Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

Abstract

OBJECTIVE:

Impairments associated with attention-deficit/hyperactivity disorder (ADHD) and noncompliance are prevalent in children with autism spectrum disorder (ASD). However, ADHD response to stimulants is well below rates in typically developing children, with frequent side effects. Group studies of treatments for noncompliance are rare in ASD. We examined individual and combined-effectiveness of atomoxetine (ATX) and parent training (PT) for ADHD symptoms and noncompliance.

METHOD:

In a 3-site, 10-week, double-blind, 2 × 2 trial of ATX and PT, 128 children (ages 5-14 years) with ASD and ADHD symptoms were randomized to ATX, ATX+PT, placebo+PT, or placebo. ATX was adjusted to optimal dose (capped at 1.8 mg/kg/day) over 6 weeks and maintained for 4 additional weeks. Nine PT sessions were provided. Primary outcome measures were the parent-rated DSM ADHD symptoms on the Swanson, Nolan and Pelham (SNAP) scale and Home Situations Questionnaire (HSQ).

RESULTS:

On the SNAP, ATX, ATX+PT and placebo+PT were each superior to placebo (effect sizes 0.57-0.98; p values of .0005, .0004, and .025, respectively). For noncompliance, ATX and ATX+PT were superior to placebo (effect sizes 0.47-0.64; p values .03 and .0028, respectively). ATX was associated with decreased appetite but was otherwise well tolerated.

CONCLUSION:

Both ATX and PT resulted in significant improvement on ADHD symptoms, whereas ATX (both alone and combined with PT) was associated with significant decreases on measures of noncompliance. ATX appears to have a better side effects profile than psychostimulants in the population with ASD.

CLINICAL TRIAL REGISTRATION INFORMATION:

Atomoxetine, Placebo and Parent Management Training in Autism; http://clinicaltrials.gov/; NCT00844753.

• Authors: Benjamin L Handen, Michael G Aman, L Eugene Arnold, Susan L Hyman, Rameshwari V Tumuluru, Luc Lecavalier, Patricia Corbett-Dick, Xueliang Pan, Jill A Hollway, Kristin A Buchan-Page, Laura B Silverman, Nicole V Brown, Robert R Rice Jr, Jessica Hellings, Daniel W Mruzek, Sarah McAuliffe-Bellin, Elizabeth A Hurt, Melissa M Ryan, Lynne Levato, Tristram Smith
• Journal: Journal of the American Academy of Child and Adolescent Psychiatry (J Am Acad Child Adolesc Psychiatry) Vol. 54 Issue 11 Pg. 905-15 (Nov 2015) ISSN: 1527-5418 [Electronic] United States
• PMID: 26506581 (Publication Type: Clinical Trial, Phase IV, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic Uptake Inhibitors
• Atomoxetine Hydrochloride

Topics

• Adolescent
• Adrenergic Uptake Inhibitors (administration & dosage, adverse effects)
• Atomoxetine Hydrochloride (administration & dosage, adverse effects)
• Attention Deficit Disorder with Hyperactivity (drug therapy)
• Autism Spectrum Disorder (drug therapy)
• Behavior Rating Scale
• Child
• Child, Preschool
• Double-Blind Method
• Female
• Humans
• Male
• Parents (education)
• Psychiatric Status Rating Scales
• Severity of Illness Index
• Surveys and Questionnaires
• Treatment Outcome
• United States