May 14, 2011
Tic Disorders can co-occur with ADHD 8-15% of the time. In other words, children diagnosed with ADHD are at greater risk for developing tics than the general population. If
May 14, 2011
Tic Disorders can co-occur with ADHD 8-15% of the time. In other words, children diagnosed with ADHD are at greater risk for developing tics than the general population. If you have a child with ADHD, know what to watch for. Tics can be either motor tics (involuntary muscle movements) or vocal tics often characterized by throat clearing, repetitive cough, or other involuntary noises. Motor tics frequently involve muscles around the face or neck area, but can occur anywhere. Vocal tics, particularly of the throat clearing/coughing type, tend to be initially mistaken as an allergy.
If your ADHD child does develop tics, don’t panic. Most of the time tics are benign and kids grow out of them even with no medical intervention. The peak age for symptoms of tics is approximately age 10 or 11 and then by adolescence usually the tics will begin to fade. Knowing that tics will generally improve on their own, how do you decide when to treat them? My simple answer – treat the tic if it’s bothersome to the individual and/or interfering with daily functioning. The decision should be a collaborative one among the patient, the patient’s family, and the treating physician.
Some of the medications we use to treat tics are actually blood pressure medications called clonidine and guanfacine. They work well to decrease the frequency and severity of tics. If you do decide to try these medicines, be patient. They take time to work and initially can cause some sedation, particularly in the first few weeks.
In children with combined ADHD and tics, prior studies have shown stimulant medications can exacerbate tics so the treatment may simply be to stop the stimulant. This is not to say that stimulant medications cause tics, in fact they don’t. Many patients with ADHD and co-existing tics are able to successfully take the stimulants. If however the stimulant medications do cause problematic side effects for your child, remember there are also non-stimluant medications for treating ADHD such as Strattera or Intuniv.
In summary, tics are fairly common with ADHD, are usually benign, and tend to improve by late adolescence even without treatment. Be able to recognize symptoms of motor and vocal tics in your ADHD child so you can talk to your doctor about treatment options.
Theresa Cerulli, M.D.
February 23, 2011
Taking prescription medications can be cumbersome. It certainly challenges ones working memory skills to remember the names of medications we take, the dose, what time of day to take it, what the pill is for, the side effects, where we store it in the house so we can find it when we need it, when to call the doctor for a refill, the list goes on. To add more confusion to the mix, most prescriptions have two names, the brand name (like Benadryl) and it’s generic name (diphenhydramine). So I’ll share a question patients frequently ask me – does it matter?
Traditionally when medication is first approved by the FDA there is a patent placed on the newly “branded” drug. After a certain number of years the patent expires and any other company is welcome to make a copy-cat “generic” of the drug. Is there any difference between the original and the copy? Yes. Does it matter? That depends on who you ask. My opinion -ultimately it depends on the person taking the drug – the patient!
When generics are manufactured, the FDA allows a slight deviation from the amount of active ingredient compared with the original branded version of the medication. Maybe Brand X has 32% of the active ingredient and Generic X has 30%. Probably not a noticeable difference clinically for most people. But, where brands and generics differ the most are in the filler components – the stuff that literally holds the tablet together. These filler components can be completely different, resulting in the pill looking nothing like the original one. The size, shape, and color may be may be unrecognizable when you go to pick it up at the pharmacy. The name – the generic name – may be unrecognizable as well. This is a source of many frustrated phone calls to our office from patients worried that the pharmacy gave them the wrong bottle.
Rule of thumb is that most generics will work fine for most people. However, there are some exceptions so certainly let your doctor know if you are experiencing any change in symptoms or side effects when going to a generic. For example, you could be allergic to the red dye coating of generic Y that wasn’t in brand Y. Or your child may have trouble swallowing generic Z because it’s twice the size of brand Z.
Cost cutting is generally driving the substitution of generic medications in place of the brand. That’s good news if both drugs are equally effective for you. But if you have noticed differences in effectiveness or side effects, ask your doctor to contact your insurance company to do a “Prior Authorization” requesting coverage for the brand. It will usually take 3-5 business days for your insurance company to respond to the doctor’s request so patience and planning are helpful in these situations.
March 21, 2010
Children and adults with AD/HD may frequently experience problems with sleep. You may know this all too well 