22 Missed diagnosis of ADHD in children referred to a tic disorder clinic

Abstract

Aim To examine whether Attention Deficit Hyperactive Disorder (ADHD), a common comorbid disorder in Tourette’s Syndrome (TS) patients, is often missed by physicians referring to a Tic Disorder Clinic. Method Referral letters and first clinic attendance reports for 119 new patients aged between 4–17 that attended a national tic disorder clinic between 2015–2017 were analysed to see how many new diagnoses of ADHD were made at first consultation that were not included in the referral letters. Other variables that were noted for each patient included age, sex, if referrer had a suspicion of ADHD (rather than established or firm diagnosis), medication for ADHD and the main treatment target decided at the tic disorder clinic. Results Out of 119 patients 13 (11%) already had a diagnosis of ADHD, which is in line with the prevalence of comorbid ADHD in the general population but not with the known increased prevalence in patients with TS (up to 80% in some studies). The assessment at the Tic Disorder Clinic found 46 cases of ADHD (38%). Referrals were from pediatricians (51%), general practitioners (35%) and from mental health services (10%). Conclusions As the prevalence of comorbid ADHD is high in Tourette’s patients and this can sometimes be obscured by the presentation of the tic disorder, referrers should have a low threshold for suspecting and managing ADHD in cases where specialist input for tics is awaited. It is likely that CAMHS referrals were under-represented in the sample and it may be expected that prior ADHD diagnoses would be more likely from that source.