Handen, B. L., Aman, M. G., Arnold, L. E., Hyman, S. L., Tumuluru, R., Lecavalier, L., . . . & Smith, T. (2015). Atomoxetine, parent training and their combination in children with autism spectrum and ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 54(11), 905-915.
Reviewed by: Jennifer A. Scalera
Seton Hall University
Why research this topic?
Observed in about one-third of cases, attention deficit/hyperactivity disorder (ADHD) is one of the most common co-occurring conditions in children with autism spectrum disorder (ASD). Previous studies have demonstrated that children with ASD are being treated for ADHD symptoms, often accompanied by noncompliance, oppositional behavior and irritability, using stimulant medication. However, data show that the effectiveness rates of stimulants in children with ADHD and ASD are well below effectiveness rates in typically developing children with ADHD without ASD. In addition, side effects to stimulants are four times higher in the ASD population. The current study investigated the effectiveness of atomoxetine, a non-stimulant medication for ADHD, in isolation and in combination with parent training for treating ADHD symptoms in children with ADHD co-occurring with ASD.
What did the researcher do?
The researchers examined the individual and combined effectiveness of atomoxetine and individualized, one-on-one parent training for ADHD symptoms and noncompliance in children also diagnosed with ASD. All participants in the study exhibited symptoms of overactivity and/or inattention, and met criteria for ASD. 128 children (ages 5-14), both male and female, were randomly assigned to one of four treatment groups: atomoxetine alone, atomoxetine + parent training, placebo + parent training, or placebo alone. The study was conducted for 10 weeks across three different sites. Families who were assigned to parent training met with a clinician for 60-90 minutes weekly, and sessions covered topics such as preventing problem behaviors, reinforcement, time out procedures, and planned ignoring. Medication dosages were monitored/adjusted accordingly by the study medical providers, and families kept a daily medication log to assess medication compliance. Parents and teachers completed behavior rating scales prior to intervention to assess their child’s pre-treatment symptoms and levels of noncompliance and again at the completion of the intervention phase.
What did the researchers find?
After concluding the study, researchers found that atomoxetine was an effective, non-stimulant treatment for ADHD symptoms in children with ASD, though it was associated with decreased appetite and abdominal pain in some children. In addition, parent training showed greater effectiveness than placebo alone. Contrary to the hypothesis of the researchers, the combination of parent training and atomoxetine was no more effective than atomoxetine alone. Since parent training alone was beneficial to the participants, is cost efficient, and can be used in an outpatient setting, it might be a viable treatment option for children with ASD and ADHD symptoms whose parents are not interested in pharmacological treatment.
What are the strengths and limitations of the study?
This study was the first to investigate the separate and combined effects of a non-stimulant medication and a psychosocial intervention on the treatment of ADHD symptoms and noncompliance in children with ADHD and ASD through a large sample, double-blind, group design. Limitations of the study included a lack of ethnic and cultural diversity of the participants, reliance on parent rating scales instead of data-based observations of behavior and the parent training intervention being limited to only a 10-week trial.
What do the results mean?
Overall, based on the results of the study, the researchers suggest that the use of the non-stimulant medication, atomoxetine, may be a viable alternative to stimulant medication in the treatment of ADHD symptoms in children with a diagnosis of ASD. In addition, because the results showed benefits from parent training alone, parents of children with ASD who disagree with the use of pharmacological intervention should investigate the possibility of using a psychosocial intervention such as parent training for the treatment of co-occurring ADHD symptoms.
Citation for this article:
Scalera, J. A. (2018). Research synopses: Atomoxetine, Parent Training and Their Combination in Children With Autism Spectrum and ADHD Science in Autism Treatment, 15(1), 13-14.
