ADHD and tics

I’ve been told there is an association. Tics are an impulse and ADHD is having an issue with controlling certain impulses like the need to keep moving. So, yes, to my knowledge, while not every ADHD person has tics or every person with tics has ADHD, there is thought to be the idea that this is a similar problem expressing itself in different ways.

Jackie, I think you need to consider whether he may have Tourette’s Syndrome as your son has shown signs of more than one type of motor tic, as well as vocal tics. Please get more information on this syndrome by taking a look at the website of the Tourette’s Syndrome Association (TSA) and a site by a Lesley Packer—you can find these through a Google search. Depending on your confidence in your pediatrician and how up to date you feel he keeps himself, I think it would be worth consulting with him before going to the psychiatrist. Psychs are expensive and hard to get into and you want to make every minute count—you’re best off going in with as much information about your son and perhaps a preliminary dx from the pediatrician.

I was struck by your particular description of what your son is doing with his hands—tics in this area are particularly seen in a condition called PANDAS (pediatric autoimmune neurological disorder associated with strep). The National Institute of Mental Health (NIMH) idenitifed this disorder and is conducting ongoing studies—basically PANDAS is a disorder of sudden tics or obsessive compulsive disorder (OCD) (or severe exacerbation thereof) in children following strep infections. You can find more information on this if you search for the NIMH and PANDAS. This would be another reason to see the pediatrician because he will have records of your child’s strep infections and you can piece together whether there is a connection between the tics and strep incidents. BTW, ADHD and Tourette’s are often co-morbid (that is, found existing together).

Another great resource is the Massachusetts General Hospital’s neurology webforums at www.braintalk.org—there is one dedicated to Tourette’s where a lot of great, informed people post. If you have a hard time finding the suggested websites let me know and I will dig them up for you. Good luck. Marie

thank you marie,and Sara this info helps me I have my son a appointment with his ped. on Monday.His psychiartist just wanted to perscribe meds again over the phone he hasent see my son but 2 times back in feb.and march but over the phone changed his meds and added meds several times.I have him a appointment with a new psychiatrist July 23.Also my son has not been sick for over a year with anything he has only had 1 cold and that is it in 1 1/2 years he has only missed 1.5 days in 2 years of school due to doctor and eye doctor appointments.He complains of headaches alot and his doctor says they are migrains and to take tylenol. he has had these since he was 4.I really dont care for this ped. but he is good for my daughter who has allergies and asthma he is also a allergist for kids.

Jackie, I think it’s good you’re taking him to the pediatrician but I sense he does not have your full confidence. I looked back at your previous post that says your son has “always” done this arm stretching-finger thing. Have you ever mentioned this to your ped? If so what was his response? If he ignored you and ignores you this time too, I would think about possibly seeing another ped before seeing your psychiatrist if your health plan permits. Many peds are simply not attuned to neurological disorders in children and will pass off symptoms as emotionally-triggered (usually by subpar parenting). To avoid this trap, I cannot stress enough to you the importance of getting as much information as you can before seeing the doctors. They are less likely to be dismissive and attribute symptoms to poor parenting if they see they are dealing with a well-informed mother. Another alternative is to see a pediatric neurologist, who tend to be good at dxing (though often not with treatment). I’m sorry I cannot add too much on the subject of migraines—I do know that childhood migraines are not uncommon, but I am surprised if it’s been a problem that the child has not already been referred to a specialist like a pediatric neurologist, even if you are in an HMO. You might consider posting a question about tics + migraine on the braintalk.org Tourette Syndrome webforum (you have to register first to post)—I am sure someone there could give you some useful insights and information. Marie

thank you again ,no I have not mention his hand thing to his ped. before no I am not too happy with him on how he treats my son,there is only pne other pedatrcian around here and I dont like him at all he miss dx my daughter as a baby with hypothyroidism and she has some damage due to the meds she was on for 6 months.I have tried to get in with a ped. nueologist in Columbus but to get in we need a refferal even if my insurance dont require one we have a PPO but I dont care what it cost if it pays or not it dont for his paychiartist now we pay everything up front at 250 a 1/2 hour and 75 for a phone call.

