Tics and psychostimulants

[MrFlyGuy]

---

Members do not see this ad.

So I know that the recent consensus is that stimulants for ADHD don't cause tics but I've seen numerous times children started on stimulants develop tics 2-4 weeks later.

Is this just a confirmation bias or is there any recent studies demonstrating this link?

MrFlyGuy

 

[calvnandhobbs68]

Confirmation bias 😉This isn't even really a "recent" consensus, the literature around it has been mixed since the 90s.

Just having ADHD itself increases risk of developing transient tics drastically so your likelihood of starting or changing a stimulant during the same time period when tics would have occurred anyway is pretty high.

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/205267?utm_source=openevidence&utm_medium=referral

 

[milesed]

It's case by case. I have seen stimulants cause or worsen tics and have seen some who had improvement in tic severity as stimulants were added.

 

[calvnandhobbs68]

It's case by case. I have seen stimulants cause or worsen tics and have seen some who had improvement in tic severity as stimulants were added.

Sure, at the same rate as giving a kid a sugar pill would cause or worsen tics. Again, this has been pretty much settled for 10+ years at this point.

Meta-Analysis: Risk of Tics Associated With Psychostimulant Use in Randomized, Placebo-Controlled Trials - PubMed

Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and psychostimulant use. Clinicians may want to consider rechallenging children who report new onset or worsening of tics with psychostimulant use, as these symptoms are much more likely to...

pubmed.ncbi.nlm.nih.gov

 

[esob]

I think the ADDUCE study is worth examining for the question. Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study - PubMed

- This was a 2-year study of 1400 kids in Europe divided into three groups: 1. ADHD treated w/ Methylphenidate, 2. ADHD w/o Methylphenidate, and 3. No ADHD control.
- All three groups had a reduction of tics over the length of the study
- at the 6-month mark, there was no difference in the reduction of tics between the methylphenidate and the no methylphenidate groups
- at the 12-month mark, the reduction was greater in the no methylphenidate group (statistically significant)
- At the 24-month mark, the no methylphenidate group (~ 400 kids) rate was zero; the methylphenidate group was 2.4.

My takeaway is that, as @calvnandhobbs68 noted, this is a period of high activity for the life cycle of tics. However, given that there is a difference over time between the groups, it is also not unreasonable to look at the individual patient and consider that a stimulant might be contributing to their specific presentation.

 

[calvnandhobbs68]

I think the ADDUCE study is worth examining for the question. Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study - PubMed

- This was a 2-year study of 1400 kids in Europe divided into three groups: 1. ADHD treated w/ Methylphenidate, 2. ADHD w/o Methylphenidate, and 3. No ADHD control.
- All three groups had a reduction of tics over the length of the study
- at the 6-month mark, there was no difference in the reduction of tics between the methylphenidate and the no methylphenidate groups
- at the 12-month mark, the reduction was greater in the no methylphenidate group (statistically significant)
- At the 24-month mark, the no methylphenidate group (~ 400 kids) rate was zero; the methylphenidate group was 2.4.

My takeaway is that, as @calvnandhobbs68 noted, this is a period of high activity for the life cycle of tics. However, given that there is a difference over time between the groups, it is also not unreasonable to look at the individual patient and consider that a stimulant might be contributing to their specific presentation.

Except at baseline 21.8% of the kids who were going to be treated with methylphenidate were reporting any phonic or motor tics vs 11.3% in the no methylphenidate group.

This was also not controlled, it's a prospective observational study. The methylphenidate group started out with higher baseline severity scoring for ADHD symptoms...which is probably why they were started on methylphenidate. Your other conclusion you could draw from this is that kids with more severe ADHD are somewhat more likely have sustained tics over time, although the percentage still dropped by 20ish percent over time (lots of kids did drop out of this study though).