Long-term Methylphenidate Therapy in Children With Comorbid Attention-Deficit Hyperactivity Disorder and Chronic Multiple Tic Disorder

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Abstract
ONE OF THE most significant clinical implications of motor and vocal tics in children is their association with attention-deficit hyperactivity disorder (ADHD), because the most popular treatment for ADHD, stimulant medication,1 is purported to exacerbate tics.2-4 Because the evidence supporting this observation consists mostly of uncontrolled case reports, some researchers questioned the alleged pervasiveness of stimulant-induced tic exacerbation and the notion that these medications were contraindicated for this clinical population.5 However, it was not until the results of controlled studies conducted by several different research teams were published that perceptions of safety and efficacy began to change.6-14 It is now generally accepted that methylphenidate and dextroamphetamine are safe and effective treatments for ADHD in many (but not necessarily all) children with comorbid tic disorder.15 Nevertheless, an early report that stimulant medication can exacerbate tics during maintenance treatment,2 a recent uncontrolled study suggesting that tics improve when drug therapy is withdrawn,16 the stated preference for nonstimulant medications as the initial treatment for ADHD symptoms,16 and the opinion of some experts4 that there are "strong indications that stimulants pose a serious risk of tic symptom exacerbation" keep this controversy alive.

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