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Comorbidity of tic disorders & ADHD

Conceptual and methodological considerations

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Abstract

Background

The causes and pathophysiological mechanisms of the common comorbidity of tic disorders and Attention-deficit/Hyperactivity disorder (TD + ADHD; about 50% of TD, about 20% of ADHD) still remain unclear. Studies with a 2 × 2 design comparing groups of children with TD, ADHD, TD + ADHD and healthy controls are in need and may disentangle the influences of TD versus ADHD in the case of comorbidity. Unfortunately, conceptual and methodological problems can restrain possible conclusions from these studies.

Method

A review of the literature on artifactual and non-artifactual models of comorbidity in general and specially for TD + ADHD was conducted.

Results

The first section describes various possible models of comorbidity and their corresponding hypotheses concerning expected patterns of findings comparing groups of children with TD, ADHD, TD + ADHD and healthy controls. In the second part research results concerning psychopathological, neuropsychological, neurophysiological, structural and functional imaging, as well as genetic characteristics are summarized. In the third section possible conclusions and their limitations due to conceptual and methodological problems possibly contributing to the ambiguous results are discussed. Finally, future research strategies and the need for full causal models are outlined.

Conclusion

Some components of the etiological pathways of TD + ADHD may well be shared with the ‘pure’ conditions while others may be unique.

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Notes

  1. The Berksonian bias is the higher mathematical chance to be referred: referral rate for disorder A + referral rate for disorder B. Referral bias mostly reflects the higher rate of referral due to higher impairment in case of two disorders (A + B).

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Authors and Affiliations

  1. Child and Adolescent Psychiatry, University of Goettingen, Goettingen, Germany

    Tobias Banaschewski, Aribert Rothenberger & Veit Roessner

  2. Central Institute of Mental Health, Child and Adolescent Psychiatry, J5, Mannheim, 68159, Germany

    Tobias Banaschewski

  3. MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, London, UK

    Benjamin M. Neale

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Correspondence to Tobias Banaschewski.

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Banaschewski, T., Neale, B.M., Rothenberger, A. et al. Comorbidity of tic disorders & ADHD. Eur Child Adolesc Psychiatry 16 (Suppl 1), 5–14 (2007). https://doi.org/10.1007/s00787-007-1002-8

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