ADHD, Tourette’s, and Functional Tic Disorders: Why Accurate Assessment Matters
Tic disorders are often thought of as conditions that begin and end in childhood. In reality, they can persist into adulthood or emerge later in life — sometimes with complex presentations that blur the boundaries between neurological, psychological, and social influences.
In adults with Attention-Deficit/Hyperactivity Disorder (ADHD), tic disorders such as Tourette’s Syndrome (TS) may co-occur, while others experience functional tic-like behaviours that can mimic Tourette’s but arise through entirely different mechanisms.
Understanding these distinctions — and ensuring accurate assessment — is crucial for effective treatment and long-term wellbeing.
ADHD and Tourette’s: A Common and Complex Overlap
ADHD and Tourette’s are both neurodevelopmental disorders, meaning they arise from differences in brain development and function that begin early in life.
ADHD is characterised by symptoms of inattention, hyperactivity, and impulsivity that interfere with daily functioning across multiple settings.
Tourette’s Syndrome involves both motor tics (sudden, brief movements) and vocal tics (sounds or words), persisting for more than one year.
These conditions frequently co-occur. Research suggests that 20–60% of people with Tourette’s also meet criteria for ADHD (Hirschtritt et al., 2015). Both share overlapping brain circuits — particularly the cortico-striatal-thalamo-cortical (CSTC) networks — and may involve dysregulation in dopamine neurotransmission, contributing to difficulties in impulse control, attention, and motor inhibition (Eddy & Cavanna, 2014).
When ADHD and Tourette’s coexist, adults often experience:
Greater emotional dysregulation and impulsivity
Higher risk of anxiety or obsessive-compulsive symptoms
More significant functional impact at work, home, or in relationships
Although tics may lessen with age, ADHD symptoms often persist and continue to affect executive function, focus, and self-regulation.
Functional Tic Disorders: When Tics Are Not Tourette’s
Since the COVID-19 pandemic, clinicians have seen a surge in sudden-onset tic-like behaviours, particularly among teenagers and young adults. These are often functional — meaning they arise from changes in brain-body functioning linked to stress, psychological factors, and social influence, rather than a neurodevelopmental cause.
Functional tic-like behaviours tend to differ from classical Tourette’s in several ways:
| Feature | Tourette’s Syndrome | Functional Tic Disorder |
|---|---|---|
| Onset | Gradual, typically in early childhood | Sudden, often in adolescence or adulthood |
| Course | Fluctuating, long-term | Rapid onset, may wax and wane with stress |
| Tic pattern | Simple to complex, evolving over time | Often complex from the start (e.g. phrases, large movements) |
| Triggers | Internal urges or sensations | External triggers such as stress or social media exposure |
| Underlying cause | Neurodevelopmental and genetic | Functional neurological (psychological and brain–body interaction) |
| Treatment focus | Medication plus behavioural therapy | Functional neurological therapy plus psychological support |
Research has highlighted the influence of social media, particularly platforms such as TikTok, where exposure to Tourette-related content has been associated with the rise of functional tic presentations (Paulus et al., 2021; Müller-Vahl et al., 2022; Fremer et al., 2022).
Functional tic disorders are real and distressing, but they require a different therapeutic approach from Tourette’s or ADHD — typically involving education, stress management, and retraining of brain-body responses, rather than medication or behavioural interventions designed for neurodevelopmental tics.
Why Accurate Assessment Is So Important
Because ADHD, Tourette’s, and functional tic disorders can look similar but have different causes and treatment pathways, accurate assessment is essential.
A specialist evaluation helps to:
Differentiate between neurodevelopmental and functional causes of tics
Identify co-occurring ADHD and other conditions such as OCD, anxiety, or mood disorders
Guide appropriate treatment, ensuring that interventions target the true underlying mechanisms
At Attention to Health, a comprehensive assessment includes:
Developmental and clinical history – exploring onset, triggers, family background, and impact on daily life
Structured diagnostic interviews such as the DIVA-5 (for ADHD) and Yale Global Tic Severity Scale (YGTSS)
Screening for functional features, including sudden onset, atypical tic patterns, or situational variability
Formulation and treatment planning, integrating neurodevelopmental and psychological factors
Accurate diagnosis ensures that individuals receive care that genuinely addresses their needs — whether that’s stimulant treatment and behavioural therapy for ADHD and Tourette’s, or functional neurological rehabilitation for functional tic-like movements.
Treatment Approaches: Tailored to the Individual
ADHD and Tourette’s: Treatment may involve stimulants or non-stimulant medication, behavioural interventions such as Comprehensive Behavioral Intervention for Tics (CBIT), and psychological support for emotional regulation.
Functional Tic Disorders: Focus is on understanding triggers, stress regulation, and retraining brain-body responses through psychoeducation, physiotherapy-informed movement retraining, CBT, or acceptance-based approaches.
Because ADHD can increase stress sensitivity and emotional reactivity, recognising and managing coexisting ADHD is vital when treating tic disorders of any type.
Living Well with ADHD and Tic Disorders
Whether tics are neurodevelopmental or functional, many adults find significant improvement through understanding, targeted therapy, and lifestyle strategies. Recognising the difference between these conditions empowers individuals to access the right support and avoid unnecessary or ineffective treatments.
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.
Eddy, C. M., & Cavanna, A. E. (2014). Tourette syndrome and comorbid ADHD: Current pharmacological treatment options. European Journal of Paediatric Neurology, 18(2), 143–150. PMC5803563
Hirschtritt, M. E., Lee, P. C., Pauls, D. L., et al. (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry, 72(4), 325–333.
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.
Paulus, T., Bäumer, T., Verrel, J., et al. (2021). Pandemic Tic-Like Behaviours Following Social Media Consumption. Movement Disorders, 36(12), 2932–2935.
Fremer, C., Szejko, N., Pisarenko, A., et al. (2022). Mass Social Media-Induced Illness Presenting With Tourette-Like Behaviour. Frontiers in Psychiatry, 13, 963769.
NICE (2025). Tourette’s Syndrome: Evidence Review (HTE25). National Institute for Health and Care Excellence.