A prospective open-label trial of long-acting liquid methylphenidate for the treatment of attention deficit/hyperactivity disorder in intellectually capable adults with autism spectrum disorder

Joshi, Gagan; DiSalvo, Maura; Wozniak, Janet; Ceranoglu, Tolga Atilla; Yule, Amy; Surman, Craig; Fried, Roland; Galdo, Maribel; Hoskova, Barbora; Belser, Abigail; Biederman, Joseph

doi:10.1080/15622975.2019.1679392

“…Table 4 Attention-deficit/hyperactivity disorder (ADHD) medication mean doses (mg/day) in 6 months intervals, comparing individuals with ADHD with coexisting autism spectrum disorder (ASD) versus ADHD without coexisting ASD, and stratified analyses by sex, age category (adults/adolescents/children), substance use disorder (SUD), and intellectual disability (ID) Evidence for medical treatment of ADHD in ASD is limited and to our knowledge, there are no previous pharmacoepidemiological studies directly comparing dispenses and doses of ADHD medications in ADHD with or without coexisting ASD. However, most studies within the field conclude that ADHD medications, such as methylphenidate and atomoxetine, have effect on ADHD symptoms in ASD [15,16,19,[23][24][25][26]. Also, clinical guidelines for ADHD treatment recommend that individuals with ADHD and coexisting ASD should be offered the same medication choices as those with ADHD only [6].…”

Section: Discussionmentioning

confidence: 99%

“…Meta-analyses on available randomized clinical trials (RCTs) show that ADHD medications, e.g., methylphenidate [ 13 ], and atomoxetine [ 14 ] improve ADHD symptoms in children and adolescents with ASD. One recent clinical study on adults with ASD showed that methylphenidate was effective [ 15 ]. Yet, some studies showed that ADHD medications were less tolerated in children and adolescents with ASD [ 13 ], and individuals with ASD presented higher discontinuation rates due to side effects such as irritability [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

Johansson

¹

,

Sandin

²

,

Chang

³

et al. 2020

J Neurodevelop Disord

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Background Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD. Methods Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day. Results Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD. Conclusions The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

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“…Evidence for medical treatment of ADHD in ASD is limited and to our knowledge, there are no previous pharmacoepidemiological studies directly comparing dispenses and doses of ADHD medications in ADHD with or without coexisting ASD. However, most studies within the eld conclude that ADHD medications, such as methylphenidate and atomoxetine, have effect on ADHD symptoms in ASD [15,16,19,[23][24][25][26]. Also, clinical guidelines for ADHD treatment recommend that individuals with ADHD and coexisting ASD should be offered the same medication choices as those with ADHD only [6].…”

Section: Discussionmentioning

confidence: 99%

“…methylphenidate [13], and atomoxetine [14] improve ADHD symptoms in children and adolescents with ASD. One recent clinical study on adults with ASD showed that methylphenidate was effective [15]. Yet, some studies showed that ADHD medications were less tolerated in children and adolescents with ASD [13], and individuals with ASD presented higher discontinuation rates due to side effects such as irritability [16].…”

Section: Introductionmentioning

confidence: 99%

Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish Prescribed Drug register

Johansson

¹

,

Sandin

²

,

Chang

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background. Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD.Methods. Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5,012 individuals with ADHD and coexisting ASD, aged between 3 to 80 years. The first treatment episode with ADHD medications (≥2 filled prescriptions within 90 days) and daily doses of methylphenidate during a three-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day.Results. Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR; 0.80, 95% Confidence Interval: 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD.Conclusions. The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

show abstract

“…Evidence for treatment of ADHD in ASD is limited and to our knowledge, there are no previous pharmacoepidemiological studies directly comparing dispenses and doses of ADHD medications in ADHD with or without coexisting ASD. However, most studies within the eld conclude that ADHD medications, such as methylphenidate and atomoxetine, have effect on ADHD symptoms in ASD [15,16,19,[23][24][25][26]. Also, clinical guidelines for ADHD treatment recommend that individuals with ADHD and coexisting ASD should be offered the same medication choices as those with ADHD only [6].…”

Section: Discussionmentioning

confidence: 99%

Medications for Attention-deficit/hyperactivity Disorder in Individuals With or Without Coexisting Autism Spectrum Disorder: Analysis of Data From the Swedish Prescribed Drug Register

Johansson

¹

,

Sandin

²

,

Chang

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background. Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD.Methods. Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5,012 individuals with ADHD and coexisting ASD, aged between 3 to 80 years. The first treatment episode with ADHD medications (≥2 filled prescriptions within 90 days) and daily doses of methylphenidate during a three-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day.Results. Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR; 0.80, 95% Confidence Interval: 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD.Conclusions. The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

show abstract

A prospective open-label trial of long-acting liquid methylphenidate for the treatment of attention deficit/hyperactivity disorder in intellectually capable adults with autism spectrum disorder

Cited by 11 publications

References 28 publications

Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish prescribed drug register

Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish Prescribed Drug register

Medications for Attention-deficit/hyperactivity Disorder in Individuals With or Without Coexisting Autism Spectrum Disorder: Analysis of Data From the Swedish Prescribed Drug Register

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