Tuesday, November 08, 2005

Ritalin May Ease Hyperactivity In Autism-Related Disorders

INDIANAPOLIS, Nov. 8 - Ritalin (methylphenidate), long an approach to attention deficit hyperactivity disorder (ADHD) in children, may be effective for treating hyperactivity in autism and related pervasive developmental disorders, according to investigators here.

Nearly 50% of children with pervasive developmental disorders and hyperactivity responded to the drug, but the magnitude of the response was less than that seen with children with ADHD, reported investigator David J. Posey, M.D., of the Indiana University School of Medicine here, and colleagues in the November issue of Archives of General Psychiatry.

Seventy-two children, ages five to 14 years, participated in the randomized, placebo-controlled, crossover trial. The trial included a one-week phase to test whether the participants could tolerate three different dose levels of the medication. This was followed by a four-week crossover phase during which the children were given one of three doses of Ritalin or placebo in random order to assess effectiveness.

Children showing a positive response were treated for an additional eight weeks to ensure that gains were stable. Response to treatment was assessed by parents and teachers using standardized ratings of behavior.

Thirty-five children (49%) responded to the drug, which is less than response rates of 70% to 80% reported for children with ADHD. Responders were defined as those who showed at least a 25% decrease in hyperactivity symptoms. Some children showed as much as a 54% decrease in symptoms. The effect sizes ranged from 0.20 to 0.54, suggesting a small to medium magnitude of response.

The drug did not improve symptoms of irritability, lethargy, social withdrawal, stereotypy, or inappropriate speech. Increased social withdrawal was associated with higher doses of the medication, which is consistent with adverse events reported in other studies.

Overall, 18% of the children withdrew from the study because of adverse events, most commonly irritability. Other adverse events at the highest dose included appetite decrease (24%), difficulty falling asleep (16%), and stomach or abdominal discomfort (12%).

"At present, methylphenidate is a reasonable choice to target hyperactivity in the context of pervasive developmental disorders, given modest group effects and a response rate that approaches 50%," the study authors concluded.

"However, caregivers should be cautioned about the strong possibility of adverse effects. In addition, practitioners should be prepared to suspend treatment if considerable adverse effects are reported," they added.

The authors also raised the possibility that "the use of psychostimulants added to another psychotropic medication may be associated with a greater rate of response than when used alone. For example, persons with autism already receiving an antipsychotic medication might be protected to some extent from adverse effects associated with psychostimulants (e.g., irritability, insomnia, loss of appetite)."

Ritalin is also sold under the brand names Concerta, Metadate, and Methylin. The study was not supported by any of the drug-makers.
Ritalin May Ease Hyperactivity In Autism-Related Disorders - CME Teaching Brief - MedPage Today


Randy said...

Psychopharmacology re. autism is pretty much hit-or-miss. Ritalin may work for some kids with ASD, but it didn't work for mine. We've had better luck with a combination of antipsychotics, SSRIs, and a blood pressure med to help the boys sleep at night.

Anonymous said...

Yes, Ritalin might work in some cases, but it comes along with a rich history of unexpected side-effects. Side effects like an addiction. Because that's what you get when people use drugs to deal with their problems.

Marc said...

My Asperger's son doesn't take any drugs.

And anonymous, if you want to make such a statement like you did, please don't do it anonymously.

I assume you don't walk in anyone's shoes that has any physical or mental problems.

Sandy said...

My son has been taking 54 mg. of Concerta for his ADHD and his schoolwork has improved. However,
in the morning (before he takes his meds), he demonstrates pronounced Autistic characteristics. Could this be a
side effect of the Concerta? Has
anyone else had this problem?

Barb said...

My 6 year old son takes Methylin twice a day, generic of Ritalin, but when the Dr prescribed him a non-generic elapsed time dose of Ritalin his behavior was completely changed from normal. He became alot more aggressive, things he hasnt done in about 2 years, and he couldn't control himself. It was like he was lost. I have not given him anymore of the Ritalin but still give him the Methylin.

So my thoughts on both drugs are completely different. The Methylin makes my child alot calmer and collective, the Ritalin makes him crazy.

It just depends on the child I suppose.

Take your time if you do decide to make the choice of a medication for your child and always talk every side effect with your doctor.

Heather said...

My son was taking ritalin, I was told that it would help control some of his autistic behaviors... it did seem to relieve his repetitive speech, and his rocking. It was amazing for that purpose, however he starting showing signs of Tourettes.. his dr removed him from the medication.. Has anyone else had this side effect? Any information or suggestions?