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Chronic tic disorders in children with ADHD
  1. William Poh1,
  2. Jonathan M Payne1,2,3,
  3. Alisha Gulenc2,
  4. Daryl Efron1,2,3
  1. 1 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Population Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3 The Royal Children’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Daryl Efron, Murdoch Children’s Research Institute, Parkville, Vic 3052, Australia; daryl.efron{at}


Objective To examine in a community-based cohort: (1) the prevalence of chronic tic disorder (CTD) in children with attention-deficit/hyperactivity disorder (ADHD) compared with non-ADHD controls at ages 7 and 10; and (2) the additional psychiatric and functional burden of CTD in children with ADHD.

Methods Children aged 6–8 years with ADHD (n=179) and controls (n=212) were recruited through 43 Victorian schools using parent and teacher screening surveys (Conners 3 ADHD Index), followed by case confirmation (Diagnostic Interview Schedule for Children-IV (DISC-IV)). CTD was identified using the DISC-IV categories chronic motor tic disorder, chronic vocal tic disorder or Tourette syndrome at baseline and 36-month follow-up. Internalising and externalising disorders, social functioning, academic performance and quality of life were also measured. Tests of proportions and independent t-tests were used to compare the ADHD+CTD group with sex-matched ADHD alone children.

Results Compared with controls, children with ADHD were 4.1 (95% CI 1.1 to 14.1) times more likely to have CTD at age 7, and 5.9 (95% CI 1.6 to 17.9) times more likely at age 10. Children with ADHD+CTD experienced higher rates of internalising disorders and peer problems, and poorer quality of life than those with ADHD alone.

Conclusions CTD prevalence is higher in children with ADHD compared with controls, and confers substantial additional psychiatric and functional burden. Clinicians need to consider CTD in both the initial assessment and ongoing management of children with ADHD, and address both the symptoms and the associated impairments.

  • comm child health
  • epidemiology
  • child psychiatry
  • child psychology
  • neurodevelopment

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  • Contributors WP contributed to conceptualising the study, analysed the data and drafted the initial manuscript. JMP provided critical input, and reviewed and revised the manuscript. AG acquired the data, and reviewed and revised the manuscript. DE conceptualised and designed the study, and reviewed and revised the initial manuscript. All authors approved the final manuscript as submitted.

  • Funding This project was funded by the Australian National Health and Medical Research Council (NHMRC; 1008522), the Murdoch Children’s Research Institute (MCRI) and the Collier Foundation. DE and JMP were funded by a Clinician Scientist Fellowship from the MCRI. JMP was funded by the US Department of Defense (W81XWH-15-2-0619, W81XWH-16-1-0408) and the Children’s Tumor Foundation (2016-10-001). MCRI was supported by the Victorian Government’s Operational Infrastructure Support Program.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Human Research Ethics Committee of the Royal Children’s Hospital, Melbourne (No 31056), and the Victorian Department of Education and Early Childhood Development (No 2011_001095).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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