What to Know About ADHD Tics

Tics are involuntary movements that can occur in children and adults with both attention deficit hyperactivity disorder (ADHD) and Tourette's syndrome. About 50% of children diagnosed with ADHD have tics, and between 35% and 90% of children with Tourette's have ADHD or ADHD-like symptoms.

ADHD is a developmental disorder that usually appears in early childhood. Tourette's syndrome is a nervous system disorder that also usually surfaces in young children. Both ADHD and Tourette's can make it hard for children to sit still, focus, and control their impulses.

All children with Tourette's have tics (involuntary movements), and many children with ADHD have tics, as well. This article will discuss the types of tics seen in ADHD, their causes, and how to manage tics.

Types of ADHD Tics 

When people with ADHD develop tics, they usually start occurring a few years after their ADHD diagnosis. The tics may be "provisional," meaning that they last less than a year. Or they may be persistent, meaning that they last a year or longer. People with ADHD may have one or more of several different kinds of tics,

Tics can be:

• Vocal (sounds or words)
• Facial (twitches or squints)
• Body movements (jerking or twisting)

While tics themselves are rarely dangerous, they can cause social problems. They can also be distracting and make it harder than usual for children to focus.

In some cases, tics can create barriers to inclusion in certain activities. For example, it is difficult to include a person with motor tics in activities such as dance, and it is hard for a person with vocal tics to be part of a choir. Tics can also present problems at work, depending on the type of job.

Vocal Tics

Vocal tics are involuntary sounds people make with their voices. Vocal tics may sound fairly ordinary. Examples include throat clearing, coughing, or sniffing. They may also sound quite unusual and include snorting, repeating parts of words or phrases, or, even blurting out obscene or inappropriate words.

It may be difficult to separate some vocal tics from other common symptoms of ADHD. For example, many children with ADHD experience echolalia, in which they repeat words and phrases heard elsewhere.

Impulsivity (acting without forethought)—a core symptom of ADHD—can lead to socially inappropriate interrupting. Children with ADHD may also blurt out answers or otherwise interrupt class without having a tic disorder.

Motor Tics

The term "motor" refers to movement, and motor tics are common in ADHD. Motor tics may be mild, with movements such as excessive eye blinking or shrugging. They can also be very noticeable, with movements such as mouth opening, facial grimacing, head movements, shoulder shrugging, twitching, or combinations of these movements.

Not surprisingly, motor tics can become a serious problem for both children and adults when they become more extreme. They can distract others, create problems in the classroom and at work, and get in the way of social interactions.

They can also create dangerous situations if the person affected is using certain types of machinery or driving a car.

Skin Picking

Skin picking is obsessive scratching or picking at the skin. It can result in injury and infection. Skin picking can also create obvious injuries which can be embarrassing. For some people, this can lead to wearing long sleeves and pants even in summer.

Causes of Tics in ADHD

ADHD itself is most likely caused by genetic factors. Research suggests that Tourette's syndrome and ADHD have similar genetic signatures, and many people are diagnosed with both disorders. Genetics plays a significant role in the development of tics with ADHD, but genetics isn't the only factor.

ADHD and Anxiety

Another cause of tics can be anxiety and depression, both of which are common in both children and adults with ADHD. In some cases, treating anxiety and depression can reduce tics in ADHD. People with Tourette's can also experience psychiatric issues, which can make tics worse.

ADHD Medication and Tics

Most children with ADHD are treated with medications called stimulants. While there is some disagreement on their role in causing tics, it does seem that ADHD medication can, in rare instances, cause tics—and reducing or changing medication can lessen or eliminate tics.

Managing Tics in ADHD

ADHD is usually diagnosed in children, but it is commonly a lifelong condition. Tourette's syndrome, however, can disappear over time. That means that some people who have both ADHD and tics may outgrow the tics.

However, both children and adults can benefit from treatments that help reduce tics. There are two categories of treatments: behavioral therapy and medication.

Behavioral Therapy for Tics

Behavioral therapy is a treatment that teaches people to manage and reduce their tics. Habit reversal is a well-regarded intervention. It teaches people to become aware of their tics by identifying them out loud. Then, they do something different to help break the tic habit.

For example, if the tic causes the person to pick at their skin, they might put their hands on their hips so that they cannot pick at their skin.

Comprehensive Behavioral Intervention for Tics (CBIT) has also been studied and found effective. CBIT therapists work with patients to figure out what seems to make tics better or worse. Then they work to change the environment to avoid setting off tics.

For example, they might find that tics occur most often when a child is in a loud, crowded setting, and so they might suggest avoiding such settings for a period of time.

They might also create situations in which tics are less noticeable. For example, they might suggest changes to the seating arrangement in a classroom so that a child with tics is seated toward the back of the room.

Medical Treatments for Tics

There are medical treatments available for tics, but many do have significant side effects. None is thought to be a cure.

Three drugs are approved by the Food and Drug Administration (FDA) to treat tics. These include Haldol (haloperidol), Orap (pimozide), and Abilify (aripiprazole). However, healthcare providers may try blood pressure medicines such as Intuniv (guanfacine) or Catapres (clonidine) to treat tics because they may be helpful and have fewer side effects.

If a child with ADHD has developed tics after starting a stimulant, their healthcare provider may suspect that the medication is causing the tics. When this happens, it may be possible to reduce or change the medication to manage the tics.

Summary

Many children and adults with ADHD have tics. They may be a result of ADHD, or the person may also have Tourette's syndrome. Tics may also be caused by anxiety or by stimulants used to treat other symptoms of ADHD.

Tics can often be managed through behavioral therapies, and they may disappear with age or when a stressful situation changes. There are medications for tics, but they have significant side effects and may not be completely successful.

A Word From Verywell

Tics associated with ADHD can be a serious problem, but they can also be quite mild. It's not always necessary to take action to treat tics, especially if they have little or no impact on quality of life.

If tics are serious enough to warrant treatment, be sure to look into behavioral options before considering medications that could have serious side effects.

If you or your child is taking stimulants to treat ADHD and tics emerged after you started the medication, talk to your healthcare provider about reducing or changing the medication.