 13(Suppl 1):I102–I116CrossRefPubMedGoogle Scholar
  6. 6.
    Barker MJ, Benitez JG, Ternullo S, Juhl GA (2004) Acute oxcarbazepine and atomoxetine overdose with quetiapine. Vet Hum Toxicol 46(3):130–132PubMedGoogle Scholar
  7. 7.
    Borcherding BG, Keysor CS, Rapoport JL, Elia J, Amass J (1990) Motor/vocal tics and compulsive behaviours on stimulant drugs: is there a common vulnerability? Psychiatry Res 33:83–94CrossRefPubMedGoogle Scholar
  8. 8.
    Bourdon KH, Goodman R, Rae DS, Simpson G, Koretz DS (2005) The strengths and difficulties questionnaire: US normative data and psychometric properties. J Am Acad Child Adolesc Psychiatry 44(6):557–564CrossRefPubMedGoogle Scholar
  9. 9.
    Brand N, Geenen R, Oudenhoven M, Lindenborn B, van der Ree A, Cohen Kettenis P, Buitelaar JK (2002) Brief report: cognitive functioning in children with Tourette’s syndrome with and without comorbid ADHD. J Pediatr Psychol 27(2):203–208CrossRefPubMedGoogle Scholar
  10. 10.
    Brynska A, Tomaszewicz-Libudzic E, Wolanczyk T (2001) Obsessive-compulsive disorder and acquired toxoplasmosis in two children. Eur Child Adolesc Psychiatry 10(3):200–204CrossRefPubMedGoogle Scholar
  11. 11.
    Buitelaar JK, Danckaerts M, Gillberg C, Zuddas A, Becker K, Bouvard M, Fagan J,Gadoros J, Harpin V, Hazell P, Johnson M, Lerman-Sagie T, Soutullo CA, Wolanczyk T, Zeiner P, Fouche DS, Krikke-Workel J, Zhang S, Michelson D, Stomoxetine International Study Group (2004) A prospective, multi center, open-label assessment of atomoxetine in non-North American children and adolescents with ADHD. Eur Child Adolesc Psychiatry 13(4):249–257PubMedGoogle Scholar
  12. 12.
    Bullock GL, Schall U (2005) Dyssomnia in children diagnosed with attention deficit hyperactivity disorder: a critical review. Aust NZ J Psychiatry 39(5):373–377Google Scholar
  13. 13.
    Cardona F, Romano A, Bollea L, Chiarotti F (2004) Psychopathological problems in children affected by tic disorders: Study on a large Italian population. Eur Child Adolesc Psychiatry 13(3):166–171CrossRefPubMedGoogle Scholar
  14. 14.
    Carter As, O’Donnell DA, Schultz RT, Scahill L, Leckman JF, Pauls DL (2000) Social and emotional adjustment in children affected with Gilles de la Tourette’s syndrome: associations with ADHD and family function. Atten Deficit Hyperactivity Disord 47(2):215–223Google Scholar
  15. 15.
    Castellanos FX, Acosta MT (2004) Tourette syndrome: an analysis of its comorbidity and specialist treatment. Rev Neurol 38(Suppl 1):S124–S130PubMedGoogle Scholar
  16. 16.
    Castellanos FX, Giedd JN, Elia J,Marsh WL, Ritchie GF, Hamburger SD, et al. (1997) Controlled stimulant treatment of ADHD and comorbid Tourette’s syndrome: effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry 36:589–596PubMedGoogle Scholar
  17. 17.
    Channon S, Sinclair E, Waller D, Healey L, Robertson MM (2004) Social cognition in Tourette’s Syndrome: Intact theory of mind and impaired inhibitory functioning. J Autism Dev Disord 34(6):669–677CrossRefPubMedGoogle Scholar
  18. 18.
    Cohen-Zion M, Ancoli-Israel S (2004) Sleeping in children with attention-deficit hyperactivity disorder (ADHD): a review of naturalistic and stimulant intervention studies. Sleep Med Rev 8(5):379–402PubMedGoogle Scholar
  19. 19.
    Comings DE, Comings BG (1984) Tourette’s syndrome and attention deficit disorder with hyperactivity: are they genetically related? J Am Acad Child Psychiatry 23:138–146PubMedGoogle Scholar
  20. 20.
    Cummings DD, Singer HS, Krieger M, Miller TL, Mahone EM (2002) Neuropsychiatric effects of guanfacine in children with mild Tourette Syndrome: a pilot study. Clin Neuropharmacol 25(6):325–332PubMedGoogle Scholar
  21. 21.
