Medication use and treatment patterns in children and adolescents with chronic tic disorders: an EMTICS study

The treatment of tic disorders in children and adolescents poses significant challenges, especially when comorbid conditions such as obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) are present. Pharmacological treatments are often guided by clinical judgment, prescriber preferences, and medication availability. This study describes pharmacological treatment use in a large cohort of children and adolescents with chronic tic disorders (CTDs). We analyzed baseline data from the European Multicenter Tics in Children Study (EMTICS) to examine associations between medication use, tic severity, and psychiatric comorbidities, using parent-reported questionnaires and clinical interviews to assess tics, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and children's self-rated premonitory urges. Among 709 children aged 3-16 years with CTDs, 230 (32%) received any pharmacological treatment, 22% received antipsychotics and 10% received ADHD medications, with limited use of alpha-2 agonists (3%). Medication use was more common among individuals with comorbid ADHD (54%) than those with CTD only (23%) or comorbid OCD only (26%). Those on tic-suppressing medications had significantly greater severity of tics, tic-related impairment, and comorbid ADHD, ODD, and obsessive symptom severity compared to those with non-tic-suppressing medications. There was no relationship with the severity of compulsions or premonitory urges. While largely consistent with published guidelines, these findings indicate limited utilization of recommended agents, such as alpha-2 agonists, alongside higher reported symptom severity among those receiving tic-suppressing medications. Further studies should explore the integration of pharmacological, behavioral, and psychoeducational approaches tailored to comorbidity profiles and symptom severity.