Autism and Medication Part 5 – Stimulants

Stimulant drugs are used to treat impulsivity, hyperactivity, and to increase attentiveness in children and adults diagnosed with ADD or ADHD.

They work by increasing certain chemicals in the brain, such as dopamine and norepinephrine, which help transmit signals between nerves. Common stimulant medications include Adderall, Concerta, Dexedrine, Daytrana, Metadate, Methylin, Ritalin, Vyvanse, and Quilivant.

Side effects include loss of appetite, headache, upset stomach, and increased blood pressure. Individuals who suffer from glaucoma, severe anxiety, motor tics or a family history of Tourette’s syndrome, or psychosis should not take stimulant medications.

Since many children with autism exhibit symptoms of ADHD, including inattentiveness, impulsiveness and hyperactivity, stimulant medications are often prescribed to help with these difficulties. A 2011 study by Autism Speaks’ Autism Treatment Network (ATN) found that over half of the 2,000 children with autism seen at one of the ATN’s 17 autism treatment centers across North America exhibited symptoms of ADHD.

ATN Medical Director Dan Coury, M.D., one of the study’s co-authors, says,

“Over half of these children had symptoms of inattention, over half had hyperactivity, and over a third had symptoms that were in the high range on both of these scales.”

Only one in ten (11%) of these children were receiving treatment for their ADHD symptoms.

A 2005 study at the Indiana University School of Medicine found that 50% of the 72 children with autism, ages 5 to 14, showed a 25-54% reduction in hyperactivity symptoms. The randomized, placebo-controlled, crossover trial included a one-week phase to test whether the participants could tolerate three different dose levels of the medication, followed by a four-week crossover phase where children were given one of three doses of Ritalin or a placebo. Children showing a positive response were treated for 8 additional weeks to ensure that gains were stable.

The drug did not improve symptoms of irritability, lethargy, social withdrawal, stereotypy, or inappropriate speech. 18% of the children withdrew from the study due to adverse side effects, including irritability, decreased appetite, difficulty falling asleep, and abdominal discomfort.

For now, trial and error is the best way to determine whether stimulant medication will help. Most doctors will start with a low dose, while parents and teachers report on effectiveness and side effects. The best way to find out if a given medication works is to try it.

Christopher, a 17 year-old boy with autism, posts the following on the Special Children at listserv,

“I believe that reducing my hyperactivity and attention deficit with Ritalin allows me to focus on my real interests as well as perform to a higher standard in both my studies and my alternate activities.”

Angela, a parent, says,

“My son is now 11. He was diagnosed with PDD-NOS/ADHD at the age of 3. We first tried Adderall, that was a disaster in the first week! He literally destroyed my kitchen!”

Many parents report that the right dose of the right stimulant can make a huge difference, but it can be tricky to find the right one.

Previous articles in this series can be found here.