Talks
Presenting Author Academic/Professional Position
Psychiatry Resident
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Psychiatry
Discipline Track
Patient Care
Abstract Type
Research/Clinical
Abstract
Background: The prevalence of chronic and transient tic disorders in children with neurodevelopmental delays is substantially higher than in the general pediatric population. Disorders including Tourette’s Syndrome, Chronic Persistent Motor Tic Disorder or Provisional Tic Disorder, can present challenges in treatment when comorbid neurodevelopmental disorders. Children with Autism Spectrum Disorder (ASD), Down’s Syndrome or other developmental delays may not be able to participate in first-line behavioral interventions like CBIT (Comprehensive Behavioral Intervention for Tics) therapy. Therefore, optimization of pharmacologic treatment is often necessary in this population, especially in the case of severe, refractory tics. Additionally, pharmacologic treatment can be even further complicated due to communication limitations and heightened sensitivity to medication side effects in this vulnerable population.
Objective: To summarize and evaluate current literature on the treatment of tic disorders in children and adolescents with co-occurring neurodevelopmental disorders.
Methods: A narrative review of peer-reviewed literature was conducted, focusing on studies involving tic disorder treatment in pediatric patients with neurodevelopmental disorders.
Results: Behavioral interventions such as Comprehensive Behavioral Intervention for Tics (CBIT) are considered first-line for tic disorder, but often have limited applicability in patients with cognitive, behavioral and language impairments. Among pharmacologic options, alpha-2 adrenergic agonists (clonidine, guanfacine) offer a favorable side-effect profile and have demonstrated moderate efficacy, making them suitable for medically complex children. Atypical antipsychotics (notably risperidone and aripiprazole) show robust efficacy in tic reduction, especially refractory tics, but are associated with metabolic, anti-cholinergic and extrapyramidal side effects. These side effect concerns are amplified in patients with neurodevelopmental disabilities.
Preliminary trials of non-dopaminergic agents (e.g., topiramate, baclofen) and VMAT2 inhibitors (e.g., deutetrabenazine) suggest potential benefit, but pediatric safety data remain limited. There has also been exploration of anxiety as a driving exacerbating factor of underlying tic disorders, especially in patients with autism, IDD and Down’s Syndrome due to difficulties in expressive language and communication of these anxiety symptoms. As such, there has been evidence for using SSRIs, SNRIs and anxiolytics to address anxiety-driven tics, with particular evidence for buspirone being significantly effective in children with Down’s syndrome and potentially other neurodevelopmental or genetic disorders.
Conclusion: In children with neurodevelopmental disorders, psychotropic medications may be the mainstay for treatment of tic disorders due to an inability of this population to participate in behavioral interventions. However, there remains a substantial need for research on tic disorder management in these patients. Currently, trials of alpha-2 agonists followed by second-generation antipsychotics have the most evidence as the primary framework for tics. If tics remain refractory, there is emerging evidence for some non-dopaminergic agents, VMAT-2 inhibitors and anxiolytic drugs to reduce and control symptom severity and control. These findings suggest a need for further exploration and clinical trials of pharmacologic treatment of refractory tics in patients with comorbid neurodevelopmental disorders
Presentation Type
Talk
Recommended Citation
Ahmad, Faiza, "Treatment of Tics in Pediatric Patients with Neurodevelopmental Disorders" (2025). Research Colloquium. 3.
https://scholarworks.utrgv.edu/colloquium/2025/talks/3
Treatment of Tics in Pediatric Patients with Neurodevelopmental Disorders
Background: The prevalence of chronic and transient tic disorders in children with neurodevelopmental delays is substantially higher than in the general pediatric population. Disorders including Tourette’s Syndrome, Chronic Persistent Motor Tic Disorder or Provisional Tic Disorder, can present challenges in treatment when comorbid neurodevelopmental disorders. Children with Autism Spectrum Disorder (ASD), Down’s Syndrome or other developmental delays may not be able to participate in first-line behavioral interventions like CBIT (Comprehensive Behavioral Intervention for Tics) therapy. Therefore, optimization of pharmacologic treatment is often necessary in this population, especially in the case of severe, refractory tics. Additionally, pharmacologic treatment can be even further complicated due to communication limitations and heightened sensitivity to medication side effects in this vulnerable population.
Objective: To summarize and evaluate current literature on the treatment of tic disorders in children and adolescents with co-occurring neurodevelopmental disorders.
Methods: A narrative review of peer-reviewed literature was conducted, focusing on studies involving tic disorder treatment in pediatric patients with neurodevelopmental disorders.
Results: Behavioral interventions such as Comprehensive Behavioral Intervention for Tics (CBIT) are considered first-line for tic disorder, but often have limited applicability in patients with cognitive, behavioral and language impairments. Among pharmacologic options, alpha-2 adrenergic agonists (clonidine, guanfacine) offer a favorable side-effect profile and have demonstrated moderate efficacy, making them suitable for medically complex children. Atypical antipsychotics (notably risperidone and aripiprazole) show robust efficacy in tic reduction, especially refractory tics, but are associated with metabolic, anti-cholinergic and extrapyramidal side effects. These side effect concerns are amplified in patients with neurodevelopmental disabilities.
Preliminary trials of non-dopaminergic agents (e.g., topiramate, baclofen) and VMAT2 inhibitors (e.g., deutetrabenazine) suggest potential benefit, but pediatric safety data remain limited. There has also been exploration of anxiety as a driving exacerbating factor of underlying tic disorders, especially in patients with autism, IDD and Down’s Syndrome due to difficulties in expressive language and communication of these anxiety symptoms. As such, there has been evidence for using SSRIs, SNRIs and anxiolytics to address anxiety-driven tics, with particular evidence for buspirone being significantly effective in children with Down’s syndrome and potentially other neurodevelopmental or genetic disorders.
Conclusion: In children with neurodevelopmental disorders, psychotropic medications may be the mainstay for treatment of tic disorders due to an inability of this population to participate in behavioral interventions. However, there remains a substantial need for research on tic disorder management in these patients. Currently, trials of alpha-2 agonists followed by second-generation antipsychotics have the most evidence as the primary framework for tics. If tics remain refractory, there is emerging evidence for some non-dopaminergic agents, VMAT-2 inhibitors and anxiolytic drugs to reduce and control symptom severity and control. These findings suggest a need for further exploration and clinical trials of pharmacologic treatment of refractory tics in patients with comorbid neurodevelopmental disorders
