Understanding ADHD Tics: Signs, Symptoms, And Management
Attention-deficit/hyperactivity disorder (ADHD) can impact a person in many ways. Common ADHD symptoms can include difficulty paying attention, hyperactivity, and impulsivity. In addition, many individuals with ADHD experience tic disorders like Tourette syndrome, vocal tic disorders, and tics resulting from obsessive-compulsive disorder (OCD).
For individuals with an ADHD diagnosis, symptoms, including chronic tics, can be managed by implementing coping strategies and seeking support from a mental health professional. Learning about the signs and symptoms of both ADHD and tic disorders, as well as understanding what triggers them, can be a good place to start.
What are ADHD tics?
Tics can be defined as sudden, uncontrolled movements, noises, or twitches that a person expresses repeatedly over time. While many conditions and stressful situations can cause tics, a tic disorder, such as Tourette’s syndrome, may be chronic and longer lasting.
ADHD and tics tend to be connected, with around 20% of individuals with ADHD also experiencing vocal or motor tics.
In individuals with ADHD, both motor and vocal tics may occur. Each type of tic can have a distinct impact on a person’s daily life. Vocal tics generally involve making sounds or noises. These could include humming, yelling, saying a word or phrase, and clearing the throat. In a school or work setting, vocal tics may be challenging to manage and could cause inadvertent disruptions. However, using coping skills may minimize or eliminate vocal tics.
Some individuals may experience motor tics. Motor tics usually involve quick and uncontrolled motions, such as squinting the eyes, clapping, or jerking an arm. Like vocal tics, a person with motor tics can improve tic symptoms over time.
Signs and symptoms of tics
Tic disorders may manifest in different ways for different people. However, most tic disorders start early in childhood and may continue through adolescence and into adulthood. Some common tics can include the following:
- Throat clearing
- Grunting
- Coughing
- Sniffing
- Barking
- Shouting
- Uttering obscenities (can be referred to as coprolalia; this tends to be less common)
- Eye blinking
- Head jerking
- Shoulder shrugging
- Facial grimacing
- Nose twitching
- Mouth movements (e.g., lip smacking, tongue clicking)
- Neck stretching
- Arm or leg jerking
- Touching or tapping objects or people
- Jumping or hopping
These tics can vary in frequency, intensity, and complexity from person to person. They may also change over time, with some tics disappearing and new ones appearing.
Tics and ADHD symptoms in children may be different than in adults. For a tic disorder to be diagnosed as Tourette syndrome, chronic tic disorder, or provisional tic disorder, the individual must usually be under 18 years old. For many individuals with tics, the symptoms are reduced or disappear over time.
Causes and triggers of tics related to ADHD
Although tic symptoms and disorders may occur in many individuals with ADHD, the cause or link between the two is not yet widely understood. Genetic factors may play a role in both disorders, although updated evidence may be necessary. It is also possible that both types of disorders could be related to neurotransmitter systems, particularly dopamine. This could mean that when one disorder occurs, the other may be more likely to occur as well.
At the individual level, many factors could cause or trigger a tic. These could include internal triggers, such as stress, anxiety, excitement, or fatigue, as well as external triggers, such as environmental factors like noise, temperature, and unpleasant social situations.
All of these situations can make it more challenging to use coping strategies and may increase how often a person experiences a tic. For people with ADHD, these triggers, especially internal triggers, may occur more often due to higher rates of stress and anxiety in individuals with ADHD.
Living with tics and ADHD
Tics can have a significant impact on daily life, potentially affecting various aspects of an individual's functioning and overall health. For many individuals, tics and ADHD can impact interpersonal or social relationships, academics or work, and physical and emotional well-being. While the impact of tics and ADHD may vary from person to person, some general ways that these disorders may impact a person’s life include those listed below.
- Interpersonal relationships – Socially, tics can lead to embarrassment, social isolation, and difficulty forming and maintaining relationships. The presence of tics can draw unwanted attention and may be misunderstood by others, possibly leading to feelings of self-consciousness and shame.
- Academics and career implications – In academic or work settings, tics can interfere with concentration, productivity, and performance. Individuals with tics may struggle to focus on tasks, potentially contributing to frustration and challenges with meeting academic or work-related goals.
- Physical health – Physically, tics can be exhausting and may cause discomfort or pain, especially if they involve repetitive movements or vocalizations. Chronic tics can also lead to muscle strain or other physical complications over time.
- Emotional health – Tics can be emotionally distressing, often contributing to feelings of anxiety, depression, and low self-esteem. The unpredictability of tics and the lack of control over them can contribute to feelings of frustration.
Although these impacts may seem overwhelming, it can be important to remember that, for individuals with tics and ADHD, treatment and coping skills can improve overall symptoms. Working with a licensed mental health professional can help a person look at ADHD and tics from a different perspective, and a therapist can make recommendations to manage tics in daily life.
Managing and coping with tics
Although managing tics can be challenging, many strategies can reduce their frequency and intensity. One way a person can reduce and manage tics may be by making lifestyle changes, such as getting enough sleep, prioritizing nutrient-rich foods, and exercising regularly. In addition to providing many potential health benefits, these changes can also reduce stress and anxiety, which can, in turn, reduce tics.
An individual can also make environmental modifications to reduce tics associated with ADHD. This could include removing noises or other external stimuli that trigger tics. While it can be challenging to identify triggers, a licensed mental health professional may be able to evaluate your daily environment and make recommendations.
In some situations, medication may help individuals reduce tics and ADHD symptoms. A licensed psychiatrist may work with you to develop a plan that involves both talk therapy and medication. Please note that only a doctor or psychiatrist (not a therapist) can prescribe medication, and you should always consult your doctor before starting, stopping, or changing the way you take medication.
Managing tics with therapy
A non-medication option that can effectively treat tic disorders and ADHD may be comprehensive behavioral intervention therapy, or CBIT. With CBIT, a therapist may first train the individual to be aware of their tics, specifically noting when they occur and under what circumstances. The therapist may then train the individual to enact a competing behavior or action when they sense the tic is going to happen. This could include reducing situations in which tics are likely to occur or changing the situation to avoid the tics altogether.
For many individuals with ADHD and tics, making it to an in-person therapy session can be challenging. Online therapy can offer the opportunity to attend therapy from any location with an internet connection, which can mean that a person may attend sessions from a distraction-free and familiar environment. Another benefit for individuals with tic disorders may be that online therapy usually comes with a wide range of therapists with whom to connect. CBIT can be considered a specialized therapy technique, and having many options online may mean that individuals with tic disorders and ADHD can find an expert with whom they are comfortable and who has the necessary expertise.
Online CBIT can be highly effective for treating individuals with tic disorders. A 2022 study investigated how online CBIT compared to a placebo, and the results demonstrated that individuals who received the CBIT treatment usually experienced reduced tic-related symptoms.
Takeaway
ADHD and tics occur in some individuals as comorbid disorders. For individuals who experience ADHD and tics, symptoms can impact their daily lives by disrupting academics and work, making interpersonal relationships more challenging, and impacting physical and emotional health and well-being.
Although there can be challenges for individuals with tics and ADHD, there may also be resources available to provide coping skills and strategies to reduce symptoms. Online or in-person therapy, especially CBIT, can be an effective way to reduce symptoms over time and prepare an individual to replace tics with other behaviors that are less disruptive to daily life.
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