Approximately 20% of people diagnosed with ADHD also have a co-occurring tic disorder.1 The relationship between ADHD and tic disorders does not appear to be causal, however, it seems that both ADHD and tic disorders share the trait of low inhibition levels. This means that people who are low on inhibition are more susceptible to both ADHD and tic disorders than the general population.
What Are Tics?
Tics are fast, idiosyncratic muscle movements that are difficult to control. Tics can vary between individuals, though some are more common than others. Tics can be simple or complex. People can also have more than one tic. Tics can also range from mild to severe due to their interference in a person’s life and difficulty controlling them. A person can have tic behaviors and not have tic disorders. To have chronic tic disorder, an individual must have one or more tics that occur more days than not for longer than one year, tics have to start before the age of 18, and the tics cannot be due to another underlying condition or substance.2
According to the CDC, there are currently two types of tics, and they can be simple or complex:
- Vocal Tics: A sound or vocalization a person makes repetitively with their voice. For example, someone yells a repetitive word or phrase.
- Motor Tics: Motor tics are repetitive body movements. These movements can be subtle or not subtle. For example, someone might repetitively twitch the corner of their mouth.
Can ADHD Cause Tics?
It is unlikely that ADHD causes tics, but a high number of people with ADHD have a co-occurring tic disorder and/or a co-occurring condition that involves tics. It is currently believed that approximately 20% of children with ADHD and adults with ADHD have tics. According to the CDC, about 1.4 million people in the United States have chronic tic disorder, which approximates about .5% of the population.3 ADHD and tic disorders tend to overlap because of the shared trait of low behavioral inhibition that is present in both disorders.
Tic disorders and conditions that commonly occur alongside ADHD include:
- Tourette syndrome (TS): Tourette syndrome is a condition of the nervous system that causes individuals to have tics. According to a 2007 study, there is a 55% overlap between individuals with Tourette syndrome and ADHD.4
- Obsessive-compulsive disorder (OCD): People with OCD can also have a high incidence of co-occurring tic disorder. According to the National Institute of Health, the overlap between OCD and tic disorder is 22-44%.5 Furthermore, 40-60% of people with OCD also have ADHD.6
- Autism spectrum conditions: Approximately 22-34% of people with autism also meet the criteria for tic disorder.7 People with more severe autism symptoms are more likely to develop tic disorders. People with autism can have vocal or motor tics. The prevalence of co-occurring ADHD and autism is believed to be around 50-70%.8
What Is the Connection Between ADHD & Tics?
ADHD symptoms and tic disorder symptoms share the trait of low behavioral inhibition, meaning that an individual likely has more difficulty controlling their behavior than people in the general population. Research has found that both disorders share chemical imbalances of dopamine in the brain, as well as other genetic factors that might predispose someone to these neurological differences shared with ADHD and tic disorder.9
Structural differences in the brain have also been found for ADHD diagnoses, including changes in the density of white and gray matter in the brain, lack of maturation in the temporal gyrus, and in the fronto-basal positions of the frontal lobes. These structural differences have been observed more acutely in children with an ADHD diagnosis.10 Structural differences found to be common in the brains of individuals with Tourette syndrome include differences in the sensorimotor corticostriatal circuit as well as the limbic circuit.11 These findings would indicate that while structural differences may exist between ADHD and tic disorders in the brain, the imbalance of dopamine in the brain is a widely supported commonality.
The Impact of Having Both ADHD & Tics
Having ADHD and tic disorder may cause people of all ages to have low self-esteem. For example, low levels of behavioral inhibition can be more widely observed in social contexts such as friendships, careers, and romantic relationships. This can cause people to feel self-conscious about their behavior being perceived as odd or strange by others and become more acutely sensitive to the judgments of others. The experience can ultimately result in co-occurring anxiety disorders, social anxiety disorder, and depression.
ADHD Stimulant Medications & Tics
It has previously been believed that ADHD stimulant medications can exacerbate or cause the onset of tic disorder in children. Though this has not been supported by research, providers continue to exercise caution when prescribing stimulants to children with ADHD who exhibit tic behaviors.12 The association between stimulant medication and increased tic behaviors is because of the shared factor of stimulants producing more dopaminergic activity in the brain, which can indirectly result in increased behavioral inhibition and may be associated with an increase in tics. For this reason, parents need to monitor children on stimulant medication prescribed for ADHD and consult with a prescribing provider if behavioral changes occur.
Combined Treatment for ADHD & Tics
It is important to treat the symptoms of ADHD and tic disorder when the diagnoses are co-occurring. There is likely overlap that exists for someone with impulsive/hyperactive type ADHD and symptoms of tic disorder. Effective treatment of ADHD symptoms can lead to improvement in tic disorder symptoms as well, especially when targeting behavioral inhibition within the context of the treatment plan.
