Pharmacotherapy of attention deficit/hyperactivity disorder in individuals with autism spectrum disorder: A systematic review of the literature

Abstract

Aim: To assess the empirical evidence for the treatment of attention deficit/hyperactivity disorder (ADHD) in populations with autism spectrum disorder (ASD). Methods: A systemic PubMed, PsychINFO, Embase, and Medline database search of peer-reviewed literature was conducted. Included in the review were controlled trials published in English with sample sizes ⩾10 participants examining the safety and efficacy of anti-ADHD medication in ASD populations. Data was extracted on relevant variables of study design, demographics, associated psychopathology, medication dose, efficacy, and tolerability. Results: Nine controlled trials met the inclusion and exclusion criteria: five with methylphenidate, three with atomoxetine, and one with guanfacine. Sample sizes ranged from 10 to 128 with 430 children participating across all the trials. In all the trials, treatment response was significantly superior to placebo. However, almost all trials assessed only hyperactivity, and most included only participants with intellectual disability with high levels of irritability. None of the trials distinguished agitation from hyperactivity. The response on hyperactivity for methylphenidate and atomoxetine was less than that observed in the neurotypical population; however, the response for guanfacine surpassed results observed in neurotypical populations. Treatment-emergent mood lability (i.e. mood dysregulation and mood-related adverse events) was frequently associated with methylphenidate and guanfacine treatments. Worse treatment outcomes were associated with individuals with lower intellectual capability compared with those with higher IQs. Conclusions: here is a scarcity of controlled trials examining ADHD treatments in ASD populations, particularly in intellectually capable individuals with ASD and in adults. Response to ADHD medications in ASD were adversely moderated by the presence of intellectual disability and mood lability.

Case report: Treatment of persistent atypical odontalgia with attention deficit hyperactivity disorder and autism spectrum disorder with risperidone and atomoxetine

“…The final dose of ATX in this case was 120 mg/day, which was at the acceptable upper end of the adult ATX dosage range (37). Pediatric study has shown that atomoxetine for ADHD with comorbid ASD produced gastrointestinal side effects in most cases (38), but no significant side effects were observed in this case.…”

Five Ways Providers Can Improve Mental Healthcare for Autistic Adults: A Review of Mental Healthcare Use, Barriers to Care, and Evidence-Based Recommendations

“…When describing how CBT didn’t work for them, one autistic adult said, “[the provider] expected me to be neurotypical, so I would take things too literally and they thought it was a defense mechanism, or I’d try to explain meltdowns and they focused on my thoughts rather than how to deal with over-reactive sensory perception [ 14 ••].” Other autistic adults may have difficulty with receptive and/or expressive language; one parent of an autistic adult described how their son “gets overwhelmed with too much verbal input” and, as a result, was discharged from mental healthcare that relied heavily on group therapy and talking [ 40 ] . Traditional pharmacotherapy approaches for managing conditions such as ADHD or obsessive–compulsive disorder (OCD) may be less effective for some autistic people [ 21 , 41 ]. Consideration of different medications or types of therapy in these situations is essential for success.…”

“…Other autistic adults may have difficulty with receptive and/or expressive language; one parent of an autistic adult described how their son "gets overwhelmed with too much verbal input" and, as a result, was discharged from mental healthcare that relied heavily on group therapy and talking [40]. Traditional pharmacotherapy approaches for managing conditions such as ADHD or obsessivecompulsive disorder (OCD) may be less effective for some autistic people [21,41]. Consideration of different medications or types of therapy in these situations is essential for success.…”

Guanfacine for Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and/or Oppositional Defiance Disorder

“…Systematic reviews in which all relevant studies were captured in other more recent or more comprehensive systematic reviews were excluded. [6][7][8][9][10][11][12][13][14] Primary studies retrieved by the search were excluded if they were captured in 1 or more included systematic reviews. 15 Guidelines with unclear methodology were also excluded.…”