Methylphenidate Treatment of Attention Deficit Hyperactivity Disorder in Boys with Tourette Syndrome

Grant Type
Clinical
Grant Year
1989
Institution Location
NY
Institution Organization Name
State University of New York
Investigators Name
Sverd, Jeffrey, MD

Research conducted in our clinic and investigations in other university centers clearly indicate that Attention-Deficit Hyperactivity Disorder (ADHD) is a common behavioral concomitant of Tourette Syndrome in child patients. For many individuals, ADHD symptoms are a greater impediment to social and academic success than their tics, particularly during the elementary school years. Unfortunately, the most effective and widely used pharmacological treatment for ADHD, namely methylphenidate (MPH) is widely thought to exacerbate TS symptoms and therefore to be contraindicated in such patients. Clinical evidence, however, indicates that many TS children do not experience tic exacerbation, or if they do, it is mild and transient. Results of a small pilot study conducted in our clinic provide preliminary experimental evidence for the efficacy and safety of MPH treatment of TS children with ADHD. Clinical ratings and playroom observations of the 4 boys treated with MPH showed improvement in ADHD symptoms and indicated that for those subjects MPH had no clinically significant adverse effect on the frequency of tic occurrence. The highest dose (10 or 15 mg twice daily) resulted in improved classroom ratings of tics compared with initial placebo treatment. In addition to improved behavior and attention to task, 3 children showed improvement in mood. In this study the effects of MPH in TS boys with ADHD will be assessed in a placebo controlled study .using parent and teacher ratings of behavior and attention to task, direct school observations of behavior and playroom and laboratory tests of attention. Medication effects on tic status will be assessed using parent and teacher ratings and playroom observation of tic frequency. The study seeks to assess the safety and efficacy of MPH in children with TS and to provide insight into the neurophysiology of TS with particular reference to the theory of a role of hyperdopaminergic dysfunction. Because there has been very little research on methylphenidate in TS patients, we believe that a compelling need exists to further examine the safety and efficacy of methylphenidate for ADHD and TS symptoms. Jeffrey Sverd, M.D., Kenneth Gadow, Ph.D. S.U.N.Y., Stony Brook, NY Award: $25,000 Tourette Association of America Inc. – Research Grant Award 1989