Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome
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Tourette syndrome (TS) is a neurodevelopmental disorder with frequent comorbidity with Attention- deficit-Hyperactivity disorder (ADHD). The impact of this association is still a matter of debate.
Using the TIC database containing 6,805 cases, the clinical differences were ascertained between subjects with and without ADHD.
The reported prevalence of ADHD in TS was 55%, within the range of many other reports. If the proband was diagnosed with ADHD, a family history of ADHD was much more likely. ADHD was associated with earlier diagnosis of TS and a much higher rate of anger control problems, sleep problems, specific learning disability, OCD, Oppositional-defiant disorder, mood disorder, social skill deficits, sexually inappropriate behaviour, and self-injurious behaviour. Subjects with seizures and with Developmental Coordination Disorder also had high rates of ADHD. Anxiety disorder, however, was not more frequent. Preliminary data suggest that most behavioural difficulties in ADHD are associated with the Combined or Hyperactive-Impulsive Subtypes of ADHD. Every large site (>200 cases) had a significantly increased rate of anger control problems in cases with ADHD.
Subjects with TS have high rates of ADHD and complex associations with other disorders. Clinically the findings confirm other research indicating the importance of ADHD in understanding the behavioural problems often associated with the diagnosis of TS. Additional ADHD comorbidity should be taken into account in diagnosis, management, and training.
Keywordscomorbidity attention-deficit/hyperactivity disorder obsessive-compulsive disorder oppositional-defiant disorder tourette syndrome
I wish to thank Larry Burd, Ph.D., for his frequent inspiration, and Boris Kuzeljevic (Statistician/Data Manager, BC Research Institute) for helping with logistic regression procedures and their interpretation.
- 1.American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders—DSM-III-R. APA, Washington, DCGoogle Scholar
- 2.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders—DSM-IV. APA, Washington, DCGoogle Scholar
- 7.Budman CL, Bockmore L, Stokes J, Sossin M (2003) Clinical phemoneology of episodic rage in children with Tourette syndrome. J Pediatr Psychol 27:203–208Google Scholar
- 10.Coffey BJ, Biederman J, Geller D, Frazier J, Spencer T, Doyle R, Gianini L, Small A, Frisone DF, Magovcecic M, Steen N, Faraone SV (2004) Reexamining tic persistence and tic-associated impairment in Tourette’s disorder: findings from a naturalistic follow-up study. J Nerv Ment Dis 192:776–780PubMedCrossRefGoogle Scholar
- 15.Gillberg C, Gillberg IC, Rasmussen P, Kadesjo B, Soderstrom H, Rastam M, Johnson M, Rothenberger A, Niklasson L (2004) Co-existing disorders in ADHD—implications for diagnosis and intervention. Eur Child Adolesc Psychiatry 13(suppl 1):180–192Google Scholar
- 17.Hoekstra PJ, Steenhuis MP, Troost PW, Korf J, Kallenberg CG, Minderaa RB (2004) Relative contribution of attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and tic severity to social and behavioral problems in tic disorders. J Dev Behav Pediatr 25:272–279PubMedCrossRefGoogle Scholar
- 29.Palumbo DR (2005) New directions in the treatment of comorbid Attention Deficit Hyperactivity Disorder and Tourette’s syndrome. In Kurlan R (ed) Handbook of Tourette’s Syndrome and Related Tic and Behavioral Disorders, 2nd edn. Marcel Dekker, New York, pp 89–108Google Scholar
- 32.Roessner V, Becker A, Banaschewski T, Rothenberger A (2007) Executive functions in children with chronic tic disorders with/without ADHD: new insights. Eur Child Adolesc Psychiatry 16(Suppl 1):I/36–I/44Google Scholar
- 34.Rothenberger A, Döpfner M, Sergeant J, Steinhausen HC (eds) (2004) ADHD beyond core symptoms—not only a European perspective. Eur Child Adolesc Psychiatry 13(suppl 1):1–130Google Scholar
- 40.Sukhodolsky DG, Scahill L, Zhang H, Peterson BS, King RA, Lombroso PJ, Katsovich L, Findley D, Leckman JF (2003) Disruptive behavior in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity, and functional impairment. J Am Acad Child Adolesc Psychiatry 42:98–105PubMedCrossRefGoogle Scholar
- 41.Tourette Syndrome Classification Study Group (1993) Definition and classification of tic disorders. Arch Neurol 50:1013–1016Google Scholar