ADHD and Tic Disorders/Tourette Syndrome in Adults: Understanding the Overlap, Assessment, and Treatment

Attention-Deficit/Hyperactivity Disorder (ADHD) and tic disorders, including Tourette Syndrome (TS), are often thought of as childhood conditions. However, both can persist into adulthood, frequently co-occurring and influencing one another in complex ways. For clinicians and individuals navigating these conditions, understanding their comorbidity, assessment, and treatment options is key to improving long-term outcomes.

ADHD and Tic Disorders: Distinct but Intertwined

ADHD is a neuro-developmental condition characterised by persistent symptoms of inattention, impulsivity, and/or hyperactivity that interfere with daily functioning across settings. In adults, hyperactivity often presents as internal restlessness, disorganisation, or difficulty sustaining attention rather than overt motor activity.

Tic disorders are defined by sudden, rapid, recurrent, non-rhythmic motor movements or vocalisations. When both motor and vocal tics persist for more than one year, the diagnosis of Tourette Syndrome may apply. Although tic frequency and severity often decline with age, a significant proportion of adults continue to experience tics that fluctuate in intensity.

Comorbidity Between ADHD and Tic Disorders

ADHD and tic disorders frequently co-occur. Research suggests that 20–60% of people with Tourette Syndrome also meet criteria for ADHD (Hirschtritt et al., 2015). Meanwhile, tic disorders in general have high rates of comorbidity with other neurodevelopmental or psychiatric disorders (Robertson, 2015).

This overlap is believed to reflect shared genetic, neurobiological, and neurochemical mechanisms — particularly involving dopaminergic dysregulation within cortico-striatal-thalamo-cortical (CSTC) circuits. Both conditions are associated with difficulties in inhibitory control and executive functioning.

In adults, the coexistence of ADHD and tics is often associated with:

• Increased functional impairment, especially in occupational and social domains

• Greater risk of comorbidities such as obsessive-compulsive disorder (OCD), anxiety, and mood disorders

• Higher rates of impulsivity and emotional dysregulation

While tics themselves may become less prominent over time, ADHD symptoms often persist, continuing to affect attention, motivation, and self-regulation.

Assessment in Adults: A Comprehensive, Nuanced Process

Accurate assessment in adults can be challenging, as both ADHD and tics may have evolved from childhood or been misinterpreted as anxiety, stress responses, or habits.

A thorough evaluation should include:

1. Clinical history – exploring developmental onset, progression of symptoms, family history, and impact on functioning.

2. Structured diagnostic interviews – such as the DIVA-5 (for ADHD) and the Yale Global Tic Severity Scale (YGTSS) for tic evaluation.

3. Collateral information – from family, partners, or historical records to confirm early-life symptoms.

4. Assessment of comorbidities – including OCD, anxiety, depression, substance use, and sleep difficulties.

Differential diagnosis is essential, particularly distinguishing tics from compulsions, stereotypies, or medication-induced movements.

TikTok and the Rise of Social Media–Associated Tic-Like Behaviours

In recent years, clinicians have reported a surge in functional tic-like behaviours—especially among adolescents and young adults—linked to social media exposure, particularly on platforms such as TikTok. These presentations often differ from classical Tourette Syndrome in onset, pattern, and phenomenology.

Clinicians should be mindful of these functional presentations and consider psychosocial factors, media exposure, and stress-related influences during assessment.

Treatment: Balancing Symptom Management and Quality of Life

Effective management of co-occurring ADHD and tic disorders in adults requires an integrated, individualised approach that addresses both symptom clusters without exacerbating either.

1. Pharmacological Management

Medication decisions must balance benefits for attention and impulse control against potential tic exacerbation. Evidence suggests:

• Stimulant medications (e.g., methylphenidate, dexamphetamine) remain effective for adult ADHD, and generally do not cause significant or lasting worsening of tics. (Bloch et al., 2009)

• Non-stimulant options such as atomoxetine, guanfacine, or clonidine may be preferable if tics are prominent or stimulants are poorly tolerated.

• Antipsychotic agents (e.g., aripiprazole, risperidone, haloperidol) can reduce tic severity but require caution due to metabolic and extrapyramidal side-effects.

