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Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study.
Child Care Health Dev. 2006 Sep; 32(5):575-83.CC

Abstract

BACKGROUND

In the recent past, psychiatrists and paediatricians have avoided prescribing stimulant medication, such as methylphenidate and dexamphetamine to patients with autism spectrum disorders (ASD) because of both doubts about efficacy and concern that these medications make stereotypies worse. Recently, a number of small trials have suggested that methyphenidate does have a role in the management of hyperactivity in children with autistic spectrum disorders.

METHODS

Children with ASD and attention deficit hyperactivity disorder (ADHD), and children with ADHD without ASD received standard treatment with methyphenidate from one specialist centre. A combination of standardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospective study of a further 52 children to be carried out.

RESULTS

After treatment with stimulants, the subjects in both groups showed statistically significant improvements in target symptoms of 'hyperactivity', 'impulsivity', 'inattention', 'oppositionality', 'aggression' and 'intermittent explosive rage'. The Clinical Global Impression-Improvement and efficacy index measures also improved in each group. In both the retrospective and the prospective studies, there was no statistically significant difference in the degree of improvements between each group. Importantly, neither tics nor repetitive behaviours worsened in either group. Children in the 'ADHD-only' group who were prescribed stimulants experienced significant 'nausea', 'giddiness', 'headaches' and 'sleep difficulties', whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group.

CONCLUSIONS

Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone. Although randomized controlled trials remain the gold standard for efficacy studies, systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play. Furthermore, such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials.

Authors+Show Affiliations

Department of Psychological Medicine, St Thomas' Hospital, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16919137

Citation

Santosh, P J., et al. "Impact of Comorbid Autism Spectrum Disorders On Stimulant Response in Children With Attention Deficit Hyperactivity Disorder: a Retrospective and Prospective Effectiveness Study." Child: Care, Health and Development, vol. 32, no. 5, 2006, pp. 575-83.
Santosh PJ, Baird G, Pityaratstian N, et al. Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Child Care Health Dev. 2006;32(5):575-83.
Santosh, P. J., Baird, G., Pityaratstian, N., Tavare, E., & Gringras, P. (2006). Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Child: Care, Health and Development, 32(5), 575-83.
Santosh PJ, et al. Impact of Comorbid Autism Spectrum Disorders On Stimulant Response in Children With Attention Deficit Hyperactivity Disorder: a Retrospective and Prospective Effectiveness Study. Child Care Health Dev. 2006;32(5):575-83. PubMed PMID: 16919137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. AU - Santosh,P J, AU - Baird,G, AU - Pityaratstian,N, AU - Tavare,E, AU - Gringras,P, PY - 2006/8/22/pubmed PY - 2007/3/30/medline PY - 2006/8/22/entrez SP - 575 EP - 83 JF - Child: care, health and development JO - Child Care Health Dev VL - 32 IS - 5 N2 - BACKGROUND: In the recent past, psychiatrists and paediatricians have avoided prescribing stimulant medication, such as methylphenidate and dexamphetamine to patients with autism spectrum disorders (ASD) because of both doubts about efficacy and concern that these medications make stereotypies worse. Recently, a number of small trials have suggested that methyphenidate does have a role in the management of hyperactivity in children with autistic spectrum disorders. METHODS: Children with ASD and attention deficit hyperactivity disorder (ADHD), and children with ADHD without ASD received standard treatment with methyphenidate from one specialist centre. A combination of standardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospective study of a further 52 children to be carried out. RESULTS: After treatment with stimulants, the subjects in both groups showed statistically significant improvements in target symptoms of 'hyperactivity', 'impulsivity', 'inattention', 'oppositionality', 'aggression' and 'intermittent explosive rage'. The Clinical Global Impression-Improvement and efficacy index measures also improved in each group. In both the retrospective and the prospective studies, there was no statistically significant difference in the degree of improvements between each group. Importantly, neither tics nor repetitive behaviours worsened in either group. Children in the 'ADHD-only' group who were prescribed stimulants experienced significant 'nausea', 'giddiness', 'headaches' and 'sleep difficulties', whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group. CONCLUSIONS: Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone. Although randomized controlled trials remain the gold standard for efficacy studies, systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play. Furthermore, such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials. SN - 0305-1862 UR - https://www.unboundmedicine.com/medline/citation/16919137/Impact_of_comorbid_autism_spectrum_disorders_on_stimulant_response_in_children_with_attention_deficit_hyperactivity_disorder:_a_retrospective_and_prospective_effectiveness_study_ L2 - https://doi.org/10.1111/j.1365-2214.2006.00631.x DB - PRIME DP - Unbound Medicine ER -