First-onset tics in patients with attention-deficit-hyperactivity disorder: Impact of stimulants

Department of Child and Adolescent Psychiatry, University of Goettingen, Germany.
Developmental Medicine & Child Neurology (Impact Factor: 3.51). 08/2006; 48(7):616-21. DOI: 10.1017/S0012162206001290
Source: PubMed


First-onset tics during stimulant treatment of attention-deficit-hyperactivity disorder (ADHD) are clinically relevant and remain a matter of scientific debate. Because there are limited clinical trials analyzing the risk of first-onset tics in stimulant-treated ADHD, a comprehensive evaluation is required for evidence-based clinical recommendations. An analysis of studies with high methodological quality (i.e. double-blind placebo-controlled) on first-onset tics during stimulant treatment of ADHD revealed that there seems to be no elevated risk of first-onset tics in children undergoing this treatment. Although a close temporal relationship might be seen in a few patients, the role of treatment duration, dose of stimulant, genetic vulnerability, and developmental aspects need to be further explored to clarify possible pathophysiological mechanisms of tic emergence under stimulant treatment. The results of high quality studies, in addition to specialized studies with methodological limitations, suggest that stimulants are the criterion standard for the safe and successful treatment of ADHD.

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    • "The same has to be stated concerning the proposed removal of the stimulants in DSM-5 as an example of tic induction due to the direct physiological effects of a substance. We welcome the removal because recent evidence neither points to a relationship between stimulants and onset [13] nor exacerbation of existing tics [2]. "
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    ABSTRACT: Classification of tic disorders will be revised in the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). We do not support the suggestion to move tic disorders to "Anxiety and Obsessive-Compulsive Disorders", if the section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" is not retained. Other than that, most proposed changes of the criteria for tic disorders contain a number of welcome improvements, e.g., the more unified definition of tics including the removal of the term "stereotyped" and the better capture of the temporal pattern of tics (e.g., removal of the maximum 3 months criterion for a tic-free period in chronic tic disorders). But, unfortunately there are some inconsistencies in detail, e.g., the unification of diagnostic criteria for tic disorders had not been consistently pursued in transient tic disorder. In sum, the proposed DSM-5 criteria could be seen as an important step forward particularly in clinical routine. However, continued research is needed to justify the existing and proposed classification of tic disorders as well as to better clarify what other changes should be made in the DSM-5 and beyond.
    Full-text · Article · Nov 2010 · European Child & Adolescent Psychiatry

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    ABSTRACT: Unter Tics versteht man repetitive, unwill-kürliche, rasch ablaufende Bewegungen oder Lautproduktionen, die keinem erkennbaren Zweck dienen. Ihre Frequenz steigt in Belastungssituationen und bei emotionaler Erregung. Im Schlaf mildert sich die Symptomatik ab. Die Tics sind für eine gewisse Zeit unterdrückbar. Neben einfachen Bewegungs- und Lautimpulsen können auch komplexere motorische (z. B. sich Schlagen, Hüpfen, Kopropraxie=obszöne Gestik, Echopraxie =Imitation anderer) und sprachliche (z. B. Koprolalie=Verwendung obszöner Begriffe, Palilalie=Wiederholung der/des zuletzt gesprochenen Silbe/Wortes) Abläufe auftreten. Die Kombination chronischer (länger als ein Jahr andauernder) vokaler und multipler motorischer Tics wird als Tourette-Syndrom bezeichnet.
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