What is it about?
We also carried out a literature review relating to the management of tic disorders in children and adolescents with ADHD. We performed a comprehensive search of Medline, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis (meta-analysis) was deemed appropriate.
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Why is it important?
ADHD is the most common neurodevelopmental disorder in children and adolescents in developed countries. Up to 20% ADHD patients have a Tic disorder. There is conflicting evidence of the role of psychostimulants in either precipitating or exacerbating tics in ADHD patients. Tics naturally wax and wane in clinical severity and are exacerbated by stress (eg consequences of untreated ADHD). It is often difficult to attribute blame to treatment.
Perspectives
The incidence of tic disorders and the severity of tics are not increased by the use of stimulants in paediatric patients treated with for ADHD. For patients with pre-existing tic disorders, the usual recommended dosing of stimulants should be used because supratherapeutic doses of dextroamphetamine have been shown to exacerbate tic disorders. If tics are disabling, stimulants could be substituted or complemented with alpha adrenergics (Clonidine or Guanfacine), or trial of non-stimulant Atomoxetine considered. Antipsychotics should be reserved for the most severe and uncontrollable tic disorders.
Dr Michael O Ogundele
Mid Cheshire Hospitals NHS Foundation Trust Postgraduate Medical Centre
Read the Original
This page is a summary of: G421 Evidence-based management of tics in children with adhd, May 2017, BMJ,
DOI: 10.1136/archdischild-2017-313087.414.
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