Jackie, I don’t understand how your psychiatrist costs $250/half hour and $75 for a phone call. I live in D.C., which is a much higher cost area than Ohio. My son sees a pediatric psychiatrist who is a pharmacologist. His waiting list for new patients is now one year long. I pay only $90 for a half hour. He is not available for telephone consults but I can give questions by telephone or fax them to the secretary who relays them to the doctor and gets back to me. There is no charge for this. Unless there is something really strange in the dynamics of the Ohio medical marketplace, the fees your psych is charging (particuarly in view of the services you are receiving) seem really out of line, at least to me.

I think you need to sit back and think through a strategy for getting your son diagnosed and treated properly. Even if he doesn’t have Tourette’s Syndrome, he certainly has symptoms that would warrant consideration of it. I suggest informing yourself by looking tonight at some of the websites I suggested plus this one— http://members.home.net/tourettenowwhat —look in particular at the section on doctors and how to choose one. Then I suggest you call your local chapter of the TSA. The tsa-usa.org website shows that the Ohio chapter is in Columbus and can be reached at 800-543-2675. Tell the person your son is dxed ADHD and you think it’s possible he also has TS and are trying to find a qualified doctor to make a diagnosis. Hopefully, they can give you some advice based on their knowledge of your area. (I’ve never heard that you need a referral to see a pediatric neurologist even if you’re paying on your own. But if that’s the case, get your pediatrician to give you the referral and if he won’t get your own doctor to.) You can also post on the braintalk.org forum asking if anyone in your area knows of a doctor. I admire you for wanting to pay whatever it takes to help your son, but I think you need to try to take the most effective steps by leveraging off other people’s experiences in order to save your resources (in terms of time, money, and emotional stress.) Marie

(By the way, I meant to mention earlier that even if your son has not been sick with strep he could still have it—my son’s strep was caught only because his sister had it and he was tested—he never showed any symptoms. To be sure they have to take blood titers.)

that was his price he billed my insurance but we have a 600 deductible and my son was only in his office 3 times 2 times to see him and it was 250 a 1/2 hour.He also had a few test tova and one other one and I cant find the paper on it right now and my insurance would not cover these type of testing my bill from the dr for the first month 2 phone consults and 2 meetings and the 2 test came to 945 the doctor did take off 300 after my insurance said his charges were too high for network charges.The new psychaiartrist does not charge as much as this one and he takes off for income and family size.I am a college student as well as a mother of 4 so this should help.I was told by the receptionist my portion of the bill should only be 17 per 1/2 hour .the first psy was the one the ped. referred him too.The reason we need a refferal to a nurologist because ther is none in our area and one comes around once a week and Columbus is 2 hors or more away.Things are different around here and I dont care for it I am from Winchester VA area so I know a little bit about DC I also grew up in Va.Beach met my husband and he likes small towns our town has less than 500.Thank you for the websites I am going to check them all out tonight when I get the kids to sleep.My son is my oldest.Thank you about the strep info it was around his school bad the past 2 years they were always sending home notes about it.His school psychologist told me about this other mental health place with his new dr. it is rather new in the area.My son also is LD too but has a high IQ around 150 or better I was told but cant write or read on grade level and he is a year behind.

Jackie, You certainly have your hands full. If you have any further questions after looking at the sites, please feel free to post. I’m glad you found a lower cost psychiatrist but hope that he has enough experience in the types of symptoms your son is having to dx properly. About the strep, you might be able to convince the ped to take blood titers for strep on your visit on Monday. If they are elevated it could be indicative of PANDAS, though not conclusively so. I still thinks it’s worth having a chat with the Columbus TSA chapter—when I called the one for the DC area the woman was very chatty and full of really good information and tips on schools and doctors even though I didn’t have a solid dx at that point. Marie

Greetings Jackie,

According to nationally recognized ADD specialist Dr. Daniel G. Amen, tic disorders are more common among people with ADD. Tourette’s syndrome occurs when there are both motor and vocal tics that have been present for more than a year. Up to 60% of people who have Tourette’s also have ADD, and 50% of people with Tourette’s have OCD. TS is frequently associated with Type 3 (Overfocused) ADD. SPECT studies have shown abnormalities in the basal ganglia of the brain of TS patients. TS does run in families.

