A person with ADHD might shift, shuffle, sniffle, tap their feet, bite their nails, or make noise to reach a certain level of stimulation. 

Hyperactive movement is common with ADHD, but when are these involuntary movements a tic disorder? Frequently, tic disorder and ADHD co-occur, making the symptoms hard to separate. 

Let’s look at recognizing types of tic disorders and how they're different from ADHD.

Too long; didn’t read

• There are three types of tic disorders: provisional, persistent, and Tourette
• Types are categorized by whether tics are motor or vocal, and by how long they’ve been present
• Tourette syndrome (TS) commonly co-occurs with at least one other condition
• Anxiety and ADHD are the most common comorbid conditions 
• People with Tourette syndrome may perform better in some fields than neurotypicals.
• TS presents differently in everyone
• It's unclear if ADHD medications cause tics; more research is needed

What are tics?

Tics are involuntary movements or sounds that are characterized by rapid repetition. Most tics will onset in early childhood and disappear again with the beginning of puberty. Tics often come and go depending on the person’s surroundings.¹

There are two types of tics: motor tics and vocal tics.¹

Two types of tics

Motor tics:

• Blinking
• Wrinkling the nose
• Grimacing
• Jerking or banging the head
• Clicking the fingers
• Touching other people or things

Vocal tics:

• Coughing
• Grunting
• Sniffing
• Repeating a sound or phrase

Defining tics by their complexity

Simple tics

These tics are typically characterized by brief movements or sounds. Each episode tends to be short in comparison to complex tics.

Complex tics

Complex tics are comprised of more significant gestures or full words. These typically last longer per episode.

Tic disorders, as described by the DSM-V²

Tourette syndrome (TS)

• At least 2 motor tics and at least one vocal tic (do not need to occur simultaneously)
• Tics have been present for over a year.
• Tics usually happen in bouts, nearly every day or on and off
• Tics are unassociated with other conditions or medications

Persistent (chronic) tic disorder

• At least one motor tic or at least one vocal tic (not both)
• Tics have been present for more than a year
• Tics occur multiple times a day (either every day or sporadically)
• Tics are unassociated with other conditions or medications

Provisional tic disorder

• At least one motor or vocal tic
• Tic(s) have been present for less than a year (12 months)
• Tics are unassociated with other conditions or medications
• No existing or previous diagnoses for persistent tic disorder or TS

Can someone have ADHD and Tourette syndrome?

Just like ADHD, Tourette syndrome is a neurodevelopmental condition, and diagnosis ideally happens in childhood. 

The likelihood of having Tourette syndrome and ADHD is very high. Over half of children with TS also have ADHD, and about 20% of those with ADHD also have TS. 

Conditions that co-occur with TS:

Other mental, behavioral, or developmental conditions are common in children with TS.³ Some examples include:

• Anxiety (61%)
• Behavioral conditions (34%)
• Learning disabilities (34%)
• Obsessive-compulsive disorder (33%)
• Developmental delays (26%)
• Autism (21%) 

ADHD and Tourette syndrome: what to expect

Strengths of Tourette syndrome

In his autobiography, professional football (soccer) goalkeeper, Tim Howard, quotes the doctor who diagnosed him with Tourette syndrome and OCD. The doctor says:

[T]here’s one thing I’m absolutely sure of: with every challenge a kid faces, there’s some flip side. I have no way to prove it, but I believe this: there’s always a flip side.

Tim Howard’s doctor speaks about intuition and hyperfocus abilities, too, skills that aren’t easily acquired by neurotypicals. (Hyperfocus and intuition are also common strengths in people with ADHD!)

A “fingerprint condition”

Tourette syndrome is called a “fingerprint condition” because the presentations are unique to everyone — just as they are in people with ADHD. Therefore, each individual can find their very own advantages and disadvantages in the condition. 

Success with TS

Like many neurodevelopmental conditions, Tourette syndrome can come with challenges — but it also comes with gifts.

1. Stronger cognitive control

People with tic disorders have been found to have stronger cognitive control,⁴ as many of them have learned how to control their movements.

2. Improved time processing

Many people with TS have learned how to suppress their tics, or - at the very least - have become more aware of how long their vocal or motor tics last, and when they may happen. Because of this, they have a stronger sense of time.⁵

3. Fast learners

Children with TS exhibit a faster understanding of grammar than neurotypical children.^6,7

Does ADHD medication cause tics?

Reportedly, tics can be worsened or caused by taking certain ADHD medications, namely stimulants, but the exact reasons are unclear.

Yes?

When tic disorder and ADHD occur together, ADHD symptoms typically precede the tics by a few years. This could imply that the tics started when the ADHD symptoms are treated with medication.

No?

Another possible explanation is that tic severity can increase or decrease depending on external factors such as stress, excitement, fatigue, etc.⁸

It’s difficult to determine whether a tic would have developed on its own or if the medications caused it.

When to seek a diagnosis

TS is typically first noticed in elementary-aged children. However, to be diagnosed with TS, the symptoms must have presented before age 18. While it is possible to treat TS with medication, there’s no guarantee of success.³ To be evaluated for and eventually diagnosed with TS, seek out a specialized medical professional.

For more information on Tourette syndrome, get informed at the Tourette Association of America.