Tics are repetitive, sudden movements you make without wanting to make them.

For example, you might repeatedly twitch your nose or your neck, shrug your shoulders, or blink your eyes with more force than most. Some people have vocal tics — sounds like coughing, grunting, or sniffing. These sounds and movements vary in complexity, in intensity, in what causes them, and in how long they’re likely to last.

Tics that happen very often every day and that go on for longer than a year may be part of a tic disorder, such as Tourette syndrome, or they could stem from a recent illness, such as a strep infection.

If you or a child in your care have been diagnosed with attention deficit hyperactivity disorder (ADHD), you may be wondering whether the tics have anything to do with ADHD. Here’s a quick explanation of the connections between the two conditions.

ADHD is a complex disorder with many different symptoms and effects. While ADHD itself doesn’t cause tics, people with ADHD can have a co-occurring tic disorder. It’s also possible to have ADHD and another condition with symptoms that include tics.

Over the years, there has been some concern about whether medications you take for ADHD could cause or worsen tics. Here’s what the research indicates.

Multiple disorders

People with ADHD sometimes have other health conditions at the same time. Researchers have found, for example, that between 50 percent and 70 percent of children with ADHD also have a tic disorder.

ADHD often occurs alongside other disorders and conditions that can cause tics, including:

  • Tourette syndrome (TS). Many people diagnosed with TS also experience the symptoms of ADHD. The percentage could be as high as 90 percent. Some studies show that for people with TS, tics decline in the teen years. The symptoms of ADHD and OCD may also become less severe in people with TS during adolescence.
  • Obsessive compulsive disorder (OCD). Researchers have found that tics are most common in people whose OCD symptoms involve aggressive compulsions and symmetry behaviors.
  • Autism spectrum conditions. Some of the repetitive behaviors associated with autism are face, body, and voice tics. Around 20 to 50 percent of those with ADHD are also autistic.

These neurodevelopmental conditions affect many of the same structures and regions of the brain as ADHD. They also share some genetic origins, so it isn’t surprising that the conditions cause overlapping or similar kinds of symptoms. All of this shared territory can make it difficult to pinpoint exactly what’s causing tics to happen.

Medication side effects

In recent decades, some health professionals have expressed concern about the possibility that certain ADHD medications could cause or worsen tics. A number of studies have examined the side effects of ADHD medications, tracking the number and severity of any tics people experienced while taking them.

Stimulant medications and the chance of tics

The Food and Drug Administration (FDA) has approved certain stimulants to treat ADHD symptoms in children. Right now, the FDA doesn’t recommend using stimulant medications for people with tic disorders like Tourette syndrome or for people with a family history of tic disorders.

However, researchers have reviewed numerous studies conducted over several decades and have reported that it’s not likely stimulant medications cause or worsen tics in children with ADHD.

In the 1970s, the FDA warned patients not to use methylphenidate, a stimulant often prescribed for ADHD symptoms, out of concern that the drug could cause tics. Since then, researchers have studied the effects of the medication extensively and concluded that any increase in tics isn’t related to methylphenidate. The FDA lists methylphenidate on its inventory of medications approved for treatment of ADHD.

Nonstimulant medications and the chance of tics

The FDA has approved three nonstimulant medications to treat ADHD in children:

  • atomoxetine (Strattera)
  • clonidine (Kapvay)
  • guanfacine (Intuniv)

Research supports the use of these drugs to safely manage tics and ADHD symptoms in children, but there have been a few case studies that suggested atomoxetine may have caused tics in some children.

Some tics go away on their own or are so mild that you may not want or need to treat them. For others, here are some treatment options to try:

Consider behavioral therapies

Two forms of psychotherapy have been effective in reducing tics: habit reversal therapy (HR) and exposure response prevention (ERP).

HR trains you to recognize the feeling that builds up just before a tic, giving you a chance to control the movement or use an alternate movement to release the tension.

In ERP therapy, you work with a therapist to build up resistance in situations that prompt tics.

It’s important to be aware that, while HRT and ERP work well for many people, ADHD can sometimes interfere with the effectiveness of these two therapies.

Because tics can affect self-esteem and social functioning, it might also be a good idea to explore psychotherapy methods that specifically focus on those areas of mental health.

Talk with a healthcare professional about medication

It’s important to talk with a healthcare professional about the symptoms that disrupt your life most. For some people, ADHD symptoms cause bigger problems than mild tics. For people with severe or complex tics and mild ADHD difficulties, treating tic symptoms effectively might be more important.

Some ADHD medications have a positive effect on tics. If tics don’t respond to your ADHD treatment, it may be necessary to try another medication. It may take time to find out which medications and dosages relieve your symptoms best.

Focus on improving your sleep life

For many people, tics get worse — or at least more frequent — when they’re fatigued. Getting a good night’s sleep can make a difference. This can be especially challenging for people with ADHD, since sleep issues are a hallmark of the condition.

Some ADHD medications can help you fall asleep, or you may want to talk with a healthcare professional about adding melatonin to your nighttime routine.

Do what you can to reduce stress and anxiety

Stress and anxiety are known to increase the severity of tics. In fact, tics may have developed as a means of responding to stress. These are all effective ways to lower anxiety and deal with stressful events:

Address trauma recovery

There’s quite a lot of evidence suggesting that tics can develop or worsen as a result of chronic trauma, especially where the genetic “groundwork” for tics is already present.

If trauma has been a factor in your life — especially in childhood, when neural pathways are developing — it’s important to find out more on ways to treat the effects of trauma on your mind and body.

Educate your circle

It’s always important to respect the privacy and boundaries of people in your life who have a health condition. In some cases, it may be a good idea with talk with teachers, coaches, other caregivers, and even peers about a tic disorder, especially when tics are likely to be noticeable.

The Tourette Association of America points out that educating people about a tic disorder can help create a supportive environment.

Some tics resolve on their own over a period of weeks or months. If tics are interfering with your sense of well-being or your ability to function at work, school, home, or in your social life, it’s probably time to discuss them with a healthcare professional.

It’s especially important to seek help if you notice that tics are worsening with a new medication or treatment.

ADHD by itself doesn’t cause tics, but many people with ADHD have another disorder that does cause them. Tic disorders, including Tourette syndrome, can co-exist with ADHD. OCD and autism spectrum conditions frequently occur with ADHD, and these conditions can also cause tics and repetitive movements.

Some health professionals have expressed concern about whether ADHD medications might cause or worsen tics, but the evidence indicates that isn’t the case.

If you or a child in your care are experiencing tics and ADHD, it’s important to talk with a healthcare professional so you can get help for any other condition that may be causing this symptom. You may be able to improve your symptoms with medication, more rest, behavior therapies, and a reduction in your stress levels.