OTSLPCase ReportJournal of developmental and behavioral pediatrics : JDBP2025

Complex ADHD in a Child With Tic Disorder.

Tyler Lackey, Demvihin Ihyembe, Zachary Riemenschneider and 4 others

PMID 40493907

WHAT IT FOUND

A child with ADHD and new-onset tics illustrates the clinical dilemma of balancing medication efficacy against side effects.

Management involves distinguishing tics from stimming, considering alpha-2 agonists or CBIT, and prioritizing functional impact over symptom suppression.

Key findings

01The case highlights the challenge of balancing ADHD medication efficacy with side effect mitigation, specifically when new tics emerge during treatment.

02Distinguishing between ADHD-related fidgeting (stimming) and tics is critical, as tics are typically distressing and preceded by an urge, whereas stimming is often soothing.

03Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line non-pharmacological strategy to manage tic-related impairment and shame.

STILL TO COME

How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs

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What it does not show

This is a single case report and expert commentary, not a controlled trial, so it does not provide evidence of efficacy for any specific treatment. The recommendations are based on clinical experience and existing guidelines rather than new data generated by this paper. Generalizability is limited to the specific presentation of complex ADHD with comorbid tics described in the case.

Declared interests

The authors are identified as MDs and PhDs from various institutions, but no specific funding sources or conflicts of interest are declared in the provided text.

The easy way to misread this

Do not interpret this case as evidence that stimulants cause tics or that alpha-2 agonists are the only solution. The paper states that current evidence does not support a causal link between stimulants and tics, and treatment must be individualized based on functional impairment rather than a fixed protocol.

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