OBJECTIVE: Attention Deficit/Hyperactivity Disorder(ADHD) and tic disorders are relatively common childhood onset neuropsychiatric disorders, and these two disorders frequently cooccur in some individual. Although the efficacy of psychostimulants is well established in ADHD, as many as 25% of children fail to respond to psychostimulant treatment due either to a lack of efficacy or to intolerable side effects including exacerbations of tics. Guanfacine, a selective alpha2A-adrenergic agonist, was recently introduced for the treatment of children with ADHD. This study is to evaluate the efficacy and safety of guanfacine in children with ADHD and comorbid habit disorders and to identify subgroups of children who may have a more favorable response to guanfacine. METHODS: Twenty five children who were 6 to 16 years old were enrolled in an open trial of guanfacine for two months. Primary outcome measures were DuPaul Parent and Teacher Rating Scales, Conners Parent and Teacher Rating Scales and Yale Global Tic Severity Scale. Paired t-test and multiple logistic regression were performed to evaluate symptom improvement and to examine predictor variables for positive drug response. RESULTS: Severity of ADHD symptoms and tics after guanfacine administration was significantly reduced at each follow-up point in the ratings completed by both parents and teachers and in clinical evaluation, compared to their pre-medication status. Children with moderate ADHD symptoms responded more favorably to guanfacine than children with mild or severe symptoms. CONCLUSION: These findings suggest that guanfacine may be a safe and an effective medication for ADHD children who cannot benefit from psychostimulants, but more definitive research strategies are needed for future investigation.
Adolescent ; Child ; Comorbidity ; Follow-Up Studies ; Guanfacine* ; Humans ; Logistic Models ; Outcome Assessment (Health Care) ; Parents ; Tic Disorders ; Tics ; Weights and Measures

Objective: In patients with Tourette syndrome and other primary tic disorders (PTDs), tics are typically preceded by premonitory urges (PUs). To date, only a few studies have investigated the location and frequency of PUs, and contrary to clinical experience, the results suggest that PUs are not located in the same anatomic region as the tics. This study aimed to further explore PU location and frequency in detail, differentiating the kind and complexity of the corresponding tics, in a large sample of patients with PTD. Methods: A total of 291 adult (≥ 18 years) patients with a confirmed diagnosis of chronic PTD were included. The study was conducted online, assement included tics and the general characterization of PUs and a sophisticated body drawing for locating PUs. Results: We found that PUs were located in the same body area as, or in direct proximity to, the corresponding tic. Most frequently, PUs were located in the face and at the head (62.1%). Compared with simple tics, complex (motor and vocal) tics were more often preceded by a PU; but there was no difference in PU frequency observed between motor tics and vocal tics. PUs were more often experienced at the front than at the back of the body (73% vs. 27%), while there was no difference between the right and left sides (41.6% vs. 41.3%). Conclusion The strong association between PU and tic location further supports the hypothesis that PUs represent the core of PTD. Accordingly, future therapies should focus on treating PUs to achieve greater tic reduction.