THE TREATMENT OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER IN TOURETTES-SYNDROME - A DOUBLE-BLIND PLACEBO-CONTROLLED STUDY WITH CLONIDINE AND DESIPRAMINE

Objectives. Because psychostimulants can exacerbate preexisting motor/ phonic ties in individuals with Tourette's syndrome (TS), a clinical t rial was performed to examine the ability of clonidine and desipramine to modify attention-deficit hyperactivity disorder (ADHD) behaviors i n children with TS + ADHD. Methods. A double-blind, placebo-controlled protocol was used in which each subject served as his or her own cont rol and received, in a randomly assigned fashion, 6-week medication cy cles with clonidine (0.05 mg four times daily), desipramine (25 mg fou r times daily), and placebo. Results. Thirty-seven children with TS ADHD between the ages 7 to 13 years and of normal intellect were recru ited, and 34 (31 males, 3 females) completed the entire protocol. Outc ome measures for ADHD included Parent and Teacher Child Behavior Check lists (CBCL), continuous performance tests, and neuropsychologic tests of executive function. Several markers for ADHD were shown to improve significantly (P < .05) after treatment with desipramine (parent line ar analogue rating, parent CBCL ''hyperactivity'' subscale, and teache r CBCL subscales ''nervous/overactive,'' ''anxious,'' and ''unpopular' '). Improvement with desipramine was always superior to that noted wit h clonidine. Clinical improvement did not correlate with drug blood le vels. On measures of tic severity, neither drug made ties worse. Desip ramine showed a statistically significant improvement on a global line ar analogue scale, but not on the Hopkins Motor/Vocal Tic Severity Sca le, the Tourette Syndrome Severity Scale, or the Yale Global Tic Sever ity Scale. Clonidine did not significantly alter tic severity on any m easure. Conclusion. The results of this study suggest that desipramine may be a useful alternative for the treatment of symptoms of ADHD in children with TS.