***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The treatment of children with attention deficit hyperactivity disorder ( ADHD ) and Tourette syndrome ( TS ) has been problematic because methylpheni date (MPH)—the most commonly used drug to treat ADHD — has been reported to worsen tics and because clonidine (CLON)—the most commonly prescribed alternative — has unproven efficacy . Methods The authors conducted a multicenter , r and omized , double-blind clinical trial in which 136 children with ADHD and a chronic tic disorder were r and omly administered CLON alone , MPH alone , combined CLON + MPH , or placebo ( 2 × 2 factorial design ) . Each subject participated for 16 weeks ( weeks 1–4 CLON/placebo dose titration , weeks 5–8 added MPH/placebo dose titration , weeks 9–16 maintenance therapy ) . Results Thirty-seven children were administered MPH alone , 34 were administered CLON alone , 33 were administered CLON + MPH , and 32 were administered placebo . For our primary outcome measure of ADHD ( Conners Abbreviated Symptom Question naire – Teacher ) , significant improvement occurred for subjects assigned to CLON ( p < 0.002 ) and those assigned to MPH ( p < 0.003 ) . Compared with placebo , the greatest benefit occurred with combined CLON + MPH ( p < 0.0001 ) . CLON appeared to be most helpful for impulsivity and hyperactivity ; MPH appeared to be most helpful for inattention . The proportion of individual subjects reporting a worsening of tics as an adverse effect was no higher in those treated with MPH ( 20 % ) than those being administered CLON alone ( 26 % ) or placebo ( 22 % ) . Compared with placebo , measured tic severity lessened in all active treatment groups in the following order : CLON + MPH , CLON alone , MPH alone . Sedation was common with CLON treatment ( 28 % reported moderate or severe sedation ) , but otherwise the drugs were tolerated well , including absence of any evident cardiac toxicity . Conclusions Methylpheni date and clonidine ( particularly in combination ) are effective for ADHD in children with comorbid tics . Prior recommendations to avoid methylpheni date in these children because of concerns of worsening tics are unsupported by this trial Objective : To test the hypothesis that atomoxetine does not significantly worsen tic severity relative to placebo in children and adolescents with attention deficit/hyperactivity disorder ( ADHD ) and comorbid tic disorders . Methods : Study subjects were 7 to 17 years old , met Diagnostic and Statistical Manual of Mental Disorders – IV criteria for ADHD , and had concurrent Tourette syndrome or chronic motor tic disorder . Patients were r and omly assigned to double-blind treatment with placebo ( n = 72 ) or atomoxetine ( 0.5 to 1.5 mg/kg/day , n = 76 ) for up to 18 weeks . Results : Atomoxetine treatment was associated with greater reduction of tic severity at endpoint relative to placebo , approaching significance on the Yale Global Tic Severity Scale total score ( –5.5 ± 6.9 vs –3.0 ± 8.7 , p = 0.063 ) and Tic Symptom Self-Report total score ( –4.7 ± 6.5 vs –2.9 ± 5.2 , p = 0.095 ) and achieving significance on the Clinical Global Impressions ( CGI ) tic/neurologic severity scale score ( –0.7 ± 1.2 vs –0.1 ± 1.0 , p =  0.002 ) . Atomoxetine patients also showed greater improvement on the ADHD Rating Scale total score ( –10.9 ± 10.9 vs –4.9 ± 10.3 , p < 0.001 ) and CGI severity of ADHD/psychiatric symptoms scale score ( –0.8 ± 1.1 vs –0.3 ± 1.0 , p = 0.015 ) . Discontinuation rates were not significantly different between treatment groups . Atomoxetine patients had greater increases in heart rate and decreases of body weight , and rates of treatment-emergent decreased appetite and nausea were higher . No other clinical ly relevant treatment differences were seen in any other vital sign , adverse event , or electrocardiographic or laboratory measures . Conclusions : Atomoxetine did not exacerbate tic symptoms . Rather , there was some evidence of reduction in tic severity with a significant reduction of attention deficit/hyperactivity disorder symptoms . Atomoxetine treatment appeared safe and well tolerated BACKGROUND Current pharmacological treatments for Tourette Syndrome ( TS ) , such as antipsychotic agents and α-2 agonists , are moderately effective in the treatment of tics , but have substantial side effects that limit their use . N-acetylcysteine ( NAC ) modulates glutamatergic