Ritalin helps about 70-80% of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) with a 1 1/2 percent who discontinue due to side effects. Now research shows that Ritalin helps children with Autistic Spectrum Disorders — not to the same extent and with more side effects. A 2005 study shows that Ritalin helps 50% of children on the spectrum with a an 18% discontinue rate due to side effects.
My question: What is helped the most? Executive functioning abilities (attention, planning, sequencing) or impulsively or what?
See the following research article:
“Hyperactivity, distractibility, and impulsivity are common symptoms in children with autism and other pervasive developmental disorders (PDD). Children with PDD who experience these symptoms are not considered to also have Attention Deficit Hyperactivity Disorder (ADHD). This is because their symptoms of hyperactivity and inattention are thought to be secondary to the autistic symptoms and/or intellectual disability, and also the response to treatment may be different. A number of studies have explored the use of stimulants such as methylphenidate in typically developing children with ADHD, but few have examined the use of methylphenidate in children with PDD. This study sought to determine the efficacy and safety of methylphenidate in children with PDD and hyperactivity.
Seventy-two children with PDD and moderate to severe hyperactivity participated in a 1 week test-dose phase to see how well they tolerated methylphenidate. Each child received placebo for 1 day, then increasing doses of methylphenidate (low, medium, high) for 2 days each. The 66 children who tolerated the test-dose were then randomly assigned to the next 4 week phase. The trial was double-blind, meaning that neither child, parent, nor doctor knew whether the children were receiving active drug or placebo. It was also a crossover trial. In a crossover trial subjects are randomly allocated to one of two groups. Subjectsallocated to the methylphenidate group receive methylphenidate first, followedby placebo. Vice versa subjects in the placebo group receive placebo first, followed by methylphenidate treatment. This designallows contrasting the response of a subject to placebowith the same subject’s response to methylphenidate. Each child therefore received placebo and the 3 different dosage levels (provided they were able to tolerate the dosages during this longer phase). Children who responded positively during the crossover phase were then entered into an 8 week open label (i.e. no longer blinded) continuation phase at their best dosage. The primary outcome measure of the study was the hyperactivity scale of the Aberrant Behavior Checklist (ABC).
The investigators found that methylphenidate was more effective in improving symptoms of hyperactivity and inattention than placebo in children with PDD (49% response rate). Adverse effects were more frequent with methylphenidate than placebo and included irritability, decreased appetite, difficulty falling asleep and emotional outbursts. There was an 18% discontinuation rate due to adverse effects. The 49% response rate is less than the 70% – 80% response previously reported in a large study of children with ADHD; the 18% adverse event rate for children with PDD was higher than the 1.4% rate reported in the aforementioned study of children with ADHD.
Conclusions
The investigators conclude that methylphenidate is a reasonable choice for treating hyperactivity in the context of PDD given the response rate of 49%, with the caution that there is a strong possibility of adverse effects.
