Attention-Deficit Hyperactivity Disorder (ADHD) Comorbidity: A Case for ``Pure'' Tourette Syndrome?
Kennedy Krieger Institute, Baltiomore, MD 21205, USA.Journal of Child Neurology (Impact Factor: 1.72). 09/2006; 21(8):701-3. DOI: 10.1177/08830738060210080701
More than a decade of research regarding the motoric characteristics of the attention-deficit hyperactivity disorder (ADHD) that accompanies Tourette syndrome has revealed unique anatomic and neurobehavioral differences and highlighted the importance of distinguishing children with this form from the 40% of children with Tourette syndrome who do not have ADHD. This distinction is important in providing guidance to parents and to patients and in formulating expectations for short- and long-term prognoses. In addition, study methodologies that fail to categorize patients in this way and instead involve covarying for dimensional symptoms of ADHD obscure biologically distinctive circuits and clinically meaningful patient characteristics.
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ABSTRACT: Tics, patterned movements distinct from stereotypies, myoclonus, and other hyperkinetic movements, are quite common in children, particularly among those with developmental and psychiatric disorders. Thus, tics can indicate the presence of atypical neurodevelopment or broader difficulties with cognition or mood. Tics are also the cardinal feature of Tourette syndrome, a childhood-onset neurobehavioral disorder characterized by a chronic inability to suppress or an urge to perform patterned, repetitive movements. Patients with Tourette syndrome most commonly have, in addition to tics, symptoms of inattention, hyperactivity, obsessiveness, or anxiety. Achieving the most effective treatment of a child with tics is contingent on proper diagnosis of the movement disorder and thorough assessment for other problems, followed by consideration of both nonpharmacologic and pharmacologic interventions for any and all symptoms interfering with the child's function and quality of life. This review focuses primarily on the diagnosis and medical treatment of tics in children and adolescents with Tourette syndrome.Journal of Child Neurology 09/2006; 21(8):690-700. DOI:10.1177/08830738060210080401 · 1.72 Impact Factor
Chapter: Disruptive Behavior Disorders[Show abstract] [Hide abstract]
ABSTRACT: Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder are a heterogeneous group of childhood onset behavioral disorders that are traditionally lumped together as Disruptive Behavior Disorders (DBD) because they share behaviors that cause significant disturbance and distress within the child’s environment, usually school and/or family, as well as causing severe developmental and psychosocial dysfunction for the individual. ADHD is characterized by symptoms of inattention, impulsivity, and hyperactivity; ODD by hostility, anger, argumentativeness, and defiance; and conduct disorder by aggression, deceitfulness and violation of the rights of others. The DBDs play an enormous social role because they represent a high risk for developmental trajectories that harbor psychosocial, economic, psychiatric, and criminal morbidity across the lifespan and have significant socioeconomic and health impact on a national level. The DBDs may share comorbidities and some etiologic and pathophysiologic characteristics, however, their clinical manifestations, developmental trajectories, and biologic substrates are distinct. The explosion of neurobiological literature regarding the DBDs, most specifically on ADHD, reflects the complex, fluid, and often contradictory manifestations of brain–behavior relationships. This complexity is enhanced further by the accumulating research demonstrating significant differences in manifestations according to age, cognitive status, sex, comorbidities, psychosocial context, and treatment response. There is an enormous degree of individual variation shaped by the transaction of biological and environmental factors, which again has major implications for prevention and diagnostic and therapeutic interventions. For practical purposes, the current discussion focuses on each condition separately.12/2007: pages 301-333;
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ABSTRACT: Our primary objective was to determine if immediate-release methylphenidate is an effective treatment for oppositional defiant disorder diagnosed from mother's report in children with both chronic multiple tic disorder and attention-deficit hyperactivity disorder (ADHD). Children (n = 31) aged 6 to 12 years received placebo and 3 doses of methylphenidate twice daily for 2 weeks each under double-blind conditions and were assessed with ratings scales and laboratory measures. Results indicated significant improvement in both oppositional and ADHD behaviors with medication; however, the magnitude of treatment effect varied considerably as a function of disorder (ADHD > Oppositional behaviors), informant (teacher > mother), assessment instrument, and specific oppositional behavior (rebellious > disobeys rules). Drug response was comparable with that in children (n = 26) who did not have diagnosed oppositional defiant disorder, but comorbidity appeared to alter the perceived benefits for ADHD according to mother's report. Methylphenidate is an effective short-term treatment for oppositional behavior in children with comorbid ADHD and chronic multiple tic disorder.Journal of child neurology 06/2008; 23(9):981-90. DOI:10.1177/0883073808315412 · 1.72 Impact Factor
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