Ritalin probe

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Methylphenidate — popularly known as Ritalin — is well studied in children with attention deficit hyperactivity disorder (ADHD), but only a handful of studies have assessed its effects in children with both autism and ADHD.

A new study, published 19 June in the Journal of Child and Adolescent Psychiatry, shows that Ritalin lowers impulsivity and oppositional behavior in children with both disorders and has mild short-term side effects.

Up to 75 percent of children with autism have features of ADHD, such as inattention, hyperactivity and impulsivity. Although roughly a third of these children take stimulants for their ADHD symptoms, surprisingly little is known about the drugs’ short- or long-term side effects in this group.

Several case studies have raised concerns about Ritalin’s side effects in children with autism, such as worsening repetitive behaviors, depression and insomnia. However, there is little information about the prevalence of these side effects.

The new study evaluated 24 children with high-functioning autism and ADHD, aged 9 years, who each received a weeklong supply of a placebo followed by escalating doses of Ritalin over three weeks.

The children took the medication twice daily: a long-release drug in the morning and an immediate-release treatment in the afternoon. All of the children completed the study, but five discontinued their afternoon treatment after they experienced irritability, difficulty sleeping or increased repetitive behaviors.

The parents of children taking the drug also reported that their children have more insomnia and appetite loss than before, but only at at higher doses of the drug. Teachers reported observing no side effects.

The teachers and parents both reported that the children showed a significant drop in impulsivity, oppositional behavior and core ADHD symptoms such as hyperactivity at higher doses of Ritalin. The parents also found decreases in irritability and inappropriate speech, and improvements in social skills. Teachers noted fewer cases of inappropriate emotional behavior, such as laughing at sad events.

Still, the researchers caution that the study is small, short-lived and does not assess long-term side effects.