ADHD And Tics. What Is The Connection?

ADHD and tics often come together. One research study concluded that an estimated half of the children with ADHD have a tic disorder and 35–90% of children with a tic disorder called Tourette syndrome also had ADHD. Both ADHD and tics can interfere with day-to-day life. What is the connection and how can both be treated? This article provides an overview of tic disorders, the link between these two, and solutions to overcome the symptoms. ADHD symptoms, causes, and treatments had been covered in detail in other articles.

About Tics 

Tics are described as sudden, rapid, non-rhythmic, stereotyped, recurring, and involuntary motor (involving movement)  or vocal tics. Tics can also be further classified as simple or complex. Examples of simple common motor tics include eye blinking, teeth grinding, shoulder shrugging, and head jerking. Some may experience facial grimacing, hand-clapping, neck unusual mouth movements,  arm or leg jerks. Complex motor tics involve a cluster of involuntary movements, touching objects or people, and even obscene gestures (medically known as copropraxia).

Simple vocal tics are common as well and include throat clearing, coughing, or spitting. Some may have these tics in the form of barking, sniffing, grunting, or hissing. Complex vocal tics include repeating words or phrases spoken by other people, or compulsive use of obscene words. 

Tourette syndrome is one of the most common tic disorders. According to DSM-5 diagnostic criteria, there should be at least two motors and at least one vocal tic that should be present, although not at the same time. These tics can be more or less frequent but must start before the age of 18,  experienced for more than a year, and not caused by another medical condition or substance abuse. 

Other tics disorders include chronic (or persistent) tic disorder, which can be either motor or vocal and cannot be both motor and vocal. Provisional tic disorders are defined as motor and/or vocal tics that are present for less than a year, and can’t be classified as Tourette syndrome or chronic motor or a vocal tic disorder. 

About 5-20% of school-age children have a tic disorder and about up to 1% of them experience impairments as a result of the tics. Tic disorders are not only associated with ADHD but also with obsessive-compulsive disorder (OCD), learning difficulties, sleep problems, anxiety, and depression. The average onset of tics is around 4-6 years of age, and they become more severe around age 10-12. 

The link between ADHD and tics

Genetics plays a role in both conditions, as certain genetic variations had been identified in both cases.  Prenatal exposure to substance abuse autoimmune response and other environmental factors seem to contribute to the development of both ADHD and tics. 

Gender. Males are more affected than females by both conditions. Males are three times more likely than females to develop a tic disorder and four times more likely to have ADHD. Therefore researchers suggest that changes in testosterone and brain chemical dopamine levels may play a role, especially during early stages, in utero. 

Brain chemistry. Several neurotransmitter imbalances (dopamine, serotonin, GABA, glutamate), and brain scans show certain changes associated with tic disorders and ADHD. Anxiety, depression, OCD, and other mental health conditions are associated with both conditions as well. 

ADHD stimulant medication may cause or worsen pre-existing tics.  ADHD has the highest association with Tourette syndrome, as well. Doctors need to prescribe stimulants cautiously when both conditions exist, and only when the benefits outweigh the risks.  On the other hand, non-stimulant ADHD drugs like clonidine and guanfacine can help manage both ADHD and tics. Tics may also improve with antipsychotic medication. More recently, not drug options like psychotherapy and transcranial magnetic stimulation (TMS) have also shown promising results. 

How to manage tics and ADHD

  • Reduce stress. Stress worsens tics and ADHD. Keep busy with fun activities like exercise, learning a new instrument, gardening or  going out for a walk in the park. There are some video games that can be beneficial for ADHD.Parents of children with ADHD and tics also need stress relief and have a clear stress management time. A positive, calm atmosphere at home is essential. 
  • Work with a team of professionals. In addition to standard therapy, consider psychotherapy, music therapy, nutritionists, coaches or yoga trainers. Review the medication with the doctor in case stimulants aggravate the tics and don’t provide enough relief for ADHD symptoms. There are several alternative drugs available.
  • Certain tics and ADHD hyperactivity  can improve with certain strategies. For mouth tics, try chewing gum or sucking on ice cubes. Arm and feet jerking as well as neck movements may decrease if you set up specific time during the day to stretch, have a quick, 5 minute workout or get a relaxing massage. If your child is prone to hit or kick, teach how to simply contract the arm muscles or clench a fist rather than actually hit. Taking martial art classes can also help, as the instructor teaches how to perform these movements in a controlled, safe way.