Thursday, May 20, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
2:00 PM
Background:
Several studies have reported relatively high rates of comorbidity between Asperger Syndrome (AS)/Autistic Spectrum disorders and Attention Deficit and Hyperactivity, attention and emotional processes, Disorder (ADHD), although nowadays the DSMIVTR and ICD10 exclude inattentive and/or hyperactive-impulsive children with Autistic Spectrum Disorders (ASD) from a diagnosis of ADHD. Individuals with AS may have a range of behavioral symptoms such as hyperactivity, impulsivity, short attention span, aggressiveness. Furthmore, many children with AS often are initially misdiagnosed with ADHD. Psychostimulant medications, such as Methylphenidate (MPH), are considered pharmacological goal treatment in children with ADHD. The broad overlapping between ADHD and autistics spetrum symptoms can be explained by a common neurobiological dysfunction of dopaminergic system, given that dopamine plays a key role on behavioral, cognition, selective implicated both in the pathogenesis of autism and ADHD.
Objectives:
The purpose of this study was to evaluate the responsiveness and the effects of MPH on the core symptoms of ADHD in children with AS trough a retrospective analyses.
Methods:
The clinical sample included 13 male subjects, aged between 8-12, with AS and an additional diagnosis of ADHD. All the patients have been treated with MPH during a period of 6-12 weeks; dosage was based at approximately dose of 0,2-0,4 mg/Kg/die. Before medication exposure, all children have been submitted to cardiological visit, ECG and blood analysis. We also routinely monitor height and weight, hematologic analysis, blood pressure, and heart rate during medication exposure.
Results:
10 of 13 subjects (77%) have shown a significant clinical improvement with in the Clinical Global Impression (reduction > 2), and in the Conners’ Parent and Teachers ADHD Index. Three patients have experienced adverse events during the first weeks of treatments: 2 patients showed dysphoria, agitation, anxiety and mood instability and 1 patients showed decrease in appetite and irritability. The severity of these side effects have required the interruption of the treatment.
Conclusions:
MPH reduces symptoms of ADHD in children with Asperger syndrome; symptoms of ADHD are common in Asperger/autistic popoulation and MPH emerges as one of the best empirically validated treatments for the target of ADHD symptoms. Finally,we did not observe any exacerbation of repetitive behaviors, in contrast to the common belief that MPH may worsen stereotypies in autistic children. The best goal will be in defining predictors of response for each individual to this medication and in documenting effectiveness on cognitive and social domains and long-term outcomes. In this ways, pharmacogenetic studies may be informative in this regard.
Several studies have reported relatively high rates of comorbidity between Asperger Syndrome (AS)/Autistic Spectrum disorders and Attention Deficit and Hyperactivity, attention and emotional processes, Disorder (ADHD), although nowadays the DSMIVTR and ICD10 exclude inattentive and/or hyperactive-impulsive children with Autistic Spectrum Disorders (ASD) from a diagnosis of ADHD. Individuals with AS may have a range of behavioral symptoms such as hyperactivity, impulsivity, short attention span, aggressiveness. Furthmore, many children with AS often are initially misdiagnosed with ADHD. Psychostimulant medications, such as Methylphenidate (MPH), are considered pharmacological goal treatment in children with ADHD. The broad overlapping between ADHD and autistics spetrum symptoms can be explained by a common neurobiological dysfunction of dopaminergic system, given that dopamine plays a key role on behavioral, cognition, selective implicated both in the pathogenesis of autism and ADHD.
Objectives:
The purpose of this study was to evaluate the responsiveness and the effects of MPH on the core symptoms of ADHD in children with AS trough a retrospective analyses.
Methods:
The clinical sample included 13 male subjects, aged between 8-12, with AS and an additional diagnosis of ADHD. All the patients have been treated with MPH during a period of 6-12 weeks; dosage was based at approximately dose of 0,2-0,4 mg/Kg/die. Before medication exposure, all children have been submitted to cardiological visit, ECG and blood analysis. We also routinely monitor height and weight, hematologic analysis, blood pressure, and heart rate during medication exposure.
Results:
10 of 13 subjects (77%) have shown a significant clinical improvement with in the Clinical Global Impression (reduction > 2), and in the Conners’ Parent and Teachers ADHD Index. Three patients have experienced adverse events during the first weeks of treatments: 2 patients showed dysphoria, agitation, anxiety and mood instability and 1 patients showed decrease in appetite and irritability. The severity of these side effects have required the interruption of the treatment.
Conclusions:
MPH reduces symptoms of ADHD in children with Asperger syndrome; symptoms of ADHD are common in Asperger/autistic popoulation and MPH emerges as one of the best empirically validated treatments for the target of ADHD symptoms. Finally,we did not observe any exacerbation of repetitive behaviors, in contrast to the common belief that MPH may worsen stereotypies in autistic children. The best goal will be in defining predictors of response for each individual to this medication and in documenting effectiveness on cognitive and social domains and long-term outcomes. In this ways, pharmacogenetic studies may be informative in this regard.