Methylphenidate in Autism Spectrum Disorder: A Long-Term Follow Up Naturalistic Study

Abstract

Autism spectrum disorder (ASD) often co-occurs with attention deficit/hyperactivity disorder (ADHD). Although methylphenidate (MPH) efficacy and safety are well-demonstrated for ADHD, evidences are scant in the context of ASD. This naturalistic study aimed to analyze long-term MPH efficacy and safety in 40 ADHD children and adolescents with comorbid ASD, comparing them with 40 ones affected by ADHD without ASD. Treatment lasted from 6 to 156 months (longer than 24 months in more than three quarters of patients). Efficacy and safety were measured by clinical global impression and children global assessment scales; influence of intellectual functioning was examined. Comparisons between groups were made by Wilcoxon or Friedmann tests; relationships between functioning scores and other characteristics were analyzed by ordinal logistic and linear regression. Results demonstrated that MPH in patients with ASD was associated with significative reduction of illness severity, clinical improvement and amelioration of global functioning, without significant differences with patients having ADHD without ASD. The trend of reduction of illness severity and increase of global functioning were favorably related with intellectual functioning. No serious adverse events were reported. The findings showed that long-term MPH was effective and well-tolerated in ADHD children and adolescents with comorbid high functioning ASD.

The effect of autistic traits on response to and side-effects of pharmacological ADHD treatment in children with ADHD: results from a prospective clinical cohort

“…In children with ADHD without ASD, Jensen et al reported considerably lower discontinuation rates: 1.4% [16]. On the contrary, a recent study from Ventura et al, did not find a significant difference in discontinuation rates between ADHD patients and ADHD + ASD patients [31]. However, adherence rate was preserved by strictly monitored follow-up.…”

Emotional and sensory dysregulation as a possible missing link in attention deficit hyperactivity disorder: A review

“…Acute and chronic MPH administration has beneficial effects on ADHD symptomatology (Dougherty et al, 2016;Pliszka et al, 2017;Karci et al, 2018). Acute and chronic administration of MPH in those with ADHD reduces sensory dysregulation (Durukan et al, 2011;Treister et al, 2015;Shang et al, 2020), emotional dysregulation (Segev et al, 2016;Kutlu et al, 2017;Lelieveld et al, 2019;Ventura et al, 2020). Hypothetically, as above-discussed, MPH treatment effectiveness on the 'classical' ADHD symptoms may be due to its' additional role in lessening sensory and emotional dysregulation, preventing the development of higher-order symptoms of impulsivity, hyperactivity, and inattention.…”

Methylphenidate Use for Emotional Dysregulation in Children and Adolescents with ADHD and ADHD and ASD: A Naturalistic Study

“…However, these results are based on small samples of patients (frequently case report), often comorbid with intellectual disability [ 59 , 60 , 61 ]. Thus, most recent literature on MPH treatment in children with ASD with comorbid ADHD suggests more positive outcomes [ 12 , 62 , 63 , 64 , 65 , 66 ], with an ES between 0.54 [ 67 ] and 0.67 [ 68 ] particularly in the case of average intellectual functioning [ 69 ]. Indeed, in our previous study, involving 80 ADHD children and adolescents of whom 40 had high-functioning ASD, long-term MPH treatment resulted in amelioration of global functioning [ 69 ].…”

“…Thus, most recent literature on MPH treatment in children with ASD with comorbid ADHD suggests more positive outcomes [ 12 , 62 , 63 , 64 , 65 , 66 ], with an ES between 0.54 [ 67 ] and 0.67 [ 68 ] particularly in the case of average intellectual functioning [ 69 ]. Indeed, in our previous study, involving 80 ADHD children and adolescents of whom 40 had high-functioning ASD, long-term MPH treatment resulted in amelioration of global functioning [ 69 ]. Although promising results on the efficacy of MPH in ASD individuals have been described, no studies have been conducted on its effect on ED to date.…”