systems , and has been used safely as an antioxidant agent with minimal side effects for decades . NAC has been increasingly studied for the treatment of other obsessive-compulsive spectrum disorders . We aim to examine the efficacy of NAC for the treatment of pediatric TS in a double-blind , placebo-controlled , add-on study . METHODS Thirty-one children and adolescents 8 - 17 years of age with TS were r and omly assigned to receive NAC or matching placebo for 12 weeks . Our primary outcome was change in severity of tics as measured by the Yale Global Tic Severity Scale ( YGTSS ) , Total tic score . Secondary measures assessed comorbid obsessive-compulsive disorder ( OCD ) , depression , anxiety , and attention-deficit/hyperactivity disorder ( ADHD ) . Linear mixed models in SAS were used to examine differences between NAC and placebo . RESULTS Of 31 r and omized subjects , 14 were assigned to placebo ( two females ; 11.5 + 2.8 years ) and 17 to active NAC ( five females ; 12.4 + 1.4 years ) treatment . No significant difference between NAC and placebo was found in reducing tic severity or any secondary outcomes . CONCLUSIONS We found no evidence for efficacy of NAC in treating tic symptoms . Our findings st and in contrast to studies suggesting benefits of NAC in the treatment of other obsessive-compulsive spectrum disorders in adults , including OCD and trichotillomania , but are similar to a recent placebo-controlled trial of pediatric trichotillomania that found no benefit of NAC Talipexole is a new dopamine autoagonist with putative preferential activity on presynaptic dopamine receptors . In a double-blind , placebo-controlled study , we tested the drug 's safety and efficacy in 13 adult men with Gilles de la Tourette 's syndrome . The drug was poorly tolerated because of clinical ly significant sedation and dizziness . Tics did not improve at tolerable doses . These findings suggest that talipexole has no role in the regular management of tic disorders BACKGROUND Tic disorders , in particular chronic tic disorder and Tourette syndrome , affect about 1 % of the population . The current treatment of choice is pharmacological or behavioural , addressing tics or the premonitory urges preceding tic onset . AIMS The current study reports an open trial evaluating the effectiveness of a cognitive psychophysiological treatment addressing Tourette-specific sensorimotor activation processes rather than the tic . METHOD Forty-nine people with Tourette syndrome and 36 people with chronic tics completed 10 weeks of individual cognitive psychophysiological therapy . Outcome measures included two tic severity scales and psychosocial measures . RESULTS Post-treatment both groups had significantly improved on the tic scales with strong effect sizes across tic locations and complex and simple tics , maintained at 6-month follow-up with further change in perfectionism and self-esteem . CONCLUSIONS The cognitive psychophysiological approach targeting underlying sensorimotor processes rather than tics in Tourette 's and chronic tic disorder reduced symptoms with a large effect size BACKGROUND Dopamine agonists could theoretically normalize the suspected central dopamine hypersensitivity in Tourette 's syndrome . METHODS There was a multicenter r and omized , placebo-controlled , double-blind clinical trial of pramipexole given for 6 weeks in 63 children and adolescents with Tourette 's syndrome . RESULTS There were no significant differences in the adjusted mean change in the Total Tic Score of the Yale Global Tic Severity Scale for patients treated with pramipexole ( -7.16 ) and placebo ( -7.17 ) . There were no significant treatment effects on change from baseline in the Global Severity score of the Yale Scale and parent- and investigator-scored Clinical Global Impression of Improvement . In patients with attention deficit hyperactivity disorder , there was improvement in DuPaul ADHD scale scores for patients receiving pramipexole compared with placebo . CONCLUSIONS There was no evidence that pramipexole has efficacy in suppressing tics .  