30.2 THE RELATIONSHIP BETWEEN PSYCHOSTIMULANT USE AND TICS

Objectives: Clinical practice currently restricts the use of psychostimulant medications in children with tics or a family history of tics for fear that tics will develop or worsen as a side effect of treatment. This presentation will examine the evidence behind the possible association between psychostimulants and tics. Specifically, we will present data from two meta-analyses published in JAACAP that examine the following: 1) the risk of new onset or worsening of tics as an adverse event of psychostimulants in randomized, placebo-controlled trials, and 2) the effects of psychostimulants in treating tic and ADHD symptoms in children with both conditions. Methods: We conducted PubMed searches to identify eligible articles for these meta-analyses. Our primary outcomes were as follows: 1) risk ratio of new onset or worsening tics in children, and 2) standardized mean difference in reducing ADHD and tic symptoms of psychostimulants compared with placebo as the primary outcomes of the two meta-analyses. Results: New onset tics or worsening of tic symptoms were commonly reported in the psychostimulant (event rate = 5.7 percent, 95% CI = 3.7-8.6%) and placebo groups (event rate = 6.5 percent, 95% CI = 4.4-9.5%). The risk of new onset or worsening of tics associated with psychostimulant treatment was similar to that observed with placebo (risk ratio = 0.99, 95% CI = 0.78-1.27, z = -0.05, P = 0.962). Methylphenidate demonstrated superior efficacy compared with placebo in the treatment of ADHD in children with comorbid tics (ES = 0.73; 95% CI 0.53-0.94; z = 7.1, P < 0.001) and also improved tic symptoms at trend levels (ES = 0.28; 95% CI -0.03 to 0.58; z = 1.8, P = 0.07). Conclusions: Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and psychostimulant use. Clinicians may want to consider rechallenging children who report new onset or worsening of tics with psychostimulant use, as these symptoms are much more likely to be coincidental rather than caused by psychostimulants. We also found evidence from randomized, placebo-controlled trials that psychostimulants were effective in reducing ADHD symptoms in children with ADHD and comorbid tics and did not worsen symptoms of tic disorder.