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Drug Combo May Work Best for Kids with ADHD, Tics

Study challenges notion that Ritalin worsens tic disorders

MONDAY, Feb. 25, 2002 (HealthDayNews) -- A one-two drug punch may be the best method for tackling a troublesome twosome: attention deficit hyperactivity disorder (ADHD) combined with a chronic twitching disorder.

New research suggests that mixing two of the most commonly prescribed drugs for ADHD is the most effective therapy for boys and girls who struggle with a combination of ADHD and muscular control disorders, such as Tourette syndrome.

Roughly 3 percent to 5 percent of school-aged children are diagnosed with ADHD. And it is estimated that roughly 200,000 Americans have some sort of chronic tic disorder.

Various studies have shown that between 21 percent and 90 percent of children with a tic disorder also have ADHD. This combination has posed a unique therapeutic problem because the consensus has been that Ritalin – the most commonly used drug for treating ADHD's symptoms– is a stimulant, and stimulants were thought to worsen tics.

"It's even in the Physician's Desk Reference," says lead investigator Dr. Roger Kurlan, a professor of neurology at the University of Rochester in Rochester, N.Y. "The PDR is the bible of how you prescribe medications, and if you look up Ritalin it says that it shouldn't be used in children with tics or even a family history of tics."

But so far, there has been no evidence proving this to be true. Hoping to lay this question to rest, a group of researchers headed by Kurlan and known as the Tourette's Syndrome Study Group set out to study the most effective drug therapy for children with this combination of disorders.

The findings appear in the Feb. 26 issue of the journal Neurology.

In the study, 136 children between the ages of 7 and 14 with both ADHD and a chronic tic disorder were divided into four groups. While one group received a placebo, a second received Ritalin, a third received clonidine, and a fourth received a combination of the two drugs.

Prior to the 16-week course of drug treatment, each child was rated by teachers and parents using questionnaires measuring symptoms of ADHD and tics, and these scores were compared to those gathered after 16 weeks of drug therapy.

The biggest reductions in ADHD symptoms were seen in children taking both clonidine and Ritalin; about 85 percent showed improvement. And when it came to reducing the severity of a child's tic symptoms, the most effective treatment also appeared to be a combination of Ritalin and clonidine (75 percent showed improvement), followed by clonidine alone (66.5 percent), and Ritalin by itself (55 percent).

However, an increase in tics was reported in 14 children who received Ritalin versus nine treated with clonidine and seven who received a placebo. The effectiveness of the drug therapies didn't differ between boys and girls.

The major side effect reported was sleepiness, which affected 48 percent of children taking clonidine, compared to 14 percent of children who took Ritalin and 6 percent of the placebo group.

The sleepiness was described as moderate or severe in 28 percent of children taking clonidine, but the researchers found that this lessened over time in some children.

The researchers found no evidence of cardiac side effects, which have been associated with stimulants, but they stress that this issue requires further research.

Kurlan suggests that the current PDR recommendations on Ritalin use in children with tic disorders be revised.

In the meantime, his team hopes to study the latest generation of ADHD/tic drugs, including guanfacine, a relative of clonidine that's supposed to cause less sleepiness.

What to Do: For information on tics and Tourette syndrome, check out the Tourette Syndrome Association. You can find out about ADHD from the American Psychiatric Association (you'll need Adobe Acrobat Reader to open this file).

SOURCES: Interview with Roger Kurlan, M.D., professor, Department of Neurology, University of Rochester Medical Center, Rochester, N.Y.; Feb. 26 Neurology
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