• Combination therapy may be appropriate where ADHD remains disabling after tics are managed.

2. Psychological and Behavioural Interventions

• Cognitive-behavioural therapy (CBT) adapted for ADHD can improve organisation, planning, and emotional regulation.

• Comprehensive Behavioural Intervention for Tics (CBIT) remains the behavioural gold standard for tic management, teaching awareness and competing-response strategies, this could be habit reversal training (HRT) or exposure and response prevention (ERP) therapy.

• Mindfulness-based therapies can reduce stress and enhance self-awareness, which often exacerbates both ADHD symptoms and tics.

3. Psychoeducation and Lifestyle Management

Educating individuals about the neurobiological basis of both conditions helps reduce stigma and supports self-advocacy.

What Attention to Health Can Offer

At Attention to Health, we recognise the complexity of co-occurring ADHD and tic disorders, including Tourette Syndrome. Our clinicians provide specialist, evidence-based care tailored to adults living with these overlapping conditions.

We offer:

• Comprehensive assessment for ADHD and tic disorders, including administration of the Yale Global Tic Severity Scale (YGTSS) to evaluate tic type, frequency, and impact.

• Direct assessment of tic disorders for adults who have already been diagnosed with ADHD, to support clarification of symptoms and provide a detailed diagnostic formulation.

• Evidence-based treatment options for tic disorders, adapted to the needs of individuals with ADHD, drawing on approaches such as CBIT, psychoeducation, and cognitive-behavioural strategies.

• Detailed formulation and diagnostic report, integrating developmental history, symptom profile, and comorbidity screening.

• Personalised treatment recommendations, which may include medication guidance (liaising with prescribers as needed), CBT for ADHD, or CBIT for tics.

• Holistic management planning, supporting individuals to understand their conditions, develop practical strategies, and enhance wellbeing, function, and quality of life.

While we do not currently provide open screening for Tourette Syndrome via our website, we do offer direct assessment and treatment for tic disorders in adults with an existing ADHD diagnosis.

While co-occurring ADHD and tic disorders can present ongoing challenges, many adults learn to manage their symptoms effectively with the right combination of treatment, self-awareness, and support. Recognising strengths such as creativity, energy, and resilience is equally important.

Clinicians should aim for a holistic, person-centred approach, addressing not just symptom reduction but overall quality of life, functioning, and emotional wellbeing.

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References

Bloch, M. H., Panza, K. E., Landeros-Weisenberger, A., & Leckman, J. F. (2009). Meta-analysis: Treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 48(9), 884–893.

Hirschtritt, M. E., et al. (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry, 72(4), 325–333.

Robertson, M. M. (2015). A personal 35-year perspective on Gilles de la Tourette syndrome: Prevalence, phenomenology, comorbidities, and co-existent psychopathologies. The Lancet Psychiatry, 2(1), 68–87.

Surman, C. B. H., Hammerness, P. G., & Biederman, J. (2013). ADHD in adults: Challenges and solutions. Neuropsychiatric Disease and Treatment, 9, 9–21.

[New Reference] — [Author(s) as per PMC paper]. (Year). Title of paper. [PMC article reference on tic disorders and ADHD comorbidity]. (PMC reference: PMC5803563).

Paulus, T., Bäumer, T., Verrel, J., et al. (2021). Pandemic Tic-Like Behaviours Following Social Media Consumption. Movement Disorders, 36(12), 2932–2935.

Müller-Vahl, K. R., Pisarenko, A., Jakubovski, E., Fremer, C. (2022). Stop That! It’s Not Tourette’s but a New Type of Mass Sociogenic Illness. Brain, 145(2), 476–480.

Fremer, C., Szejko, N., Pisarenko, A., et al. (2022). Mass Social Media-Induced Illness Presenting With Tourette-Like Behaviour. Frontiers in Psychiatry, 13:963769.

Hartung, K., Klages, C., Fremer, C., et al. (2024). Prevalence of Mass Social Media-Induced Illness Presenting With Tourette-Like Behaviour in Germany Between 2019 and 2021. Journal of Psychiatric Research.

National Institute for Health and Care Excellence (NICE). (2025). Tourette’s Syndrome: Evidence Review. NICE HTE25.