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khagihara, Doctor
Category: Medical
Satisfied Customers: 6590
Experience:  Trained in the multiple medical fields for many years.
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Is 22 with severe autism...he has repetitive rituals and

Customer Question

is 22 with severe autism...he has repetitive rituals and difficultywith attention and regulation. He has taken Lorazapam for catatonia features in his movement for years and that never helped. I have taken him off that. I have always b een curious about the ADD meds and autism, but the psychiatrists default to anti psychotics and ssris, which he cannot tolerate...tried prozaqc when he was 4 and he went manic. and i am not a fan of antipsychotics due to side effects on major organs. He doesnt need more issues. What is your opinion or experience with trying ritalin, adderall, etc with an adolescent with autism where regulation, attention and stereotopy are issues.
JA: Do you keep personal medical records to help track this?
Customer: Rebecca Sperber, MFT
JA: Anything else in your medical history you think the doctor should know?
Customer: son is healthy otherwise, physically and generally happy.
Submitted: 9 months ago.
Category: Medical
Expert:  khagihara replied 9 months ago.

Randomized controlled trials and meta-analyses indicate that stimulant medication improves symptoms in approximately 80 percent of children with ADHD without ASD. In randomized crossover trials, methylphenidate also improved symptoms of hyperactivity and inattention in children with ASD. However, the response rate to methylphenidate is lower in children with ASD than it is in children with ADHD without ASD.

In the largest crossover trial, approximately 50 percent of children with ASD responded to methylphenidate; the effect size ranged from 0.29 to 0.54, depending upon dose, with greater improvement at higher doses (0.25 to 0.5 mg/kg versus 0.125 mg/kg per dose). Methylphenidate also may have beneficial effects on social communication and self-regulation.

Studies of amphetamines (dextroamphetamine, amphetamine-dextroamphetamine) in the treatment of attentional symptoms in children with ASD are lacking. It is not clear that the results from trials of methylphenidate can be generalized to amphetamines. However, amphetamines frequently are used in clinical practice.

The side effects of stimulant medications in children with ASD are similar to those in other patients. However, they occur with greater frequency. In the trial of methylphenidate described above, 18 percent of subjects withdrew because of adverse effects. In comparison, in a large randomized trial of stimulants for attention deficit disorder in children without ASD, the dropout rate was only 3.5 percent. Adverse effects of stimulant medications include, but are not limited to, sleep disturbance, decreased appetite, irritability, tics, sadness, dullness, and social withdrawal.

Customer: replied 9 months ago.
Are any of the drugs you mentioned Ritalin stratera, Adderall. Did the trial indicate if short acting or longer acting more effective.
Expert:  khagihara replied 9 months ago.

Methylphenidate is Ritalin. It seems to be short-acting.