    Eapen V, Robertson MM (1996) The use of fluoxetine in Gilles de la Tourette syndrome and obsessive compulsive behaviours: preliminary clinical experience. Prog Neuro-Psychopharmacol Biol Psychiatry 20:737–743CrossRefGoogle Scholar
  22. 22.
    Efron D, Hiscock H, Sewell JR, Cranswick NE, Vance AL, Tyl Y, Luk ES (2003) Prescribing of psychotropic medications for children by Australian pediatricians and child psychiatrists. Pediatrics 111(2):372–375CrossRefPubMedGoogle Scholar
  23. 23.
    Escobar R, Soutullo C, San Sebastian J, Fernandez E, Julian I, Lahortiga F (2005) Atomoxetine safety and efficacy in children with attention deficit/hyperactivity disorder (ADHD): initial phase of 10-week treatment in a relapse prevention study with a Spanish sample. Actas Esp Psiquiatr 33(1):26–32PubMedGoogle Scholar
  24. 24.
    Feldman PD, Ruff DD, Allen AJ (2005) Atomoxetine and tics in ADHD. J Am Acad Child Adolesc Psychiatry 44(5):405–406CrossRefPubMedGoogle Scholar
  25. 25.
    Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (2000) An international perspective on Tourette syndrome: selected findings from 3.500 individuals in 22 countries. Dev Med Child Neurol 42(7):436–447CrossRefPubMedGoogle Scholar
  26. 26.
    Freeman RD (1997) Attention deficit hyperactivity disorder in the presence of Tourette syndrome. Neurol Clin Neurophysiol 15:411–420Google Scholar
  27. 27.
    Gadow KD, Nolan E, Sprafkin J, Sverd J (1995) School observations of children with attention-deficit hyperactivity disorder and comorbid tic disorder: effects of methylphenidate treatment. J Dev Behav Pediatr 16:167–176PubMedGoogle Scholar
  28. 28.
    Gadow KD, Nolan EE, Sverd J (1992) Methylphenidate in hyperactive boys with comorbid tic disorder: II. Short-term behavioural effects in school settings. J Am Acad Child Adolesc Psychiatry 31:462–471PubMedGoogle Scholar
  29. 29.
    Goodman R (2001) Pyschometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345PubMedGoogle Scholar
  30. 30.
    Goodman R, Ford T, Simmons H, Gatward R, Meltzer H (2003) Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Int Rev PsychiatryGoogle Scholar
  31. 31.
    Himpel S, Banaschewski T, Heise CA, Rothenberger A (2005) The safety of non-stimulant agents for the treatment of attention-deficit hyperactivity disorder. Expert Opin Drug Saf 4(2):311–321CrossRefPubMedGoogle Scholar
  32. 32.
    Hoekstra PJ, Steenhuis MP, Troost PW, Korf J, Kallenberg CGM, Minderaa RB (2004) Relative Contribution of Attention-Deficit Hyperactivity Disorder, Obsessive-Compulsive Disorder, and Tic Severity to Social and Behavioural Problems in Tic Disorders. J Dev Behav Pediatr 25(4):272–279PubMedGoogle Scholar
  33. 33.
    Hoge SK, Biederman J (1986) A case of Tourette’s syndrome with symptoms of attention deficit disorder treated with desipramine. J Clin Psychiatry 47(9):478–479PubMedGoogle Scholar
  34. 34.
    Hornsey H, Banerjee S, Zeitlin H, Robertson MM (2001) The prevalence of Tourette syndrome in 13–14 year-olds in mainstream schools. J Child Psychol Psychiatry 42(8):1035–1039CrossRefGoogle Scholar
  35. 35.
    Ingrassia A, Turk J (2005) The use of clonidine for severe and intractable sleep problems in children with neurodevelopmental disorders—a case series. Eur Child Adolesc Psychiatry 14(1):34–40CrossRefPubMedGoogle Scholar
  36. 36.
    Jagger J, Prusoff BA, Cohen DJ, Kidd KK, Carbonari CM, John K (1982) The epidemiology of Tourette’s syndrome: a pilot study. Schizophr Bull 8:267–278PubMedGoogle Scholar
  37. 37.
    Kadesjo B, Gillberg C (2000) Tourette’s disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry 39(5):548–555PubMedGoogle Scholar
  38. 38.
    Kaplan S, Heiligenstein J, West S, Busner J, Harder D, Dittmann R, Casat C, Wenicke JF (2004) Efficacy and safety of atomoxetine in childhood attention-deficit/hyperactivity disorder with comorbid oppositional defiant disorder. J Atten Disord 8(2):45–52PubMedGoogle Scholar
  39. 39.
