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Clinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders

TitleClinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders
Publication TypeJournal Article
Year of Publication2012
AuthorsMahajan, R, Bernal, MPilar, Panzer, R, Whitaker, A, Roberts, W, Handen, BL, Hardan, AY, Anagnostou, E, Veenstra-VanderWeele, J, Committee, ASATNPsychophar
JournalPediatrics
Volume130
PaginationS125-38
Date PublishedNov
KeywordsAdolescent, AIM, Attention Deficit Disorder with Hyperactivity/di [Diagnosis], Attention Deficit Disorder with Hyperactivity/dt [Drug Therapy], Attention Deficit Disorder with Hyperactivity/et [Etiology], Child, Child Development Disorders, Critical Pathways, Female, Humans, IM, Male, Pervasive/co [Complications]
Abstract

BACKGROUND AND OBJECTIVE: Hyperactivity, impulsivity, and inattention (referred to as "ADHD [attention-deficit/hyperactivity disorder] symptoms") occur in 41% to 78% of children with autism spectrum disorders (ASDs). These symptoms often affect quality of life, interfering with learning or interventions that target primary ASD symptoms. This practice pathway describes the guidelines for evaluation and treatment of children and adolescents with ASD and comorbid ADHD symptoms.

METHODS: Current research in this area is limited, and, therefore, these recommendations are based on a systematic literature review and expert consensus in the Autism Speaks Autism Treatment Network Psychopharmacology Committee.

RESULTS: The recommended practice pathway includes the Symptom Evaluation Pathway for systematic assessment of ADHD symptoms across settings; examination for comorbid sleep, medical, or psychiatric comorbidities that may contribute to symptoms; and evaluation of behavioral interventions that may ameliorate these symptoms. For children for whom medication is being considered to target the ADHD symptoms, the medication choice pathway provides guidance on the selection of the appropriate agent based on a review of available research, assessment of specific advantages and disadvantages of each agent, and dosing considerations.

CONCLUSIONS: These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. Our systematic review of the current evidence indicates the need for more randomized controlled trials of the medications for ADHD symptoms in ASD. There will also be a need for studies of the effectiveness of these practice pathways in the future.

Summary

Lead Author
Rajneesh Mahajan

Study Aims and Objectives
To describe guidelines for evaluating and treating children and adolescents with Autism Spectrum Disorder (ASD) who also exhibit symptoms of Attention-Deficit/Hyperactivity (ADHD).

Methods - Sample, Procedure, Study Measures, Analysis
A systematic review of literature was conducted. Based on the findings, ASD experts from the Autism Speaks Autism Treatment Network made recommendations on how to best care for children with ASD and co-occurring ADHD.

Results – Main Finding(s)
The recommendations include the Symptom Evaluation Pathway for assessment of ADHD symptoms across setting; examination for sleep, medical and psychiatric problems that may contribute to ADHD symptoms; and evaluation of behavioral interventions that may improve these symptoms. For children for whom medication is being considered to target ADHD symptoms, this guideline provides guidance on the selection of the appropriate medication, an assessment of specific advantages and disadvantages of prescriptions, and dosing considerations.

Conclusion – Summary Statement
These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. The review of current evidence indicates the need for more randomized controlled trials of medications for ADHD symptoms in children with ASD. Future studies should assess the effectiveness of this guideline.

PubMed ID23118243