This question was forward from Shari due to the medical implications.

Shari

Our 7 year old son was diagnosed with PDD-NOS at the age of 3 1/2. We were making positive strides in our home program combined with his public schooling IEP. Unfortunately our son's attention is progressively getting worse and his energy level continues to increase (ADHD). That being said, we are struggling to make gains with both programs. We have done two trials of Celexa and two trials of Risperdal without any success with the hopes that treating his anxiety would improve his attention. In fact while trying the Risperdal it appeared that he was having a diabetic type of reaction -- increased thirst and urination. What is the normal treatment protocol for treating ADHD in children on the spectrum? Our son has such a great personality but really lacks the ability to focus. We are so fearful of losing his sparkly personality with medication yet we know that if we don't address the poor attention he will continue to fall behind and the gap will get much wider. Can you please give us some direction and hope? We love this little guy so very much and want to help him move along the spectrum without losing his free spirit.

Thanks and I look forward to a reply ~

Mom with tears...

Answer:

Dear Teary Mom,

You pose a very good question and one that is common with parents of children on the autistic spectrum. It used to be that the diagnosis of ADHD could not be made in children on the autistic spectrum. Now, however, the two diagnoses are often made together and the incidence of ADHD is felt to be higher in children on the spectrum.

Anxiety is also common in children on the spectrum and, as with your son, Risperdal is often used to treat anxiety and other behavioral issues. Studies show that Risperdal can be helpful. However, as you discovered, one of the most troublesome side effects of Risperdal is rapid excessive weight gain and metabolic changes that go along with weight gain.

Stimulants, such as Ritalin or Dexedrine, are frequently used and seem to improve attending in children on the autistic spectrum. Studies show that these medications can effectively improve attending. I have included several internet links that describe some of this research. If stimulants are used, then your child’s anxiety should be carefully monitored since they can heighten anxiety while at the same time improving attending.

There has been interest in the use of non-stimulant medications for ADHD in children and a recent study looked at the effects of Provigil, Modafinil. However, this medication has not been approved for use in children because of some significant side effects.

All of these medications should be started at a low dose and the child monitored for improvement or significant side effects. In this way you can avoid losing the “sparkle”, while getting the best beneficial effects.

I hope that this information is useful for you and your child. I would enjoy hearing how your child is doing, particularly if you try stimulant medications.

Kay S. Browne MD
Behavioral Pediatrician

References:

http://www.springerlink.com/content/t372g3626u71q457/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11055460&dopt=Abstract

http://www.ncpamd.com/NonStimulants.htm