Disentangling the Overlap between Tourette's Disorder and ADHD

Pediatric Psychopharmacology Unit, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 11/1998; 39(7):1037-44. DOI: 10.1017/S0021963098002984
Source: PubMed


To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD.
The sample consisted of children with Tourette's syndrome with ADHD (N = 79), children with Tourette's syndrome without ADHD (N = 18), children with ADHD (N = 563), psychiatrically referred children (N = 212), and healthy controls (N = 140).
Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD.
These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.

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    • "Tic disorders and ADHD occur together in at least 30– 40% of cases, both in children and adults [16] [17]. Some researchers [18] have suggested that ADHD always accompanies TS, albeit sometimes at a subclinical level. The same neuronal circuits seem implicated [19], and the presence of ADHD impacts on the severity of tics and other behavioral problems. "
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    ABSTRACT: Attention deficit disorder with hyperactivity (ADHD) is a common comorbidity in children with Tourette syndrome (TS). However, motor restlessness and high levels of sensorimotor activation or "overactivity" may be a feature of TS rather than a distinct ADHD comorbidity. The link between overactivity and ADHD in TS has yet to be established and in particular between adult and preadolescent manifestations. The current study furthers this understanding of ADHD features in TS by investigating the relationship between cognitive and behavioral aspects of ADHD and TS. The style of planning (STOP) overactivity scale was compared in preadolescent (n = 17) and adult (n = 17) samples. The STOP overactivity scale measures the characteristic overactive style of planning in everyday life. The aims of the study were twofold as follows: (1) to see if an overactive style was present in adolescents as well as in adults, and (2) to see if this overactive style correlated with hyperactivity, impulsivity, or perfectionism. Results suggest that overactivity may be a better description of the hyperactivity manifestations in TS. Behavioral components of overactivity were present in preadolescents while the cognitive components were more frequent in adults. Overactivity relates at the same time to perfectionism and impulsivity.
    03/2013; 2013:198746. DOI:10.1155/2013/198746
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    • "T ourette syndrome (TS) is a developmental disorder characterized by involuntary, repetitive, stereotypic tics, both motor and vocal (Albin and Mink, 2006, Chowdhury, 2008, Jankovic, 2001, Leckman, 2003, Robertson, 2000, 2006, Sheppard et al., 1999, Spencer et al., 1998, Swerdlow, 2001, The Tourette Syndrome Classification Study Group, 1993). "
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    ABSTRACT: We examined the inhibition of stimulus-stimulus associations (formally 'conditioned inhibition') in Tourette syndrome (TS). The present study used video game style conditioned inhibition procedures suitable for children and adolescents. We tested 15 participants with a clinical diagnosis of TS in the absence of co-morbid attention deficit hyperactivity disorder and compared them with 19 typically developing age and sex matched controls (both groups aged 10-20 years). All children were tested for inhibition by summation test using two test stimuli in each of two conditioned inhibition tasks. TS participants showed overall normal inhibition of stimulus-stimulus associations, and there was no correlation between inhibitory learning scores and symptom severity ratings. However, there was a clear reduction in conditioned inhibition in 7 TS participants medicated with clonidine. There was no significant effect of medication on excitatory learning of the stimulus-stimulus associations. We suggest that clonidine's effect on inhibitory as opposed to excitatory learning could be related to reduced noradrenergic activity. In terms of clinical implications for TS, impaired conditioned inhibition could reduce the ability of susceptible individuals to learn to control tics in the presence of associative triggers.
    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 05/2011; 20(2):96-106.
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    • "Les mécanismes étiologiques de ces deux troubles impliqueraient une atteinte des circuits frontaux sous-corticaux, de même qu'un déséquilibre biochimique de la dopamine et de la sérotonine [7] [27]. Certains suggèrent l'existence d'un spectre des troubles impulsifs, présentant les mêmes caractéristiques neurobiologiques et comportementales que le SGT et le TDAH [28] [29]. Les études de O'Connor et de Laverdure [20,30—32] ont permis d'identifier le concept de suractivité chez des gens atteints du SGT. "
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    ABSTRACT: Motor and phonic tics are the defining characteristics of Tourette syndrome (TS). However, several comorbidities are frequently associated and the most prevalent in children are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder. Oppositional and aggressive behaviors are also highly rated for children with TS. Explosive outbursts (EO) have been defined as a disproportionate rage attack, which occurs in a sudden intensity and a recurring way according to a situational profile. EO have been viewed as a result of interplay between various comorbidities, particularly ADHD. This study evaluated the effectiveness of an innovative cognitive-behavioral intervention for decreasing frequency and intensity of EO. A case series of a child (10 years old) who participated in the program and who is showing ADHD comorbid to TS is presented. EO frequency and intensity were measured by systematic observation of events and by questionnaires. The child showed trends towards decreased EO frequency, mostly with the implementation of cognitive-behavioral exercises but no changes in EO intensity.
    Journal de Thérapie Comportementale et Cognitive 09/2010; 20(3):104-111. DOI:10.1016/j.jtcc.2010.09.007
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