Behavior therapy in tic-disorders with co-existing ADHD

Abstract

Objectives: To give an overview concerning the behavioral treatment approaches for Chronic Tic Disorder (CTD) and Attention-Deficit/Hyperactivity Disorder (ADHD) and to provide some suggestions for the behavioral treatment of children and adolescents with a combination of both disorders.

Results: Pharmacotherapy plays an important role in the treatment of both ADHD and CTD. However, behavior therapy has also been proven to ameliorate the core symptoms of both disorders. The most prominent behavioral technique to reduce tics is habit reversal training. In ADHD behavioral interventions, especially parent training and behavioral interventions in preschool/school, are effective in reducing ADHD core symptoms and comorbid problems. In children and adolescents with ADHD plus CTD both ADHD and tic symptoms can be treated by behavioral interventions alone or in combination with pharmacotherapy. However, most of the published studies on behavioral interventions in children with ADHD or CTD do not give detailed information on comorbidity and many studies excluded patients with comorbid problems.

Conclusions: Clinical experience suggests that in CTD+ADHD success may be easier to achieve using behavioral treatment of ADHD first. Adherence to the habit reversal procedure to reduce tics in daily living is the most important problem in the behavioral treatment of tics especially in children with comorbid ADHD. Practical suggestions to overcome these difficulties are presented.