Medication to Treat ADHD in Autistic Children and Adults

Studies indicate that approximately 50% to 70% of autistic individuals also exhibit symptoms of ADHD (Hours et al., 2022). Medications such as methylphenidate and atomoxetine remain at the forefront of pharmacological management for ADHD, and autism plus ADHD. Evidence indicates that these medications provide therapeutic benefits in improving attention, hyperactivity, and associated behavioural challenges (Johansson et al., 2020).

Medication options

The first line of medications for ADHD are stimulants such as methylphenidate (Ritalin or Concerta) and amphetamines (Dexamphetamine or Adderall).

Research on methylphenidate has indicated a positive response rate of 73% in children with ADHD and 49% in autistic children with ADHD. (King et al, 2020).

Methylphenidate and lisdexamphetamine (Vyvanse, Elvanse) are the first-line option for Autistic adults who have ADHD (De Crescenzo et al, 2017).

Alternatives are nonstimulant medications are atomoxetine (Straterra) and guanfacine (Intuniv).

Side-effects

Stimulant medications, such as methylphenidate and amphetamines, are the most commonly prescribed for ADHD. While they are generally effective, common side effects include insomnia, decreased appetite, irritability, and headache (McCarthy, 2014) and increased anxiety (Toomey et al., 2012).

There may also be rebound effects (where symptoms temporarily worsen after medication wears off), mood swings, and increased emotional sensitivity (Stueber & Cuttler, 2021). The experience of these adverse effects can significantly impact adherence to medication regimens and affect the choice and frequency of taking medication for ADHD.

Non-stimulant medications, including atomoxetine, also have side effects, which can include fatigue, sedation, and gastrointestinal disturbances (Lilja et al., 2022). However, non-stimulant medications may provide a useful alternative for those who cannot tolerate stimulants.

Discontinuing medication

As much as there will be a plan to start and regularly review medication for ADHD, there will also be consideration of determining when and how to end medication. This will be based on recognising increasing maturity and the cognitive management of ADHD, support network, accommodations in daily life and consideration of alternative treatments to medication. An example is meditation. An evaluation of a meditation programme for children with ADHD recorded a 35% improvement in behaviour after only six weeks, and for more than half of the 24 participants, a significant decrease or cessation of medication (Harrison, Manocha and Rubia, 2004).

Where to from here

On the 20th of June 2025, we will present our Event, Autism, ADHD and Executive Function.

What you will gain from the course:

1. Achieve an up-to-date understanding of the co-occurrence of autism and ADHD, and the status of treatments for ADHD and executive function based on the latest research
2. Understand the unique strengths and challenges that occur when an autistic person also has ADHD
3. Know the pros and cons of medication for ADHD for autistic individuals across the age span
4. Know how to support an autistic student with ADHD or executive function difficulties in the classroom, as a teacher and/or a parent
5. Implement strategies as an autistic adult managing ADHD in the workplace
6. Support an autistic person with ADHD at home– developing realistic expectations and support strategies
7. Learn strategies to manage ADHD as an autistic adult or adolescent

References

De Crescenzo F, Cortese S, Adamo N, et al. Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review BMJ Ment Health 2017;20:4-11).

Harrison, L. J., Manocha, R., & Rubia, K. (2004). Sahaja yoga meditation as a family treatment programme for children with attention deficit-hyperactivity disorder. Clinical Child Psychology and Psychiatry, 9(4), 479-497.

Hours, C., Recasens, C., & Baleyte, J. (2022). ASD and ADHD comorbidity: what are we talking about?. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.837424

Johansson, V., Sandin, S., Chang, Z., Taylor, M., Lichtenstein, P., D’Onofrio, B., … & Halldner, L. (2020). Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder: analysis of data from the Swedish Prescribed Drug Register. https://doi.org/10.21203/rs.3.rs-41061/v1

King et al (2020) In, White, S., Maddox B., and Mazefsky C. (eds) The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions,  Oxford Library of Psychology.

Lilja, M., Sandblom, E., Lichtenstein, P., Serlachius, E., Hellner, C., Bhagia, J., … & Halldner, L. (2022). 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. Journal of Neurodevelopmental Disorders, 14(1). https://doi.org/10.1186/s11689-022-09424-2

McCarthy, S. (2014). Pharmacological interventions for ADHD: how adolescent and adult patient beliefs and attitudes impact treatment adherence?. Patient Preference and Adherence, 1317. https://doi.org/10.2147/ppa.s42145

Stueber, A. and Cuttler, C. (2021). Self-reported effects of cannabis on adhd symptoms, adhd medication side effects, and ADHD-related executive dysfunction. Journal of Attention Disorders, 26(6), 942-955. https://doi.org/10.1177/10870547211050949

Toomey, S., Sox, C., Rusinak, D., & Finkelstein, J. (2012). Why do children with adhd discontinue their medication?. Clinical Pediatrics, 51(8), 763-769. https://doi.org/10.1177/0009922812446744