    Kelsey DK, Sumner CR, Casat CD, Coury DL, Quintana H, Saylor KE, Sutton VK, Gonzales J, Malcolm SK, Schuh KJ, Allen AJ (2004) Once-daily atomoxetine treatment for children with attention-deficit/hyperactivity disorder, including as assessment of evening and morning behaviour: a double-blind, placebo-controlled trial. Pediatrics 114(7):e1-e8CrossRefPubMedGoogle Scholar
  40. 40.
    Khalifa N, von Knorring AL (2003) Prevalence of tic disorders and Tourette syndrome in a Swedish school population. Dev Med Child Neurol 45(5):315–319CrossRefPubMedGoogle Scholar
  41. 41.
    Knell ER, Comings DE (1993) Tourette’s syndrome and attention-deficit hyperactivity disorder: evidence for a genetic relationship. J Clin Psychiatry 54:331–337PubMedGoogle Scholar
  42. 42.
    Kostanecka-Endress T, Banaschewski T, Kinkelbur J, Wullner I, Lichtblau S, Cohrs S, Ruther E, Woerner W, Hajak G, Rothenberger A (2003) Disturbed sleep in children with Tourette syndrome: a polysomnographic study. J Psychosom Res 55(1):23–29CrossRefPubMedGoogle Scholar
  43. 43.
    Kurlan R, Como PG, Miller B, Palumbo D, Deeley C, Andresen EM, Eapen S, Mc-Dermott MP (2002) The behavioral spectrum of tic disorders. Neurology 59:414–420PubMedGoogle Scholar
  44. 44.
    Ledbetter M (2005) Atomoxetine use associated with onset of a motor tic. J Child Adolesc Psychopharmacol 15(2):331–333CrossRefPubMedGoogle Scholar
  45. 45.
    Lee TS, Lee TD, Lombroso PJ, King RA (2004) Atomoxetine and tics in ADHD. J Am Acad Child Adolesc Psychiatry 43(9):1068–1069PubMedGoogle Scholar
  46. 46.
    Lieh Mak F, Chung SY, Lee P, et al. (1982) Tourette syndrome in the Chinese: a follow-up of 15 cases. In: Friedhoff AJ, Chase TN (eds) Gilles de la Tourette Syndrome.Advances in Neurology. Vol. 35. New York: Raven PressGoogle Scholar
  47. 47.
    Lowe TL, Cohen DJ, Detlor J, Kremenitzer MW, Shaywitz BA (1982) Stimulent medications precipitate Tourette’s syndrome 247(12):1729–1801Google Scholar
  48. 48.
    Mathai J, Anderson P, Bourne A (2004) Comparing psychiatric diagnoses generated by the strengths and difficulties questionnaire with diagnoses made by clinicians. Aust N Z J Psychiatry 38(8):639–643CrossRefPubMedGoogle Scholar
  49. 49.
    Miyazaki S, Uchida S, Mukai J, Nishihara K (2004) Clonidine effects on all-night human sleep: opposite action of low- and medium-dose clonidine on human NREM-REM sleep proportion. Psychiatry Clin Neurosci 58(2):138–144CrossRefPubMedGoogle Scholar
  50. 50.
    Moll GH, Eysenbach K, Woerner W, Banaschewski T, Schmidt MH, Rothenberger A (2000) Quantitative and qualititative aspects of obsessive-compulsive behaviour in children with attention-deficit hyperactivity disorder compared with tic disorder. Acta Psychiatr Scand 101(5):389–394CrossRefPubMedGoogle Scholar
  51. 51.
    Owens JA, Rosen CL, Mindell JA (2003) Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians. Pediatrics 111(5 Pt 1):e628–e635CrossRefPubMedGoogle Scholar
  52. 52.
    Paes AH, Bakker A, Soe-Agnie CJ (1997) Impact of dosage frequency on patient compliance. Diabetes Care 20(10):1512–1517PubMedGoogle Scholar
  53. 53.
    Pauls DL, Hurst CR, Kruger SD, Leckman JF, Kidd KK, Cohen DJ (1986) Gilles da la Tourette’s syndrome and attention deficit disorder with hyperactivity. Evidence against a genetic relationship. Arch Gen Psychiatry 43:1177–1179PubMedGoogle Scholar
  54. 54.
