Tourette’s disorder (TD) is a movement disorder emerging during childhood that causes persistent motor and vocal tics. TD is treated with a variety of medications, but often with an off-label designation.

Since the 2004 FDA black-box warning on all antidepressants for pediatric use, controversy continues over the use of SSRIs and SNRIs in children and adolescents. Both classes of medication are still commonly used for pediatric depressive disorders, anxiety disorders, and obsessive-compulsive disorder.

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Discussing medications with adolescents can be challenging. Because there is so much variation in family structure and the problems that kids and families face, it’s important to maintain some flexibility in how clinicians evaluate adolescents.

In this interview, Dr. Shatkin talks about how the adolescent brain works, and how we can use this understanding to work more effectively in our practices with both adolescents and their parents. There’s a misconception that dopamine equates to pleasure. It’s not pleasure; it’s the promise of pleasure. Dopamine is the idea that something great might happen. And so high dopamine levels drive kids into high-risk situations with high amounts of potential pleasure. This is aggravated by the fact that the frontal cortical areas are not well myelinated yet and not well connected to the limbic system. So, when kids are younger, they have less control over those impulsive drives.

Tic disorders, including Tourette’s, often co-occur with ADHD, OCD, and anxiety disorders. Guanfacine is often tried for all of these conditions. Randomized placebo-controlled trials of immediate release guanfacine have been mixed, with one showing 31% improvement in tics but another showing no significant improvement.

Some studies have indicated that patients with ADHD may be at an increased risk of suicide. While these studies have shown associations between methylphenidate use and suicide, it is not clear whether the stimulant actually causes suicidality or whether patients taking stimulants are suicidal for other reasons.

The post-test for this issue is available for one year after the publication date to subscribers only . By successfully completing the test you will be awarded a certificate for 2 CME credits.

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We’re pleased to introduce Joshua D. Feder, MD, as the new editor-in-chief of the Carlat Child Psychiatry Report. Dr. Feder attended Boston University School of Medicine, and did his internship and psychiatry residency at the Naval Regional Medical Center in San Diego, followed by a child and adolescent psychiatry fellowship at Tripler Army Medical Center in Honolulu.