60–80% of patients with Tourette syndrome also have ADHD, and 25–50% have obsessive-compulsive disorder (OCD). This is because all three conditions share dysfunction in the basal ganglia–thalamus–prefrontal cortex circuit. Dopamine deficiency leads to ADHD, while overactivation makes tics more prominent — they can be seen as different expressions of the same circuit. OCD is associated with serotonin imbalance, and when it co-occurs with tics, repetitive behaviors are reinforced. Understanding this overlapping structure explains why treating only tics does not lead to overall improvement in the child. An integrated approach that evaluates all three together is necessary.

Traditional Medicine Perspective

In traditional medicine, stagnation of the liver's energy blocks the flow of qi and disrupts heart function, while deficiency of gallbladder qi causes the person to startle easily and lose concentration. Dongjedang's approach treats tics, ADHD, and OCD as an integrated imbalance of three organs — the liver, gallbladder, and heart — addressing them through a combined prescription.