Blessings, momo

The tics your son is exhibiting could be a result from the change in medication, but if has been happening for awhile, it’s probably unlikely. I teach a child with Tourette’s, and his tics usually increase after lunch. In the mornings, he is calmer and more focused. While this child can’t take medication for his Tourette’s because of blood pressure problems, there are some good ones to help control some of the more serious tics. The child I teach is very vocal, makes all sorts of noises, taps pencil constantly, can not sit still for extended periods of time, and is now beginning to poke other students with his finger. He rocks his desk, blurts out answers and simply can not control his actions (they are not inappropriate actions-no vulgar language). Most ADHD students don’t display these tics, but most Tourette’s children do show ADHD signs-that is only tipical of the disorder. I hope the new psychiatrist is helpful, but if you don’t get the answers your looking for, you really should check with a neurologist.

thank you suzie, my son is alot like your student he cant sit still and makes noises with pencils or taps fingers too, he dont blurt out answers at school but he is afraid to talk to much because he has articulation issues as well and is not always understood.He kicks his desk legs and roack on his chair.His teacher this past year was excellent and she had his schedule perfect he did not have to sit for long periods due to his classes he went to for extra help,title1, speech therapy,LD 1 on 1 tutor,specials,lunch ,and recess.His day was broken up greadt.I hope next year will be too.His IEP states he can move around freely as long as he dont disturb the class or work on the floor or a table instead of his desk he really likes to stand up to work and helps so he dont fidgit too much.

I”m glad I helped some. My student with Tourette’s has an IEP similar to your son’s. He stands up and walks around the room during reading, but it gets the job done and that’s what is important He is allowed to take frequent breaks during class periods, because he can’t sit still. Accomodations and modifications have to be made for all students with ADHD, Tourette’s, and learning differences.

Just wanted to let you know how his appointment with his ped. went well his ped dx him with Tourettes syndrome this morning.The only thing I dont get is that he is in this doctors office about every 3 months for these referrals for the other drs. and he never mentioned it before .I just today told him everything and showed him all the testing papers i have in my possession on my son and he sad this looks more like Tourettes syndrome.He said all his other things go along with it too his dyslexia,and ADHD also.My son was awlful in this office today I had to physically hold him down so he would not run out like he does everywhere I take him and he showed some of his tics there too.His doctor even pointed out some other tics that we thought was just him not even thinkingh they were tics he has shown these signs for a few years now.My husband (his father) is devestaed to hear this he is our only son.He is trying to get my son into the new psychiartist sooner for counsoling sooner than July 23 and then go from there on meds or to change what he is on now.His ped says he can treat him for this and that he has several patients that have it and will have one of their mothers call me.

Jackie,

So glad you posted—I was wondering over the weekend how your appointment would go. I think it’s great that the ped will put you in touch with another mother. Perhaps she will have insights as to good resources in your area. I still think it would be a good idea to get a referral to a neurologist who is knowledgeable. Please keep a skeptical attitude towards med suggestions. The TSnowwhat site section on doctors is very good—for example, do not accept Haldol as a first line med for Tourette’s. Some docs still do this, but it really is a last resort now that there are other meds. Also, not to discourage you, but there really is no one med for Tourette’s. Some work on some kids but not on others. We haven’t really found one that works for my son.

As the website says, don’t rush to the soonest available doctor—Tourette’s is not a medical emergency. It is a chronic condition, though, and it’s far more important in the long run to get a good doctor who understands the syndrome and related conditions (or is very interested in learning about them) than a readily available doctor who knows little.