Pramipexole may decrease symptoms of associated attention deficit hyperactivity disorder Clonidine has been suggested to be effective in Gilles de la Tourette 's syndrome ( GTS ) , but no double‐blind study has ever evaluated its effects using objective measures . Thirty patients with GTS completed a 6‐month placebo‐controlled crossover study of the effectiveness of clonidine . Videotapes were obtained at each 3‐week visit and were evaluated r and omly at the end of the study for distribution , frequency , and severity of motor and vocal tics . Quantifiable psychometric examinations were performed as well . The use of clonidine did not significantly ( p < 0.05 ) reduce motor tics , vocalizations , or behavior . The effect of a low dose ( 0.0075 mg/kg/day ) was no different from that of a high dose ( 0.015 mg/kg/day ) ; children 's responses were no different from adults ' ; and those also receiving neuroleptic agents showed the same lack of efficacy as seen in patients on no other medication . Dosing schedule did not affect the objective ratings ; scores from clonidine given twice a day were equivalent to those for three times a day There are some uncontrolled studies about the efficacy and safety of both aripiprazole and risperidone for treating tic disorder . Moreover , the efficacy of these medications has never been compared . This is the first double blind r and omized clinical trial comparing the safety and efficacy of aripiprazole and risperidone for treating patients with tic disorder . Sixty children and adolescents with tic disorder were r and omly allocated into one of the two groups to receive either aripiprazole or risperidone for 2 months . The primary outcome measure was the score of Yale Global Tic Severity Scale . In addition , health related quality of life and adverse events were assessed . Both aripiprazole and risperidone decreased the Yale Global Tic Severity Scale score during this trial . Moreover , both medications increased the health related quality of life score . Both aripiprazole and risperidone were tolerated well .  Aripiprazole [ 3.22 ( 1.9 ) mg/day ] decreased tic score as much as risperidone [ 0.6 ( 0.2 ) mg/day ] . Their adverse effects and their effects on health related quality of life were comparable . However , risperidone increased the patients ’ social functioning more than aripiprazole in short term This clinical guideline provides recommendations for the behavioural and psychosocial interventions ( BPI ) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome ( ESSTS ) . A systematic literature search was conducted to obtain an up date on the efficacy of BPI for tics . Relevant studies were identified using computerised search es of the Medline and PsycINFO data bases and the Cochrane Library for the years 1950–2010 . The search identified no meta-analyses , yet twelve ( systematic ) review s and eight r and omised controlled trials provided evidence for the current review . Most evidence was found for habit reversal training ( HRT ) and the available but smaller evidence also supports the efficacy of exposure with response prevention ( ERP ) . Both interventions are considered first line behavioural treatments for tics for both children and adults and should be offered to a patient , taking into account his preference . Treatments that are considered second line or add-on behavioural treatments are  contingency management , function based interventions and relaxation training . Neurofeedback is still experimental . Almost no research was identified that examined the efficacy of psychosocial interventions , e.g. , psychoeducation and group work . Based on clinical practice , this guideline recommends behavioural treatment as first line offer to patients in most cases . It should be embedded within a psychoeducational and supportive context and can be combined with drug treatment Objective : To evaluate the efficacy and safety of risperidone in children and adults with Tourette syndrome . Methods : This was an 8-week , r and omized , double-blind , placebo-controlled trial . The primary outcome measure was the Total Tic score of the Yale Global Tic Severity Scale ( YGTSS ) . Results : Thirty-four medication-free subjects ( 26 children and 8 adults ) ranging in age from 6 to 62 years ( mean = 19.7 ± 17.0 years ) participated . YGTSS Total Tic scores were similar at baseline ( 26.0 ± 5.1 for risperidone vs 27.4 ± 8.5 for placebo ) . After 8 weeks of treatment ( mean daily dose of 2.5 ± 0.85 ) , the  
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Typical antipsychotic agents were associated with severer side-effects than alpha-2 adrenergic agonist agents .
In summary , alpha-2 adrenergic agonist agents were associated with the optimal weigh between efficacy and safety .