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Stimulants May Treat ADHD, Tic Disorders
Feb. 25, 2002 -- Children who have attention deficit hyperactivity disorder (ADHD) and suffer from uncontrolled tics or Tourette's syndrome may find relief from an unlikely source -- stimulants. New research shows that stimulant drugs, such as Ritalin, may actually minimize the unwanted movements rather than make them worse.
Researchers say about a quarter of children who require special education in school suffer from chronic tic disorders, and as many as 90% of children with these tic disorders -- including Tourette's -- also have ADHD. Until now, treating these children with the drug most commonly prescribed for ADHD, Ritalin, has been discouraged because it's a stimulant, and stimulants have been shown to make tics worse. Little was also known about the effectiveness of the most popular prescription alternative to Ritalin, Catapres, in reducing tics.
But a new study published in the journal Neurology shows both Ritalin and Catapres -- especially when used together -- are effective in treating these children.
Researchers studied 136 children with ADHD and a chronic tic disorder between the ages of 7 and 14 and examined the effects of treating them with either one of the drugs alone, both drugs, or no treatment. Throughout the four-month study, researchers found improvement in all of the children who received medication.
"Not only did tics not worsen during treatment with [Ritalin], the severity of tics actually decreased in all treatment groups," writes study author Roger Kurlan, MD, of the University of Rochester Medical Center in New York.
Researchers also found improvements in attentiveness and behavior among those treated with Ritalin. Those treated with Catapres also showed less crying, frustration, restlessness, excitability, and impulsiveness. The most common side effect was sedation and was related to the use of Catapres.
The authors say these findings dispute the notion that children with tics and ADHD should not take stimulants such as Ritalin, which has already been shown effective in treating about 85% of children with ADHD.
"Our study indicates that prior concerns that [Ritalin] worsens tics and that the drug should be avoided in patients with tics may be unwarranted," write the authors.
In an editorial that accompanies the study, Ruth Nass, MD, and Susan Bressman, MD, write that these results clearly add to the growing support for using stimulants to treat tics. But they say more research is needed to determine whether the combination of Ritalin and Catapres is really the most effective treatment for children with ADHD and tics.
"Whether adding [Catapres] to stimulants is indeed 'worth it' when it is not required to treat significant, troublesome tics, nonstimulant responsive impulsivity, or aggressivity is best decided on an individual basis," write Nass and Bressman.
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