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Methylphenidate and Clonidine Help Children With ADHD and Tics

Methylphenidate and Clonidine Help Children With ADHD and Tics

For decades, doctors who have treated children with both attention deficit-hyperactivity disorder (ADHD) and tics have been warned not to prescribe methylphenidate (Ritalin), the most common drug for ADHD, because of a concern that it would make the tics worse. Now, the first randomized, placebo-controlled clinical trial of methylphenidate and another drug, clonidine (Catapres), has found that in fact these drugs do not adversely affect tics. The researchers also found that a combination of the drugs is more effective than either drug alone.

For decades, doctors who have treated children with both attention deficit-hyperactivity disorder (ADHD) and tics have been warned not to prescribe methylphenidate (Ritalin), the most common drug for ADHD, because of a concern that it would make the tics worse. Now, the first randomized, placebo-controlled clinical trial of methylphenidate and another drug, clonidine (Catapres), has found that in fact these drugs do not adversely affect tics. The researchers also found that a combination of the drugs is more effective than either drug alone.

The study showed that methylphenidate and clonidine are individually effective for treating ADHD in children with tics and that the two drugs help control different symptoms of ADHD, says Roger Kurlan, M.D., of the University of Rochester Medical Center in New York, who led the multicenter study. Methylphenidate primarily improved attentiveness and helped children stay "on task," while clonidine helped control hyperactivity and impulsivity. The study was supported in part by the National Institute of Neurological Disorders and Stroke (NINDS).

Most experts estimate that ADHD affects between 2 and 5 percent of children in kindergarten through grade 12, although some studies have suggested that those estimates are low. In Rochester, about a third of the children with ADHD also have tic disorders, although the tics in some children are very mild, Dr. Kurlan says. Studies have tied both ADHD and tics to problems in the brain's basal ganglia and in connections between the basal ganglia and the frontal lobes, which may explain why the two disorders often appear together, he adds.

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