    Pauls DL, Leckman JF, Cohen DJ (1993) Familial relationship between Gilles de la Tourette’s syndrome,attention deficit disorder, learning disabilities, speech disorders, and stuttering. J Am Acad Child Adolesc Psychiatry 32:1044–1050PubMedGoogle Scholar
  55. 55.
    Pelham WE, Gnagy EM, Burrows-Maclean L, Williams A, Fabiano GA, Morrisey SM, Chronis AM, Forehand GL, Nguyen CA, Hoffman MT, Lock TM, Fielbelkorn K, Coles EK, Panahon CJ, Steiner RL, Meichenbaum DL, Onyango AN, Morse GD (2001) Once-a-day concerta methyl phenidate versus three-times-daily methylphenidate in laboratory and natural settings. Pediatrics 107(6):E105CrossRefPubMedGoogle Scholar
  56. 56.
    Phillips L, Appleton RE (2004) Systematic review of melatonin treatment in children with neuro-developmental disabilities and sleep impairment. Dev Med Child Neurol 46(11):771–775CrossRefPubMedGoogle Scholar
  57. 57.
    Pierre CB, Noland EE, Gadow KD, Sverd J, Sprafkin J (1999) Comparison of internalizing and externalizing symptoms in children with attention-deficit hyperactivity disorder with and without comorbid tic disorder. J Dev Behav Pediatr 20(3):170–176PubMedGoogle Scholar
  58. 58.
    Pliszka SR (2003) Non-stimulant treatment of attention-deficit/hyperactivity disorder. CNS Spectr 8(4):253–258PubMedGoogle Scholar
  59. 59.
    Popper CW (1995) Combining methylphenidate and clonidine: pharmacological questions and news reports about sudden death. J Child Adolesc Psychopharmacol 5:157–166Google Scholar
  60. 60.
    Robertson MM (2000) Invited Review. Tourette Syndrome, associated conditions and the complexities of treatment. Brain 123:425–462PubMedGoogle Scholar
  61. 61.
    Robertson MM, Banerjee S, Eapen V, Fox-Hiley P (2002) Obsessive compulsive behaviour and depressive symptoms in young people with Tourette syndrome. A controlled study. Eur Child Adolesc Psychiatry 11(6):261–265CrossRefPubMedGoogle Scholar
  62. 62.
    Robertson MM, Eapen V (1992) Pharmacologic controversy of CNS stimulants in Gilles de la Tourette’s Syndrome. Clin Neuropharmacol 15:408–425PubMedGoogle Scholar
  63. 63.
    Rothenberger A, Banaschewski T, Heinrich H, Moll GH, Schmidt MH, Van’t Klooster B (2000) Comorbidity in ADHD children: effects of co-existing conduct disorder or tic disorder on event-related brain potentials in an auditory selective-attention risk. Eur Arch Psychiatry Clin Neurosci 250(2):101–110CrossRefPubMedGoogle Scholar
  64. 64.
    Rothenberger A, Kostanecka T, Kinkelbur J, Cohrs S, Woerner W, Hajak G (2001) Sleep and Tourette Syndrome. In: Cohen DJ (ed) Tourette SyndromeGoogle Scholar
  65. 65.
    Saccomani L, Vercellino F, Rizzo P, Rolando S, Ravera G (1999) Tic disorders in children and adolescents. Clinical and genetic features, comorbidity. Minerva Pediatr 51(4):101–108PubMedGoogle Scholar
  66. 66.
    Sandyk R, Kay SR (1991) The relationship of pineal calcification and melatonin secretion to the pathophysiology of tardive dyskinesia and Tourette’s syndrome. Int J Neurosci 58(3–4):215–247PubMedGoogle Scholar
  67. 67.
    Sangal RB, Sangal JM (2005) Attentiondeficit/hyperactivity disorder: cognitive evoked potential (P300) amplitude predicts treatment response to atomoxetine. Clin Neurophysiol 116(3):640–647CrossRefPubMedGoogle Scholar
  68. 68.
    Santosh PJ, Taylor E (2000) Stimulant drugs. Eur Child Adolesc Psychiatry 9(Suppl 1):I27–I43CrossRefPubMedGoogle Scholar
  69. 69.
    Shapiro AK, Shapiro E, Wayne HL (1973) Treatment of Tourette’s syndrome with haloperidol: review of 34 cases. Arch Gen Psychiatry (a) 28:92–96PubMedGoogle Scholar
  70. 70.
    Singer HS, Brown J, Quaskey S, Rosenberg LA, Mellits ED, Denckla B (1995) The treatment of attention-deficit hyperactivity disorder in Tourette’s syndrome: a double-blind placebo-controlled study with clonidine and desipramine. Pediatrics (a) 95:74–81PubMedGoogle Scholar
  71. 71.
