Atomoxetine for attention deficit hyperactivity disorder in children and adolescents with autism: A systematic review and meta‐analysis

Abstract

Atomoxetine is prescribed to children with autism spectrum disorder having symptoms of attention deficit hyperactivity disorder. We sought to examine the efficacy and safety of atomoxetine in this population. After screening for inclusion criteria, we identified three randomized placebo controlled trials involving 241 children. We assessed internal validity using standard Cochrane Risk of bias tool for randomized controlled trials (RCTs). We used Revman 5.3 for meta‐analysis and GRADE approach to create summary of findings with grading of the quality of evidence. Atomoxetine had a benefit on improving parent‐rated hyperactivity (standardized mean difference [SMD] = −0.73, 95% Confidence Interval, CI = −1.15 to −0.34) and parent‐rated inattention (SMD = −0.53, 95% CI = −0.93 to −0.12) but the magnitude of effects is uncertain. However, atomoxetine was also associated with increased risk of non‐serious adverse effects like nausea and vomiting, decreased sleep, and decreased appetite. Atomoxetine may be effective in improving hyperactivity and inattention in children with autism spectrum disorder and attention deficit hyperactivity disorder. However, we are uncertain about the true effect of this intervention and need more RCTs trials designed to evaluate this. Autism Research 2019, 12: 542–552. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Atomoxetine is prescribed for Attention Deficit Hyperactivity Disorder (ADHD). About a third of children and adolescents with autism also suffer from ADHD. We carried out an analysis of data reported from a specific kind of medication trials which had examined the effectiveness and side effects of atomoxetine in this patient population. We could find only three such trials and analyzed the reported data. Our analysis revealed that atomoxetine is effective in improving symptoms of ADHD like hyperactivity and inattention and also causes side effects like nausea, vomiting, decreased sleep, and decreased appetite. However, the existing data are insufficient to provide a conclusive statement with certainty and more trials are needed for this.

Practitioner Review: Pharmacological treatment of attention‐deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: a systematic review and meta‐analysis

“…In contrast, effects on parent-rated hyperactivity were smaller in the current study compared to the previously published meta-analysis on this topic (Patra et al, 2019). This difference may be due to the inclusion of two additional studies in our meta-analysis of atomoxetine effects on parent-rated hyperactivity in ASD (Harfterkamp et al, 2012(Harfterkamp et al, , 2014McDougle, 2017), whereas our meta-analysis of parent-rated inattention included the same studies submitted to meta-analysis previously (Patra et al, 2019). Based on available evidence, effect sizes for treatment efficacy with atomoxetine were slightly smaller compared to methylphenidate and perhaps less clinically meaningful based on available CGI-I data.…”

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

“…For anti‐ADHD medications, we included three NMAs 49,144,145 , 11 MAs 146‐156 , 12 RCTs 157‐168 also included in those NMA/MAs, five additional RCTs 169‐173 , and five cohort studies 99,174‐177 . There were 148,664 youth on anti‐ADHD medications, including 28,834 across 298 RCTs after eliminating duplicated RCTs in multiple NMA/MAs (27,188 in NMA/MAs, 1,646 in additional RCTs), and 119,830 in five cohort studies.…”

Attention Deficit Hyperactivity Disorder Symptoms in Young Children with Autism Spectrum Disorder

“…Given the elevated rates of ADHD symptoms in ASD, questions arise around treatment options in this young population. There have been multiple studies on medication treatment of ADHD for children with ASD, ages 5 years or above [Ghanizadeh, 2013; Goel, Hong, Findling, & Ji, 2018; Handen, Johnson, & Lubetsky, 2000; Harfterkamp et al, 2012; Jaselskis, Cook, & Fletcher, 1992; Mahajan et al, 2012; Ming, Gordon, Kang, & Wagner, 2008; Patra, Nebhinani, Viswanathan, & Kirubakaran, 2019; Pearson et al, 2013; Politte et al, 2018; Scahill et al, 2015; Sturman, Deckx, & Driel, 2017], and these studies have shown a good clinical efficacy of ADHD medications. There is also a stout body of literature examining clinical efficacy of behavior interventions in all ages of children with ASD and disruptive behaviors [Bearss et al, 2015; Brookman‐Frazee, Stahmer, Baker‐Ericzen, & Tsai, 2006; Masse, McNeil, Wagner, & Quetsch, 2016], which is commonly associated with ADHD.…”