My reaction to the dx of my son was relief—I was worried he had a brain tumor. Nonethless, I can understand your husband’s devastation—it’s often much harder on a father when it’s a son, particularly an only son. (This is my situation too.) Fathers tend to project their hopes and dreams on them and find it hard when it looks like God designed other plans for their sons. On an encouraging note, many (though not all) kids outgrow Tourette’s by late adolescence. (Bad news is that years 10 to 12 are often the worst.)

Good luck—it’s not the end of the world. Things will be more difficult than you anticipated when he was born, but I think you already had an inkling of this before you got the dx today.

Marie (P.S. Did you convince the ped to take a strep titer?)

In my opinion, your psychiatrist should never have placed your son on Ritalin, which has a known side effect in some kids of producing tics. Your son already had tics, before being placed on Ritalin and I hope this doctor did warn you that Ritalin most likely would lead to tics given your son’s pre-existing tics. Consider your son very lucky that the vocal tics stopped when you stopped the Ritalin.

Be very careful and cautious if your are considering using other psychiatric medications, given this pre-existing condition and get your doctor to give you a *written* profile of the side effects of any drugs you are considering giving your son.

Best of luck to you!

Hi. You may find some help and info about TS at http://members.home.net/tourettenowwhat/ or at www.tsa-usa.org Also, there is a great TS discussion group at www.braintalk.org with a lot of mothers of kids with TS and many with ADHD too. I am a married professional woman in my late 30s with TS and just wanted to let you know it’s not the end of the world. Sorry to make this so brief. Best wishes. - Vger

Dear Jackie, I found an Ohio support group that you can email. I hope this helps. You are very welcome to join us at the MGH Brainchat Tourette Syndrome forum if you would like to talk with other moms and dads with children that have TS and/or other comorbids (ADHD, OCD) and adults that have TS also.
Here is the link to the Ohio Support…..http://tsa-usa.org/wrapper.php3/03/usachapters.html#ohio

Please know that you are not alone. :o)

Big hugs…..Laura, mom to Blaine.jackie wrote:
>
> Just wanted to let you know how his appointment with his ped.
> went well his ped dx him with Tourettes syndrome this
> morning.The only thing I dont get is that he is in this
> doctors office about every 3 months for these referrals for
> the other drs. and he never mentioned it before .I just today
> told him everything and showed him all the testing papers i
> have in my possession on my son and he sad this looks more
> like Tourettes syndrome.He said all his other things go along
> with it too his dyslexia,and ADHD also.My son was awlful in
> this office today I had to physically hold him down so he
> would not run out like he does everywhere I take him and he
> showed some of his tics there too.His doctor even pointed out
> some other tics that we thought was just him not even
> thinkingh they were tics he has shown these signs for a few
> years now.My husband (his father) is devestaed to hear this
> he is our only son.He is trying to get my son into the new
> psychiartist sooner for counsoling sooner than July 23 and
> then go from there on meds or to change what he is on now.His
> ped says he can treat him for this and that he has several
> patients that have it and will have one of their mothers call
> me.

A link to the most recent journal-published studies on psychostimulants (e.g. Ritalin) and tics, all showing that stimulants do not worsen tics for the majority of people predisposed to tic disorders. Stimulants are often employed in people with ADHD/tics, as the ADHD is often more impairing than the tics. Ritalin and other stimulants can be used safely in the majority of persons with tics, according to all recent studies.

http://members.home.net/tourettenowwhat/tics_and_psychostimulants.htm

–—
Tourette Syndrome - Now What?
http://members.home.net/tourettenowwhatS. wrote:

>
> In my opinion, your psychiatrist should never have placed
> your son on Ritalin, which has a known side effect in some
> kids of producing tics. Your son already had tics, before
> being placed on Ritalin and I hope this doctor did warn you
> that Ritalin most likely would lead to tics given your son’s
> pre-existing tics. Consider your son very lucky that the
> vocal tics stopped when you stopped the Ritalin.
>
> Be very careful and cautious if your are considering using
> other psychiatric medications, given this pre-existing
> condition and get your doctor to give you a *written* profile
> of the side effects of any drugs you are considering giving
> your son.
>
> Best of luck to you!

