ADHD & Tourette & Comorbidities with Dr Anthony Rostain

We started the first ADHD program in
Philadelphia in 1987 and about for the first five six years I saw every single
patient that came through I was like the psychiatric consultant, but little by
little I individuated into the role of seeing the ones who had problems with
tics and Tourette’s the ones who were highly
anxious the ones who seemed explosive and had real rages and and mood mood
disorders and then the ones who had the learning disabilities that were really
impairing their ability especially to relate socially, and so little by little
we began to sort of separate what we each did on the team and then eventually
I teamed up with a neurologist and the two of us really focused on the
neuropsychiatric aspects of these various forms of developmental disorder.
Almost anybody and everybody I see now has at least has ADHD with something
else and, I was it’s a time that the first papers came out on comorbidity we
didn’t like the word comorbidity it sounded too morbid but what it really
was speaking to was complexity and how the brain and how the mind works when
you’re not only having trouble focusing and organizing your life but you’re also
having tremendous anxiety about you know how you’re going to succeed in in in
either academics or social situations or when you’re having problems
understanding social cues or when your tics are bothering you and you can’t sit
still and you’re really suppressing and you’re spending all your energy trying
to suppress these tics. It’s about a little bit under 1% and chronic tic
disorders higher than that and so they make up actually interesting is that
about 20% of people with ADHD have had tics at some point and in the treated
samples anyway we see it easily easily in my in my in my practice here easily a
third of them have had at some point tics or chronic motor tics or
vocal tics during their younger lives. Now the best example I can give is that for the
actual tick phenomenon if people don’t know what it’s like is imagine
suppressing a sneeze and trying to you feel the sneeze coming on and you want
to stop but you don’t want to sneeze but you can’t and then you finally sneeze ok
and then you feel better but all that time that you were suppressing the
sneeze you can’t pay attention to what what’s going on around you
you’ve, diverted all your in you know your your attention inwardly.
The other interesting phenomenon is that so that’s another cause of
distractibility in people with this type of tendency. The other is what I call the
sticky brain that when you get an image in there like we’ve all catch a song
in our heads that we like and will sing the song it’ll pop in there you may sing
it once or twice maybe if you really like it you’ll keep singing it for maybe
a minute or two, but my patients tell me that the song keeps coming back over and
over and over and over and they want to turn it off and it won’t turn off. So the
song will come back or the image of a say something they saw and that
frightened them or even an imaginary scenario. If I give the medication to help
they’re focusing like a stimulant they begin at times not all of them tend to
to feel that they have a greater sense of control, and so in the old days when
we first started never never would we give a child with tics a stimulant because
oh you’re gonna make their tips worse then it turns out that only 30% of the time it’s that true and 70% of the time either they don’t get worse or they get
better. So what we’re trying to do now is really cut down, we’ve gone away from
treating the tics unless they’re life-threatening or severely impairing
and now we focus a lot more on treating the attentional problems, treating the
anxiety and the obsessional tendencies and treating some of the rage and mood
mood disorder problems that we see. Thanks for watching and I want to give a
huge shout out (YELLS) well I guess no you don’t actually have to shout. I wanted to thank
all of our Patreon supporters you’re the ones
who make all of this possible… well that lamp we already had before we started, but
everything else pretty much.. the table was actually my mothers it was an old but
I don’t know these pens I think my wife…

About the author


  1. I know, what Tourette‘s is…but what exactly makes something a ‚tick‘ outside of Tourette’s? Is it a ‚tick‘, when I feel like I have to crack my knuckles to release tension, for example? Since you mentioned things like ‚clearing your throat‘? I‘m a little confused, about the difference between a ‚tick‘ and just a ‚habit‘, I guess.

  2. Does anyone know if restless leg syndrome counts as a tic? It sounds similar to the sneeze explanation…I have to move my leg and supressing it feels like trying to stop a sneeze

  3. I never looked at the things i do as tics.. wow. Legs moving up and down, skin picking on my thumbs, sniffing if i dont need to, blinking, looking around at random things. I could go on

  4. I wonder if the way i feel sometimes has to do with it…. i willhave this uncanny urge to like just yell out of nowhere. Ive had it for as long asi can remember

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