Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2016; 5(1): 128-135
Published online Feb 8, 2016. doi: 10.5409/wjcp.v5.i1.128
Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options
Olumide O Oluwabusi, Susan Parke, Paul J Ambrosini
Olumide O Oluwabusi, Paul J Ambrosini, Department of Psychiatry, Drexel University College of Medicine, Friends Hospital, Philadelphia, PA 19124, United States
Susan Parke, Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, United States
Author contributions: All authors contributed to the data analysis, literature review, writing and revision of this manuscript.
Institutional review board statement: This case report was exempted by the Institutional Review Board standards at the Drexel University College of Medicine, Philadelphia, PA, United States.
Informed consent statement: The legal guardians of the patients involved in this study provided informed written consent authorizing the use and disclosure of the respective patients protected health information. The identities of the patients were protected by using non-identifiable biographic data.
Conflict-of-interest statement: The authors have no financial disclosures and no relationship with any pharmaceutical company whose products are mentioned in this case report or with the manufacturers of competing products.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Olumide O Oluwabusi, MD, MRCPsych, Clinical Assistant Professor, Department of Psychiatry, Drexel University College of Medicine, Friends Hospital, 4641 Roosevelt Boulevard, Scattergood Building, Suite 212E, Philadelphia, PA 19124, United States. oluwabusi@gmail.com
Telephone: +1-215-8314053 Fax: +1-215-8314020
Received: August 28, 2015
Peer-review started: September 2, 2015
First decision: November 6, 2015
Revised: December 20, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 8, 2016
Processing time: 153 Days and 1.2 Hours
Abstract

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder (ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.

Keywords: Tourette syndrome; Psychopharmacology; Attention deficit hyperactivity disorder; Tics

Core tip: Tics can be a symptom of Tourette syndrome (TS). Attention deficit hyperactivity disorder (ADHD) has the highest comorbidity with TS. Psychopharmacological treatment of ADHD with stimulants may cause, or exacerbate pre-existing, tics. Because of this, providers may be reluctant to use stimulants in patients with comorbid tic disorders. However, the role of stimulants in the treatment of TS associated with ADHD, when the benefits outweigh the risks, cannot be over emphasized as a comprehensive approach, considering all treatment options for managing TS and ADHD will yield better outcomes.