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Experience with RitalinThis is for my little NT guy, not my ASD guy. Some of you may remember me posting earlier this school year about issues with my other son. I'd link in that thread if the search funcion let me find it without timing out LOL. Anyway, long and short of it is I did private comprehensive psych eval over summer. They psych feels he's borderline ADHD, but there is other stuff going on as well (reading disorder, visual processing). The school has completed their own eval, IEP is tomorrow, and they are seeing much more ADHD (inattention and hyperactivity) that the psychologist saw, but of course they can't dx. What my psych is recommending is that we do a trial course of ritalin. If it helps, she can confirm ADHD. If it just winds him up more, than we're on the wrong track. I personally am seeing ADHD (lay persons opinion) here at home as well. I'd like to hear from anyone with experiences with Ritalin, or other ADHD meds. I don't have any experience to share, but just wanted to say good luck. I basically only use the forum's search function for searching in topic names. Searching in the message body times out all the time. For searching in the message body, I use google. To limit the search to this site, you type this: site:autism-pdd.net/forum followed by a space and the word or words you're looking for. For example: site:autism-pdd.net/forum ritalin
There are tests involving a computer that help determine whether or not a course of Ritalin is the way to go. They test the child on the computer and then test again after the med is given. This is an excellent way to see if you're on the right track. Not everyone has access to this test and, sorry to say, I don't remember the name. But trying Ritalin to confirm ADHD is a tried and true method of dxing. The good news about Ritalin is that it's in the system at full strength immediately and wears off in 4 hours. It might be a good way to go. If it doesn't work, the whole experience ends in 4 hours and the drug is completely out of the system. Your "NT" one might have what is known as a "Shadow Syndrome." That is, enough asd or neurobiological disorder symptoms to not be fully NT but not enough to qualify for a dx. It might be worth taking him to your ASD child's doctor to see if a DX of mild Asperger's is in order. ADHD is present pretty-much universally in all ASD dx's. Not Ritalin, but Vyvanse ... PM me if you want more info. Also see my other post ... I have TWO kids succeeding on it. Also, there is an article out there about treating kids with CAPD and ADHD ... stimulants do not touch the CAPD, but treating the concurrent ADHD nonetheless helps hugely. (I think you can find it if you google "CAPD and ADHD" I ran across it when trying to find differnetial diagnosis info). I would think this would be true with ANY comorbid learning disorders. we are also vyvanse, this is also a stimulant but in a different family...ritalin did calm my son down but the side effects for him were greater than on the vyvanse. ( he was crabby when the med wore off, had trouble sleeping and lost his appetite. you should know within an hour of taking the med if it is working [QUOTE=drmomtojoe] you should know within an hour of taking the med if it is working [/QUOTE] Well, I did not with T -- she is the INATTENTIVE variety! The symptoms are much more subtle and many of her teachers (especially the one-on-ones) could not observe WHY she was reading slowly, and not "getting" it. I suspect it will take months till we see full effects -- as she pieces together what she was missing. Last night was the first time I heard her read a poem, in rhythm, too! Little things ... With S who was ADHD-HI, I could absolutely tell, right away! But if you do not see it that fast, it may still help ... Perhaps a good test would be an academic task of some type...for my son it could be anything that has to do with writing [QUOTE=tzoya]Your "NT" one might have what is known as a "Shadow Syndrome." That is, enough asd or neurobiological disorder symptoms to not be fully NT but not enough to qualify for a dx. It might be worth taking him to your ASD child's doctor to see if a DX of mild Asperger's is in order. ADHD is present pretty-much universally in all ASD dx's. [/QUOTE] Tzoya, I was thinking along the same lines but didn't know a name for it and I did have this checked out. There isn't a trace of ASD in R that anyone can find. He has no restricted interests / repetitive behaviors and his social skills and verbal communication skills are noted as a huge strengths by everyone that evaluates him. Everyone is seeing some possible ADHD, and some anxiety, and some visual motor stuff but nothing in the communication, social skills or repetitive/restricted interests cateogies. In my case I think "mirror syndrome" is probably more apporpriate than "shadow syndrome" LOL. C's strengths are R's weaknesses and vice versa! Ritalin worked wonders with my son for the last 18 months but now we are noticing a lot of stims/tics. The other side effects for him were trouble falling asleep (Melatonin helps), and a loss of appetite during the day when the med was in effect. Once worn off though he eats like obsessively in the evening. It really