What To Know About Tics in ADHD
Medically reviewed by Michael MacIntyre, MD
Roughly half of all children with attention deficit hyperactivity disorder (ADHD) experience tics. Tics are sudden movements that a person may have trouble controlling and include:
Vocal tics: humming, coughing, or sniffing
Verbal tics: saying words
Motor tics: moving or shrugging a body part
Tics are most commonly associated with Tourette's syndrome, which can overlap with ADHD. Research suggests 35% to 90% of children with Tourette's have ADHD or ADHD-like symptoms. Tics are also seen with autism and obsessive-compulsive disorder.
This article discusses ADHD and tics. It explains the types of tics seen in ADHD, how ADHD medications may cause tics, and ways to manage them.
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Types of ADHD Tics
Tics may occur a few years after an ADHD diagnosis. They may be either:
Provisional, lasting less than a year
Persistent, lasting a year or longer
People with ADHD may have one or more of several different kinds of tics, including:
Vocal (sounds, humming, words)
Facial (twitches, squints)
Body movements (jerking, twisting)
Skin picking
Tics themselves are rarely dangerous. However, they may cause social problems. They can also be distracting and make it challenging for children and others around them to focus.
In some cases, tics can create barriers to inclusion in certain activities. For example, it may be challenging to include a person with motor tics in activities such as dance. It can also be challenging for a person with vocal tics to be part of a choir.
Tics can also present problems at work, depending on the type of job.
Causes of Tics in ADHD
ADHD itself is most likely caused by genetic factors. Research suggests that Tourette's syndrome and ADHD have similar genetic signatures. Many people are diagnosed with both disorders.
Genetics plays a significant role in the development of tics with ADHD, but genetics isn't the only factor.
ADHD and Anxiety
Another cause of tics can be anxiety and depression, both of which are common in both children and adults with ADHD.
In some cases, treating anxiety and depression can reduce tics in ADHD. People with Tourette's can also experience psychiatric issues, which can make tics worse.
Does ADHD Medication Worsen Tics?
Researchers have speculated as to whether ADHD medication may cause or worsen tics. Although conflicting research exists.
There are two classes of medication for ADHD. One can contribute to tics, while the other may improve them. These include:
Stimulant medications like Adderall (amphetamine aspartate monohydrate) and Ritalin (methylphenidate) are amphetamines, which have the potential to worsen tics.
Non-stimulant medications like Strattera (atomoxetine) and alpha-2 agonists (Catapres (clonidine) and Intuniv (guanfacine) may help improve tics in children.
Reducing or changing medication that caused tics may lessen or eliminate them. However, individual responses to medications vary. Speak with your healthcare provider for guidance on medication choices for ADHD with tic disorders.
What Can I Do About ADHD and Tics?
ADHD is usually diagnosed in children, but it is commonly a lifelong condition. Tourette's syndrome, however, can disappear over time. That means that some people who have both ADHD and tics may outgrow the tics.
However, both children and adults can benefit from treatments that help reduce tics. Several different approaches can support the management of tics in ADHD. These include behavioral therapy, medication, self-care, and stress reduction.
Behavioral Therapy for Tics
Behavioral therapy is a treatment that teaches people to manage and reduce their tics. Habit reversal is a well-regarded intervention. It teaches people to become aware of their tics by identifying them out loud. Then, they do something different to help break the tic habit.
For example, if the tic causes the person to pick at their skin, they might put their hands on their hips so that they cannot pick at their skin.
Comprehensive Behavioral Intervention for Tics (CBIT) has also been studied and found effective. CBIT therapists work with patients to determine what makes tics better or worse. Then, they work to change the environment to avoid setting off tics.
For example, they might find that tics occur most often when a child is in a loud, crowded setting. In this case, you can either avoid such settings or try noise-canceling headphones (provided there’s no safety risk).
They might also create situations in which tics are less noticeable. For example, they might suggest changes to the seating arrangement in a classroom so that a child with tics is seated toward the back of the room.
Medical Treatments for Tics
Medical treatments are available for tics, but many have significant side effects. None is thought to be a cure.
The Food and Drug Administration (FDA) approved the following three drugs to treat tics:
Haldol (haloperidol)
Orap (pimozide)
Abilify (aripiprazole)
However, healthcare providers may also prescribe the following blood pressure medicines to treat tics:
Intuniv (guanfacine)
Catapres (clonidine)
These blood pressure medications may have fewer side effects.
Takeaway
If your child with ADHD developed tics after starting a stimulant, their healthcare provider may suspect that the medication is the cause. When this happens, they may reduce or change the medication to manage the tics.
Self-Care Strategies for Managing Tics
In general, self-care and stress reduction techniques may help manage tics.
A study at Massachusetts General Hospital with Harvard Medical School found mindfulness-based stress reduction (MBSR-tics) effectively treated tics in Tourette Syndrome (TS) and Chronic Tic Disorder (CTD).
Other ways to help support yourself or your child with tics and ADHD include the following:
Getting quality sleep
Eating an anti-inflammatory diet
Seeking therapy for any emotional issues
Getting adequate physical activity
Some supplements have been studied for reducing tics, including the following:
However, further study is needed to confirm the effects of these supplements.
Summary
Many children and adults with ADHD have tics. They may be a result of ADHD, or the person may also have Tourette's syndrome. Tics may also be associated with anxiety, stimulant medications used to treat ADHD, or other medical conditions.
Tics may disappear with age or when a stressful situation changes. There are medications for tics. Some may have side effects and may not be entirely successful. Tics can also often be managed through behavioral therapies and self-care measures. Sometimes, combining techniques can be particularly effective.
Read the original article on Verywell Health.
