Tics and ADHD – Which Impairs Social and Cognitive Functioning More?

Tic disorders (TD), which are neurodevelopmental issues that cause physical tics, are commonly found in children who also have another psychological challenge. “The majority of individuals with TD (up to 90%) have at least one comorbid psychiatric disorder, with attention-deficit/hyperactivity disorder (ADHD) being the most frequent co-occurring condition,” said Ellen Greimel of the Department of Child and Adolescent Psychiatry at the University Hospital of the RWTH Aachen in Germany. “ADHD has been shown to substantially account for impairments in social, cognitive and school functioning in individuals comorbid with TD and ADHD.” To date, research on the relationship between ADHD and TD has been mixed. “A number of studies that have investigated attentional functions in subjects with co-occurring TD and ADHD have revealed unexpected results as they have shown superior performance in participants comorbid with both disorders compared to participants with ‘ADHD only’ in selective or sustained attention tasks.”

To clarify the cloudy evidence that already exists, Greimel and her colleagues assessed the cognitive and social impact of TD, ADHD and TD and ADHD together in 96 adolescents of mixed diagnoses. What they discovered supported their hypothesis. “In sum, as expected, we found that the diagnosis of ADHD was associated with impaired attentional functions: regardless of a diagnosis of TD, participants with ADHD were found to perform worse in tasks related to the supervisory attentional system, the selectivity domain and the intensity domain of attention,” said Greimel. “Also in line with our hypothesis, a diagnosis of TD had no negative impact on attentional task parameters; participants with TD even outperformed individuals without a diagnosis of TD in the set shifting task.” Greimel added, “Our results add to previous findings showing that in TD, comorbid disorders often are far more impairing than the tics themselves with regard to functioning in several areas, including general cognitive, academic and social skills.” She believes that children with both TD and ADHD should receive treatment for the problem that most disrupts their ability to function adequately.

Greimel, Ellen, Sina Wanderer, Aribert Rothenberger, Beatte Herpertz-Dahlmann, Kerstin Konrad, and Veitt Roessner. “Attentional Performance in Children and Adolescents with Tic Disorder and Co-Occurring Attention-Deficit/Hyperactivity Disorder: New Insights from a 2×2 Factorial Design Study.” Journal of Abnormal Child Psychology 39 (2011): 819-28. Print.

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • ricki


    November 5th, 2011 at 5:03 AM

    How can you even determine which is the most hurtful for a cjild’s performance? They are probably embarsassed more by the tics but I would assume that the ADD would cause more learning problems in school.

  • Eliza


    November 6th, 2011 at 6:11 AM

    Tics are some thing that we see, whereas ADHD for the most part is something that is on the inside and there are no outward markers of this. So I would think that especially kids are going to be harder on other children with tics rather than those who are disruptive or have behavioral problems. I kind of think that the treatment cannot be isolated though, and maybe getting treatment for both simultaneously would be the way to go. Maybe helping one issue could more easily help to have another resolved.

  • Dwayn3


    November 6th, 2011 at 11:13 PM

    if I have 2 issues and you tell me that all my problems are because of 1 of them and that d other may not actually play a big role,are you not,as a professional,ignoring d other issue?while it may not show all its effects in 1 study,it could well be that when TD is present along with ADHD d effects of d latter are more pronounced,isn’t it?

  • stressmom


    November 7th, 2011 at 5:17 AM

    Either of these situations would be difficult for the family to handle. This is going to be especially true when the child comes from a home with no experience in either, and I think that there will be many parents who do not know where to turn for help. That is one of the greatest things about this site; you raise issues that real families are being forced to deal with but you give them hope that science has not forgotten about them, that studies are being done in that area and that a cure or at least a solution to their specific problem could be right around the corner. I know that there are numerous parents and educators as well who very much appreciate that.

  • F. Carson

    F. Carson

    November 7th, 2011 at 10:43 PM

    ADHD can be perceived as having an eccentric streak by peers. Those with tics, especially spasms and such, will have a much harder time gaining acceptance from some. Unfortunately many who develop facial tics in childhood are targeted for bullying during their school years. It’s a shame that some children have to deal with both conditions.

  • C.Me


    November 7th, 2011 at 11:54 PM

    Things like these can impair the normal life of any child and although it is important to see what has more of an effect I think the focus should be on treating both and seeing how best we can fix things for these little kids.

  • Susanne Goodwin

    Susanne Goodwin

    November 7th, 2011 at 11:55 PM

    @F. Carson: It is, and if you try to explain their disability the most common response you’ll get is a shrug of the shoulders and disinterest.

    I have ADHD myself and it’s not like the problems don’t eventually smooth out. It simply takes us a much longer time to “get into the groove” and after that we’ve got it.

    Tics however, those you don’t grow out of as far as I know. Of the two I think ADHD is the more manageable.

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