does help his focus, but we are wondering if the stims/tics are worth it.On my Norwegian forum there's a thread about how many have experienced that Ritalin made Asperger traits more prominent (withdrawal, rituals, etc), requiring a lower dose or a switch to another medicine. It doesn't really apply to your situation, but I thought I'd mention it because it was so interesting. I have read that 50% of autistic kids are helped by stimulants (article from Pediatrics, I think, anyhow a professional article). That in my books indicates it is worth a try. And if you have a NT kid with ADHD symptoms, I think the efficacy would be even better. I weighed my two last night and T is down one lb (but is eating better so she may have actually come up a bit!), and S is down maybe 2 lb. We are feeding them aggressively, because the meds DO help behaviorally, so much! Norway, I agree, I do see some increased ASD behavior in T but her sociability actually seems to be increased. I saw some mildly stalker-y obsessive stuff, but I also am seeing her playing with a broader range of kids! and Iam seeing more foresight and planning -- we were seeing some improvement there before hte meds, but now it is terrific! What's the status on medicating your NT son, Kristys? I also just wanted to follow up on foxl's post. [QUOTE=foxl] I have read that 50% of autistic kids are helped by stimulants (article from Pediatrics, I think, anyhow a professional article). [/QUOTE] If you find the link, let me know. It would be interesting to see it. Maybe it's one of the research articles mentioned in the Pediatrics article on Management of Autism? That article summarizes the research on pharmacology and mentioned three studies on Ritalin (methylphenidate). I took a peak at the abstracts. Here's what I found: 1. Eight of 13 child subjects with autism and symptoms of ADHD responded positively (ie minimum 50% decrease on Connors Hyperactivity Index. Decreased stereotypy and inappropriate speech. No significant change in CARS score. The abstract notes: "Results suggest that methylphenidate can be efficacious for children with autism and ADHD symptoms. However, this group of children seems to be particularly susceptible to adverse side effects." http://www.ncbi.nlm.nih.gov/pubmed/11055460?dopt=Abstract 2. "Ten children, ages 7-11, with a DSM-III-R diagnosis of autistic disorder participated in a double-blind crossover study using placebo and two MPH doses (10 mg or 20 mg bid). Subjects showed modest but statistically significant improvement on MPH over placebo. No significant side effects including worsening stereotypic movements occurred on either dose. Improvement in hyperactivity and lack of adverse effects suggest that MPH may be useful in the treatment of hyperactive autistic children." http://www.ncbi.nlm.nih.gov/pubmed/7559293?dopt=Abstract 3. Subjects: "Seventy-two drug-free children, aged 5 to 14 years, with pervasive developmental disorders accompanied by moderate to severe hyperactivity." Results: "Thirty-five (49%) of 72 enrolled subjects were classified as methylphenidate responders. Adverse effects led to the discontinuation of study medication in 13 (18%) of 72 subjects." Here's the article on Management of Autism, if some people haven't seen it before. http://pediatrics.aappublications.org/cgi/content/full/120/5 /1162#top Hmmmm ... #3 comes in at 49% responders, minus 18% with AE = 31% which is only about 1/3 ... I suspect it was that 49% "responders" I was processing? In any event, T is doing SO WELL to all accounts (at home AND school) I am going to keep her on it if I have to force feed her with a foie gras funnel! My only regret is not having tried it sooner. Hmmmm ... #3 comes in at 49% responders, minus 18% with AE = 31% which is only about 1/3 ... [/QUOTE] I wasn't sure how to interpret the 18% with bad side effects. It seemed like it could have included those whose ADHD symptoms weren't helped by the drug.
Here is another one ... Handen, cited in Volkmar's Autism and Pervasive Developmental Disorders 2007, found hyperactivity decreased in 62% of autistic children studied ... adverse effects included social withdrawal and irritability but no % of AEs listed ... ' There is also a NIMH study underway, but no results are posted yet: http://clinicaltrials.gov/ct2/show/record/NCT00178503?term=N IMH+%5BSPONSOR%5D&rank=32 Volkmar seems to think the jury is still out on using psychostimulants in PDDs. [QUOTE=foxl]Volkmar seems to think the jury is still out on using psychostimulants in PDDs. [/QUOTE] I honestly don't think anyone can make a general statement on the efficacy of anything for people with autistic spectrum disorder. I say that because I believe there are many, many different types of autism with its own genetic or biochemical cause, and Ritalin (for example) might work on some types but not others. But we haven't even identified the types yet (except Retts and Fragile X and a couple other syndromes), so until then, it'll just be trial and error. And whether or not we even want to try a medicine will depend on how strong the individual's symptoms are. The good thing about Ritalin is that it leaves the system so fast. Makes it less scary to give it a shot.
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