Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder.
ABSTRACT The findings from case reports and patient questionnaire surveys have been interpreted as indicating that administration of stimulants is ill-advised for the treatment of attention-deficit hyperactivity disorder in children with tic disorder.
Thirty-four prepubertal children with attention-deficit hyperactivity disorder and tic disorder received placebo and three dosages of methylphenidate hydrochloride (0.1, 0.3, and 0.5 mg/kg) twice daily for 2 weeks each, under double-blind conditions. Treatment effects were assessed using direct observations of child behavior in a simulated (clinic-based) classroom and using rating scales completed by the parents, teachers, and physician.
Methylphenidate effectively suppressed hyperactive, disruptive, and aggressive behavior. There was no evidence that methylphenidate altered the severity of tic disorder, but it may have a weak effect on the frequency of motor (increase) and vocal (decrease) tics.
Methylphenidate appears to be a safe and effective treatment for attention-deficit hyperactivity disorder in the majority of children with comorbid tic disorder.
SourceAvailable from: Barbara Coffey
Article: Tics and Tourette Syndrome.[Show abstract] [Hide abstract]
ABSTRACT: Tourette syndrome is a childhood onset neurodevelopmental disorder characterized by multiple motor and vocal tics. Although many youth experience attenuation or even remission of tics in adolescence and young adulthood, some individuals experience persistent tics, which can be debilitating or disabling. Most patients also have 1 or more psychiatric comorbid disorders, such as attention-deficit/hyperactivity disorder or obsessive-compulsive disorder. Treatment is multimodal, including both pharmacotherapy and cognitive-behavioral treatment, and requires disentanglement of tics and the comorbid symptoms.Psychiatric Clinics of North America 09/2014; 37(3):269-286. DOI:10.1016/j.psc.2014.05.001 · 2.13 Impact Factor
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ABSTRACT: The use of CNS stimulants for the treatment of attention deficit hyperactivity disorder (ADHD) in children has steadily increased in most areas of the world over the last 30 years. In mid-1995, at least 1.5 million US children were receiving methylphenidate or dexamphetamine (dextroamphetamine). However, in other countries these agents are not used as widely. Specific stimulant-induced benefits for children with ADHD include: improved school grades, more completed classroom work, fewer reprimands for disruptive behaviour, improved handwriting, and improved behaviour at home and in social situtions. Stimulants benefit at least 75% of children with ADHD and are remarkably well tolerated, having few (for the most part minor and temporary) adverse effects. However, the benefits of stimulants that are obvious in most patients with ADHD during a brief clinical trial are primarily symptomatic. Although the behavioural benefits of stimulants are generally present during each period of treatment for as long as the ADHD condition exists (and children with ADHD are now often staying on stimulant medication into their mid-teens), the treatment has not been shown to change the long term outcome of the disorder. Before prescribing stimulants, paediatric physicians need to perform a careful diagnostic assessment for ADHD using multiple sources of information, including detailed ratings of the child’s behaviour from his/her teachers and from a parent. If at baseline, the child’s academic and behavioural adjustment in the classroom is good, stimulant medication would be inappropriate. However, if the child’s pattern of ADHD has consistently and seriously interfered with his/her classroom and home adjustment, stimulant treatment should be actively considered. Should stimulant therapy be initiated, knowledgeable medical follow-up is required.CNS Drugs 04/1997; 7(4). DOI:10.2165/00023210-199707040-00002 · 4.38 Impact Factor
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ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is the most common comorbid condition in people with Tourette syndrome (TS), reported in 60-80% of TS clinical samples. The comorbidity between TS and ADHD appears to have a complex pathogenesis and genetic factors can be implicated. Even if the etiological relationship between TS and ADHD is unclear, it is clear that individuals with both TS and ADHD are at a much greater risk for a variety of poor outcomes. It has been largely reported that the presence of comorbid symptoms seems to have a more significant influence on the patient's quality of life than the presence of tics alone, and therefore it can be associated with a major need for pharmacological interventions. Nonpharmacological interventions, including psychotherapy, should be tried in patients with TS and comorbid ADHD before considering pharmacological treatment of ADHD symptoms. Available evidence suggests that the alpha 2-agonists should be the first-line treatment, followed by immediate release or sustained release psychostimulants as second choice, and atomoxetine as third-line treatment. Monitoring of emergence or worsening of tics is particularly recommended during a treatment course of psychostimulants.International Review of Neurobiology 01/2013; 112:415-44. DOI:10.1016/B978-0-12-411546-0.00014-7 · 2.46 Impact Factor