Youths with ADHD with and without tic disorders: comorbid psychopathology, executive function and social adjustment.
Kids who have ADHD plus tics show more anxiety yet fewer school peer problems and no added executive-function deficits compared with ADHD alone.
01Research in Context
What this study did
Lin et al. (2012) compared three groups of youths: ADHD alone, ADHD plus tic disorders, and neurotypical kids.
They looked at anxiety, executive-function skills, and how well each child got along with peers at school.
The design was quasi-experimental: kids were already in clinics, not randomly placed.
What they found
The ADHD+tics group carried more anxiety disorders than the ADHD-only group.
Surprise: these same kids had fewer peer problems and less school conflict than the ADHD-only group.
Tics did not add extra executive-function burden; both ADHD groups scored alike on EF tests.
How this fits with other research
Guttmann-Steinmetz et al. (2010) saw the same higher anxiety in ADHD+tics two years earlier, but they only studied boys and used parent/teacher ratings. Yu-Ju widened the lens to both genders and added EF data.
Ingadottir et al. (2025) extends the idea by swapping tics for autism. They found ADHD+ASD youths had stronger perceptual reasoning than ADHD-only, echoing the pattern that a second diagnosis does not always mean worse cognition across the board.
Al-Yagon et al. (2022) showed poorer EF in teens with ADHD versus typical peers. Yu-Ju agrees ADHD hurts EF, but adds that tics on top do not deepen that hurt.
Why it matters
When you see a client with both ADHD and tics, plan for more anxiety supports, but do not assume extra executive-function training is needed. The social silver lining—fewer peer conflicts—means you can lean into group activities instead of shielding the child. Check for anxiety first, then use the same EF strategies you would for any student with ADHD.
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02At a glance
03Original abstract
Attention deficit/hyperactivity disorder (ADHD) and tic disorders (TD) commonly co-occur. Clarifying the psychiatric comorbidities, executive functions and social adjustment difficulties in children and adolescents of ADHD with and without TD is informative to understand the developmental psychopathology and to identify their specific clinical needs. This matched case-control study compared three groups (n=40 each) of youths aged between 8 and 16 years: ADHD with co-occurring TD (ADHD+TD), ADHD without TD (ADHD-TD) and typically developing community controls. Both ADHD groups had more co-occurring oppositional defiant disorder than the control group, and the presence of TD was associated with more anxiety disorders. TD did not impose additional executive function impairments or social adjustment difficulties on ADHD. Interestingly, for youths with ADHD, the presence of TD was associated with less interpersonal difficulties at school, compared to those without TD. The potential various directions of effects from co-occurring TD should be carefully evaluated and investigated for youths with ADHD.
Research in developmental disabilities, 2012 · doi:10.1016/j.ridd.2012.01.001