ADHD with ASD and without it: Should they be treated differently? | Image credit: Contemporary Pediatrics

A retrospective review of electronic health records of children with attention-deficit/hyperactivity disorder (ADHD) without autism spectrum disorder (ADHD – ASD) and children with both ADHD and ASD (ADHD + ASD) found that for children with ADHD – ASD, stimulant medications were significantly more effective than α₂ agonist (α₂A) medications. For those with ADHD + ASD, however, stimulants and α₂As had similar effectiveness.

The study, conducted by the Developmental Behavioral Pediatrics Research Network at 7 academic medical centers across the United States, included 497 children, mostly male (82%), who had begun medication at a median age of 62 months. The study group comprised 389 children with ADHD – ASD and 108 with ADHD + ASD who had received a prescription from a developmental behavioral pediatrician for a stimulant or an α₂A before age 72 months; investigators abstracted treatment data for the following 5.5 years. Demographic variables were similar in the 2 groups. However, participants with ADHD + ASD reported more sleep problems than those with ADHD – ASD at the beginning of the study. In addition, children with ADHD–ASD were more likely than those in the other group to be diagnosed with a disruptive behavior disorder.

Retrospective analysis of the health records found that for children with ADHD – ASD, ADHD symptoms were more likely to improve on stimulant medication than on an α₂A medication (80% vs 66%, respectively). For children with ADHD + ASD, however, effectiveness of stimulants vs α₂As was not significantly different, with approximately two-thirds of patients responding favorably to stimulants and α₂As.

Regarding adverse effects with stimulant medication, children with ADHD-ASD experienced more appetite suppression than those with ADHD + ASD (36.9% vs 21.6%, respectively) and stomachaches (14.8% vs 3.9%). For children taking α₂As, no associations were found between ASD status and rates of common adverse effects.

THOUGHTS FROM DR FARBER

My first concern with this report was with its title, which refers to treating preschoolers, which I generally think is too young. But it turns out these children were 5 years old, not ideal but acceptable. My takeaway is that if medicine is needed, stimulants will be my first choice in this age group, regardless of whether the ADHD coexists with ASD.

Reference:

Friedman SL, Shults J, Barbaresi W, et al. Attention-deficit/hyperactivity disorder in medication treated preschool-age children without and with autism spectrum disorder: a developmental-behavioral research network study. J Dev Behav Pediatr. 2024;45(4):e372-e377. doi:10.1097/dbp.0000000000001286