Continuous Long-Term Follow-up for Methylphenidate Therapy for Children with both TS and ADHD

Grant Type
Grant Year
Institution Location
Institution Organization Name
State University of New York
Investigators Name
Gadow, Kenneth, PhD

Research clearly indicates that in some cases attention-deficit hyperactivity disorder (ADHD) can be a behavioral concomitant of Tourette Syndrome (TS) in youngsters with TS. Unfortunately, the most safe, effective, and widely used pharmacological treatment for ADHD, namely methylphenidate, has generally been thought to exacerbate TS symptoms in some cases, and therefore to be contraindicated in such people. However, the findings from recently published studies suggest that methylphenidate may be safe and effective for many (but not necessarily all) children with these co-occurring disorders. Because (a) the pharmacological alternatives to methylphenidate are often associated with increased risk of adverse drug reactions or are less efficacious for ADHD behaviors, especially for extended use; and (b) there is very little controlled research on the long-term use of stimulants in TS patients, there is a compelling need to examine the safety and efficacy of methylphenidate for ADHD in children with TS and to develop drug evaluation procedures for clinical application. Specifically, some of the questions to be addressed by this study are: Does methylphenidate continue to be effective in treating the ADHD symptoms after the short-term dose response trial? Does long-term methylphenidate therapy result in tic exacerbation? How do the frequency and severity of tics vary over time? Are there individual differences in the variability in the frequency and severity of tics over time, and if so, does anything predict this? Are the severity and frequency of the tic disorder related to treatment outcome? This research project is a continuous, long-term follow-up study of 47 children with TS and ADHD who were initially between 6 and 12 years old when they first participated in a controlled methylphenidate evaluation. Our proposal is to continue the follow-up of these children for an additional 2 years. Drug responsivity of both ADHD and TS symptoms were assessed using direct observation procedures in a simulated clinic classroom and with physician, teacher, and parent rating scales. These children are currently participating in a prospective follow up with systematic assessment of symptom status at 6-month intervals for a minimum of 2 years and at 12-month intervals for an additional 3 years (i.e., total follow up is a minimum of 5 years). To evaluate the impact of tic severity and comorbid internalizing and externalizing symptoms on clinical outcome, ADHD children with (n=35) and without (n=35) tic disorder will be compared at age 11 (outcome component). In summary, the goals of the proposed study are to (a) address the effects of long-term drug exposure using regularly scheduled follow up visits (maintenance treatment component); (b) describe developmental changes in the frequency and severity of motor and vocal tics and comorbid psychopathology (natural history component); and (c) examine the implications of tic disorder and various comorbidities for clinical outcome (outcome component). Kenneth D. Gadow, Ph.D. State University of New York, Stony Brook, NY Award $20,000 Tourette Association of America Inc. – Research Grant Award 1999-2000