Hi, I also live in a small town in West Virginia. I went to Morgantown to see the neuro. (which I wasn’t happy with) I am about 2 1/2 hours from Columbus. I am not sure what town you are located in. Do you know of Clarington, Hanibal, or Marrieta? I am right across the river from Hannibal. My son has had an unofficial dx of tourette syndrome. He has not met the time frame yet. I pray it ends but he has shown quite a few tics including the vocal. Feel free to email me at [email protected] Take care, Jenniferjackie wrote:
>

Marie,His ped. wants him to get into a psy. sooner for his ADHD behavior not the Tourettes he said he treats that and the ADHD is more important to get under control now than the tourettes.He said he will see if med. is needed after we get his ADHD under control.He is the one calling the psy to try to get him into him earlier because he referred him to this other one that only saw my son 2 times and perscribe meds over the phone and each med dont seem to work and dont want to see him back till Nov.He feels that counseling would help more or group anger therapy.We have been though several ADHD meds ritalin,Adderall,Dexadrine,and now we are on WellbutrinSR and it seems to help some with his tics at first now that I look back but nothining for hs agressiveness or hyperactivity.

Jennifer,I am up near Wheeling on the Ohio side.My son has a appointment with a nueolgist in Columbus in Sept. but his pedatrician said he noticed some of my sons tics as early as 2 years ago and showned me where he noted it in his file.he sent my son to this psychiartist for his ADHD for therapy and medacation suggestions since he did not want him on stimulants.The psy but him on ritalin to start with and it was a disaster.the ped. told me yesterday that we need to address the ADHD behavior and then he will address the tics as soon as he has his appointment with the new psy. He his going to the neuologist mainly for his migrains.His ped treats the Tourette patients himself.

I was just going through the posts and PLEASE don’t be alarmed by what I say. I believe that you should NOT leave out the symptom lip smacking when you see the neurologist. I see that your son has LD’s and from what I know about seizures this most definitely should be looked into.
This description sounds much like absense seizures to me. Especially if he is doing it in his sleep.
I would INSIST on having an EEG done to rule this out.

In the mean time…..my email is [email protected]
My name is Laura and I am the mom to a child with Epilepsy, ADHD, OCD and Tourette Syndrome.

Jackie, Please read the two posts TS Now What has put up here—it is possible to use stimulants for ADHD even if the child has Tourette’s, but you need someone knowledgeable in both conditions. Also, ritalin is not the first choice of stimulant where there is the possibility of tics—adderall is used more often. (For example, Concerta—time release ritalin—was a disaster for my son, but adderall works pretty well.) A specialized pediatric psychiatrist or neurlogist can manage both conditions and, at a minimum, has to be informed of all major problems—ADHD, tics, and migraine—at the outset so he or she doesn’t inadvertently worsen one condition while treating another. I think you will get better input to your questions if you post on a specialized bulletin board and recommend braintalk.org, particularly the board dealing with Tourette’s as the cyber forum there is particularly supportive. (Three of the regular participants have already posted to you on this website.) There is also a board there dealing with ADHD. You do need to register—don’t be put off by this requirement (as I once was). You will be known only to the webmaster who has had to require registration to keep spam off the boards. (This almost never occurs on the Tourette’s board where the participants are mostly concerned mothers.) Your information will not be passed onto anyone else. Once you register you should be able to post within a few hours. Marie

No we dont plan on leaving anything out we are going for a full evaluation on everything he has been dx with and his symtoms.

The key word is…Majority. If you are in the majority. However, if you are unlucky enough to be in the Minority, you could have a serious problem on your hands.

There is always a minority. My advice…Be informed and be aware.