Psychopharmacology for Pediatric Tics and Tourette’s Disorder

Decision-making in the treatment of tics and Tourette’s disorder is complicated, as there is frequent comorbidity with behavioral and emotional disorders, and symptoms tend to wax and wane over time. Disentangling tics from other frequently co-occurring symptoms, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) symptoms, is the first step. Prioritization of symptoms is necessary so that treatment can target those that are causing the most distress and/or functional impairment. Currently, there are only three medications FDA approved for the treatment of tics in the United States, and all are antipsychotics. However, given the potential for significant extrapyramidal and metabolic adverse effects of the antipsychotics, other evidence-based psychosocial or off-label pharmacological treatments are considered first-line. New compounds are currently under investigation.