Behavioral Therapy for ADHD & Tics
Cognitive behavioral therapy for ADHD can be an effective way to treat symptoms of ADHD and tic disorder. Behavioral therapy involves creating a treatment plan that targets underlying behavioral symptoms that cause interference in a person’s day-to-day life. Habit reversal training, for example, is an effective behavioral therapy method for treating ADHD and tic disorder symptoms in children.13
Medication for ADHD & Tics
ADHD medications may be effective at reducing ADHD and tic symptoms. It is always important to consult with a prescribing provider when considering medication for any mental health disorder. According to research, non-stimulant ADHD medications such as tricyclic antidepressants and alpha agonists can be used alongside stimulant medication to treat co-occurring tic disorders and ADHD.14 Non-stimulant medication is believed to be less effective for treating symptoms than stimulant medication, however nonstimulant medication is found to be more effective in treating symptoms than no medication.15
According to one study, there are three classes of medications that can be used to treat ADHD and tic disorder:16
- Noradrenergic agents (clonidine)
- Reuptake inhibitors (atomoxetine)
- Stimulants (methylphenidate)
6 Tips to Help Cope with ADHD & Tics
While addressing ADHD and tics can be challenging, there are strategies and skills one can use to help a person cope.
Here are six tips to help cope with ADHD and Tics:
1. Get More Sleep
Focusing on good sleep hygiene can help reduce stress associated with ADHD symptoms. Sleep impacts the mental health of people with ADHD and tics. A lack of consistent sleep is often associated with exacerbation of symptoms in many mental health disorders, as getting insufficient sleep is associated with impoverished brain function.
2. Reduce Stress & Anxiety
Reducing stress and anxiety can help to cope with ADHD and tic symptoms. Stress has been associated with exacerbating many mental health symptoms. Creating an environment free of stress will likely be associated with a decrease in the severity of tic-related symptoms.
Effective ways to reduce stress and anxiety include:
- Mindfulness: Mindfulness has been found to reduce stress and anxiety. For example, breathwork is one mindfulness method useful in reducing stress and anxiety.
- Journaling: Journaling is an effective method for reducing stress and anxiety.
- Exercise: Exercise and body movement can help reduce stress and anxiety.
- Thought Stopping Techniques: Thought stopping techniques can also help manage intrusive thoughts associated with stress and anxiety.
- Boundaries: Having healthy boundaries at work and in relationships helps reduce stress. Protecting energy through boundary setting is an important part of reducing stress and anxiety.
- Balance: Finding and maintaining balance is an effective stress-reducing method.
- Healthy Relationships: Improving the quality of relationships is an effective way to reduce and manage stress. Being discerning and intentional about the relationships in your life is an effective way to maintain relationship health.
- Rest: Getting enough rest and breaks from work and other activities in the day is important in decreasing stress and anxiety.
- Therapy: Regular therapy can help focus on causes and triggers for stress and anxiety.
- Saying No: Along the line of setting boundaries, learning to say no to things that feel too much helps reduce stress and anxiety. Our culture often encourages people to engage in people-pleasing behavior to feel loved, worthy, and accepted. Learning to say no and drawing lines around what you are and are not willing to do is an important piece of general mental health and well-being.
3. Focus on Trauma Work
If trauma is co-occurring with tic disorders or ADHD, trauma-informed therapy is a useful way to address symptoms associated with trauma that may be exacerbating other mental health symptoms.
4. Educate Your Family & Friends
Engaging in self-advocacy around needs and asserting boundaries with friends and family can be a helpful way to manage symptoms associated with many mental health disorders. Many people may not understand the impact of neurodiversity or general mental health on an individual’s life, and it is important to remember people can’t read your mind or anticipate your needs unless you learn to ask for support or assert your needs.
5. Engage In Healthy Distractions
Excessive focus on symptoms of ADHD and tics might lead to increased distress related to these mental health diagnoses. Finding healthy distractions to take focus off of symptoms can help alleviate their severity. In this case, out of sight out of mind is a good principle to follow when possible. However, it is important to know when healthy distractions might turn into unhealthy avoidance of problems that must be addressed.
6. Find Resources
Finding resources in community, therapy, and/or ADHD blogs or other educational and reliable sources of information is a helpful way to learn more about symptoms and feel less alone and isolated in your experience. Consider joining a support group for people living with ADHD and/or tic disorders or finding an online blog site that supports people going through similar struggles.
When to Seek Professional Support
If symptoms associated with ADHD and/or tic disorders are causing significant struggles in relationships, at work, or in other important areas of life, it may be helpful to find a neurodiverse-affirming therapist. An online therapist directory or online therapy platform is a good choice for finding a therapist specializing in tics and ADHD treatment. Finally, online psychiatrist options are a good choice for finding tic and ADHD medication management.
In My Experience
As a provider who specializes in ADHD assessment and treatment, I always recommend comprehensive treatment for co-occurring mental health disorders. It is important for individuals to take a holistic approach to health care rather than treating mental health disorders and symptoms as though they are separate entities and not connected and intricately intertwined. The truth is many mental health disorders, especially ADHD and tic disorders, have a lot of overlap in terms of their symptom presentation and etiology, which can make finding treatment feel overwhelming and complex. If you find a therapist you feel you have a good relationship with and a medication provider you feel listens to you and is willing to work with your specific needs and presentation, you’re in a good position to gain needed support to address these concerns and find an effective path for treatment that will ultimately reduce symptom severity.
ADHD Tics Infographics
