The effect of autistic traits on response to and side-effects of pharmacological ADHD treatment in children with ADHD: results from a prospective clinical cohort
Open accessAbstract
Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood behavioral condition that globally affects an average of around 5% of children and is associated with several adverse life outcomes. Comorbidity with autism spectrum disorder (ASD) is highly prevalent. Pharmacological treatment for ADHD symptoms has been shown to be effective. However, the prevailing perception is that children with ADHD and concomitant ASD symptoms report poorer efficacy and more side effects. This has been supported by studies on this population, but prospective studies directly comparing children with ADHD and different levels of ASD symptoms are lacking. We aimed to assess if children with ADHD and concomitant ASD symptoms differ regarding effects and side-effects of pharmacological ADHD treatment compared to children with ADHD without ASD traits. This is to our knowledge the second study to directly compare the effect of ADHD medication between ADHD patients with different levels of ASD symptoms. Methods: In a non-randomized, observational, prospective cohort study, 323 patients aged 6 to 17 years who were diagnosed with ADHD and starting pharmacological treatment were divided into two groups: one with high level of ASD symptoms (ASD group, N=71) and one with low level of ASD symptoms (non-ASD group, N = 252). Treatment outcome was measured as ADHD symptoms, and evaluated using the Swanson, Nolan and Pelham Teacher and Parent ADHD rating scale-version IV (SNAP-IV). Side-effects were evaluated using the Pediatric Side Effects Checklist (P-SEC), at 3 months follow-up. Results: From baseline to 3 months, there was no significant difference in neither treatment effect nor number of clinically significant adverse events experienced between the ASD group and the non-ASD group. Conclusions: Our results did not implicate that ADHD patients with concomitant ASD symptoms have decreased treatment effect of ADHD medication than patients with ADHD without concomitant ASD symptoms. Neither did the results support that ADHD patients with ASD symptoms experienced significantly more side-effects than ADHD patients without ASD symptoms. Although, we did not analyze different medications separately, this is in line with the only previous study directly comparing methylphenidate treatment in children with or without ASD. Trial registration: NCT02136147, May 12, 2014.
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A recent non-randomized, prospective observational cohort study evaluated 323 children with ADHD who were initiating pharmacotherapy and who also demonstrated either high or low ASD symptoms.
“A recent non-randomized, prospective observational cohort study evaluated 323 children with ADHD who were initiating pharmacotherapy and who also demonstrated either high or low ASD symptoms [82].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [82]
The data showed no difference in treatment effect or rates of adverse events between the groups with high and low ASD symptoms.
“The majority of these children were started on MPH, and the data showed no difference in treatment effect or rates of adverse events between the groups with high and low ASD symptoms [82].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [82]
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- Authors
- Lilja, M. M., Sandblom, E., Lichtenstein, P., Serlachius, E., Hellner, C., Bhagia, J., & Halldner, L.
- Affiliations
- Umeå University (SE)
- Karolinska Institutet (SE)
- Region Stockholm (SE)
- Mayo Clinic (US)
- Corresponding author
- Lilja, Maria M.
- Venue
- Journal of Neurodevelopmental Disorders
- Published
- 2022-03-06
- Volume
- 14
- Issue
- 1
- Pages
- 17-17
- ISSN
- 1866-1947 (ISSN-L)
- 1866-1955
- PMC
- PMC8903657
- OpenAlex
- W4220808658
- Cited by
- 14
- References
- 53
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 2
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Neurodevelopmental Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Region Stockholm (HNSV15316)
- Region Västerbotten (RV938804, RV855991, RV932912, RV940805)
- ALF-PPG Stockholm (SLL20120161)
- the Medical Faculty at Umeå University (FS 2.1.6-2408-18)
- Oskarsfonden
- The Mayo Clinic-Karolinska Insitutet Collaborative Travel Award
- The Mayo Clinic-Karolinska Institutet Collaborative Travel Award
- Region Västerbotten, Child and Adolescent Psychiatry
- Medicinska fakulteten, Umeå Universitet
- Umea University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, autism spectrum disorder, autistic traits, ADHD medication, pharmacotherapy, treatment efficacy, adverse drug reactions, comorbidities, methylphenidate, children, SNAP-IV
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Child, Humans, Prospective Studies
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