Article

Positive Effects of Methylphenidate on Social Communication and Self-Regulation in Children with Pervasive Developmental Disorders and Hyperactivity

School of Social and Family Dynamics, Arizona State University, Box 873701, Tempe, AZ 85287-3701, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.06). 09/2008; 39(3):395-404. DOI: 10.1007/s10803-008-0636-9
Source: PubMed

ABSTRACT

This report examined the effect of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity in a secondary analysis of RUPP Autism Network data. Participants were 33 children (29 boys) between the ages of 5 and 13 years who participated in a four-week crossover trial of placebo and increasing doses of methylphenidate given in random order each for one week. Observational measures of certain aspects of children's social communication, self-regulation, and affective behavior were obtained each week. A significant positive effect of methylphenidate was seen on children's use of joint attention initiations, response to bids for joint attention, self-regulation, and regulated affective state. The results go beyond the recent literature and suggest that methylphenidate may have positive effects on social behaviors in children with PDD and hyperactivity.

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    • "Children with ASD tolerated lower doses, required a slower rate of titration, and needed close monitoring for side effects. The only study available on adults is a case report showing its efficacy (Posey et al., 2007;Ghuman et al., 2009;Jahromi et al., 2009;Roy et al., 2009). Atomoxetine A noradrenaline reuptake inhibitor for treating ADHD of children over six years of age, adolescents and adults. "
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    ABSTRACT: Purpose – The management of individuals with autism spectrum disorders (ASDs) requires a multimodal approach of behavioural, educational and pharmacological treatments. At present, there are no available drugs to treat the core symptoms of ASDs and therefore a wide range of psychotropic medications are used in the management of problems behaviours, co-occurring psychiatric disorders and other associated features. The purpose of this paper is to map the literature on pharmacological treatment in persons with ASD in order to identify those most commonly used, choice criteria, and safety. Design/methodology/approach – A systematic mapping of the recent literature was undertaken on the basis of the following questions: What are the most frequently used psychoactive compounds in ASD? What are the criteria guiding the choice of a specific compound? How effective and safe is every psychoactive drug used in ASD? The literature search was conducted through search engines available on Medline, Medmatrix, NHS Evidence, Web of Science and the Cochrane Library. Findings – Many psychotropic medications have been studied in ASDs, but few have strong evidence to support their use. Most commonly prescribed medications, in order of frequency, are antipsychotics, antidepressants, anticonvulsants and stimulants, many of them without definitive studies guiding their usage. Recent animal studies can be useful models for understanding the common pathogenic pathways leading to ASDs, and have the potential to offer new biologically focused treatment options. Originality/value – This is a practice review paper applying recent evidence from the literature.
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    • "In the only controlled study of atomoxetine (Jahromi et al., 2009), results were significantly better than placebo, but the sample size was small and only 7 of 16 children (43%) were considered responders. Overall, both methylphenidate and atomoxetine appear to effectively treat ADHD-related symptoms in ASD (MTA Cooperative Group, 2004; Arnold et al., 2006, 2012; Posey et al., 2006; Santosh et al., 2006; Jahromi et al., 2009; Murray, 2010), but atomoxetine demonstrated better tolerability than stimulants in individuals with co-occurring ADHD and ASD. Response rates may, however, be lower in ASD plus ADHD, than in ADHD alone, and symptoms of inattention may be less likely to respond than symptoms of hyperactivity and impulsivity. "
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    ABSTRACT: Symptoms of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD) often co-occur. The DSM-IV had specified that an ASD diagnosis is an exclusion criterion for ADHD, thereby limiting research of this common clinical co-occurrence. As neurodevelopmental disorders, both ASD and ADHD share some phenotypic similarities, but are characterized by distinct diagnostic criteria. The present review will examine the frequency and implications of this clinical co-occurrence in children, with an emphasis on the available data regarding pre-school age. The review will highlight possible etiologies explaining it, and suggest future research directions necessary to enhance our understanding of both etiology and therapeutic interventions, in light of the new DSM-V criteria, allowing for a dual diagnosis.
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    • "Some of these medications have clear value in the management of interfering symptoms and behaviors associated with ASD. Improvements in social behaviors have been noted in some trials, though these findings often derive from secondary analyses [e.g., studies of risperidone (Scahill et al. 2012)], or are from open-label studies, (Aman et al. 2009) or are from populations with specific comorbidity [e.g., hyperactivity in trials of methylphenidate and guanfacine (Scahill et al. 2006; Jahromi et al. 2009)]. By contrast, few studies have prospectively aimed to demonstrate an impact on the core social and communicative symptoms of ASD. "
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    ABSTRACT: STX209 (arbaclofen), a selective GABA-B agonist, is hypothesized to modulate the balance of excitatory to inhibitory neurotransmission, and has shown preliminary evidence of benefit in fragile X syndrome. We evaluated its safety, tolerability, and efficacy in non-syndromic autism spectrum disorders, in an 8-week open-label trial enrolling 32 children and adolescents with either Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified, and a score ≥17 on the Aberrant Behavior Checklist (ABC)-Irritability subscale. STX209 was generally well-tolerated. The most common adverse events were agitation and irritability, which typically resolved without dose changes, and were often felt to represent spontaneous variation in underlying symptoms. Improvements were observed on several outcome measures in this exploratory trial, including the ABC-Irritability (the primary endpoint) and the Lethargy/Social Withdrawal subscales, the Social Responsiveness Scale, the CY-BOCS-PDD, and clinical global impression scales. Placebo-controlled study of STX209 is warranted.
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