    Singer HS (2005) Tourette’s syndrome: from behaviour to biology. Lancet Neurol 4(3):149–159PubMedGoogle Scholar
  72. 72.
    Snider LA, Seligman LD, Kethen BR, Levitt SJ, Bates LR, Garvey MA, Swedo SE (2002) Tics and Problem Behaviors in Schoolchildren: Prevalence, Characterization, and Associations. Pediatrics 110(2):331–336CrossRefPubMedGoogle Scholar
  73. 73.
    Spencer TJ, Biederman J, Wilens TE, Faraone SV (2002) Novel treatments for attention-deficit/hyperactivity disorder in children. J Clin Psychiatry 63 (Suppl 12):16–22PubMedGoogle Scholar
  74. 74.
    Spencer T, Biederman M, Coffey B, Geller D, Wilens T, Faraone S (1999) The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 57(9):842–847Google Scholar
  75. 75.
    Spencer T, Biederman J, Harding M, O’-Donnell D, Wilens T, Faraone S, Coffey B, Geller D (1998) Disentangling the overlap between Tourette’s disorder and ADHD. J Child Psychol Psychiatry 39(7):1037–1044CrossRefPubMedGoogle Scholar
  76. 76.
    Spencer T, Biederman J, Kerman K, Steingard R, Wilens T (1993) Desipramine treatment of children with attention-deficit hyperactivity disorder and tic disorder or Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 32(2):354–360PubMedGoogle Scholar
  77. 77.
    Sukhodolsky DG, Scahill L, Zhang H, Peterson BS, King RA, Lombroso PJ, Katsovich L, Findley D, Leckman JF (2003) Disruptive behaviour in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity, and function impairment. J Am Acad Child Adolesc Psychiatry 42(1):98–105CrossRefPubMedGoogle Scholar
  78. 78.
    Sverd J, Gadow KD, Paolicelli LM (1989) Methylphenidate treatment of attention-deficit hyperactivity disorder in boys with Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 28(4):574–579; discussion 580–582PubMedGoogle Scholar
  79. 79.
    Swanson J (2003) Compliance with stimulants for attention-deficit/hyperactivity disorder: issues and approaches for improvement. CNS Drugs 17(2):117–131CrossRefPubMedGoogle Scholar
  80. 80.
    Swanson JM, Wigal SB, Udrea D, Lerner M, Agler D, Flynn D, Fineberg E, Davies M, Kardatzke D, Ram A, Gupta S (1998) Evaluation of individual subjects in the analog classroom setting. I. Examination of graphical and statistical procedures for within-subject ranking response to different delivery patterns of methylphenidate. Psychopharmacol Bull 34(4):825–832PubMedGoogle Scholar
  81. 81.
    Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Rothenberger A, Sonuga-Barke E, Steinhausen H-C, Zuddas A (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry 13(Suppl):17–30CrossRefGoogle Scholar
  82. 82.
    Taylor E, Sergeant J, Dopfner M, Gunning B, Overmeyer S, Mobius HJ, Eisert HG (1998) Clinical guidelines for hyperkinetic disorder. Eur Child Adolesc Psychiatry 7(4):184–200CrossRefPubMedGoogle Scholar
  83. 83.
    Tjon Pian Gi CV, Broeren JP, Starreveld JS, Versteegh FG (2003) Melatonin for treatment of sleeping disorders in children with attention deficit/hyperactivity disorder: a preliminary open label study. Eur J Pediatr 162(7–8):554–555CrossRefPubMedGoogle Scholar
  84. 84.
    Wernicke JF, Kratochvil CJ (2002) Safety Profile of Atomoxetine in the Treatment of Children and Adolescents with ADHD. J Clin Psychiatry 63(Suppl 12):50–55PubMedGoogle Scholar
  85. 85.
    World Health Organisation (1992) International Classification of Diseases and Health Related Problems—Tenth Revision. GenevaGoogle Scholar
  86. 86.
    Yordanova J, Dumais-Huber C, Rothenberger A, Woerner W (1997) Frontocortical Activity in Children with Comorbidity of Tic Disorder and Attention-Deficit Hyperactivity Disorder. Biol Psychiatry 41(5):585–594CrossRefPubMedGoogle Scholar

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© Steinkopff Verlag 2006

Authors and Affiliations

  1. 1.Dept. of Mental Health SciencesUniversity College London, 2nd Floor, Wolfson BuildingLondon W1W 7EYUK

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