ADHD, Tics, and Obsessive Thoughts in Children

Reader’s Question

My husband has tics of mostly squinting his eyes and clearing his throat. Our two boys (8 and 10) over the last couple of years have shown mild tics that seem to come and go. I am excited now to learn that there are certain things that can trigger a tic, so I will start some research. However, one thing that caught my eye is that I saw that “obsessive thoughts” can be connected to tics. My 8-year-old complains to me about bad thoughts that he has. He is very troubled by them. We did go to a child therapist for what I always called “intrusive thoughts”, but we never really touched on that. We had several sessions that seemed to be directed more toward me trying to fix his “bad behavior”. I have always felt that my son was ADHD and very confused by the fact that none of his teachers would agree with me. They have always said things like “he is just all boy”. His teacher last year just seemed to dismiss this. She sent him to a part of the back of the room to sit by himself. Unfortunately, he liked it back there because he would just let his mind wander. I am excited now to learn that I may be onto something. What else can you tell me about “obsessive thoughts” that is related to tics?

Psychologist’s Reply

Tourette’s Disorder creates the tics and as you describe, they can range from mild to very severe. Tics typically surface between the ages of 5 to 7 years.

There is a very strong link betwen three conditions: Attention-Deficit Hyperactivity Disorder (ADHD), Tourette’s Disorder, and Obsessive-Compulsive Disorder. Studies tell us that in children with Tourette’s Disorder, 40-70 percent will also have ADHD and 30-40 percent will have Obsessive-Compulsive Disorder (cited in Tourette’s Syndrome, edited by James F Leckman and Donald J Cohen [Amazon US | Amazon UK]).

Importantly, this is a neurological and neurotransmitter link that is so strong that the conditions develop and surface in a predictable order. Typically, the children experience ADHD symptoms first, followed by the onset and recognition of tics, followed by obsessive-compulsive (OC) behaviors such as intrusive thoughts, repeated touching, counting, rituals, etc. It’s important to recognize what all three conditions have in common:

  1. the symptoms are involuntary and not under the control of the child,
  2. the disorders are considered related to brain neurochemistry, especially Dopamine and Serotonin neurotransmitters,
  3. symptoms increase when the child is excited/stressed/tired,
  4. symptoms do respond to medication treatment, and
  5. behaviors associated with all three conditions are often misunderstood as “bad behavior” in the classroom.

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As a parent of a child with symptoms in all three disorders, you will need to research the conditions, learn how they exhibit in your child, and represent ADHD, Tourette’s Disorder, and Obsessive-Compulsive Disorder to the family physican, teachers, and school administrators. Most communities have a specialist for each disorder — but not always for the three in combination. You must become the expert. As a knowledgeable parent you can provide literature, handouts, internet articles/references, and guidance to those working with your child. While encouraging the parent to be the expert may sound unusual, it’s a common situation when our child has a rare medical, learning, or mental health condition or when combinations of conditions produce behaviors and symptoms that are difficult to understand in the community.

The Internet has a wealth of information on the three conditions and their combinations. Conducting a search for ADHD +Tourette’s; ADHD +obsessive-compulsive; ADHD +Tourette’s +obsessive thoughts can produce hundreds of references. Do your homework and be prepared to answer questions posed by educators and other professionals in the community. With your guidance, the community can move away from simple interpretations of his symptoms such as “bad behavior” or “He’s all boy” to developing an educational plan that meets his specific needs.

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