Journal ofhttp://jad.sagepub.

com/
Attention Disorders

Atomoxetine for Treating ADHD Symptoms in Autism: A Systematic Review

Ahmad Ghanizadeh
Journal of Attention Disorders published online 27 April 2012
DOI: 10.1177/1087054712443154

The online version of this article can be found at:

http://jad.sagepub.com/content/early/2012/04/25/1087054712443154

Published by:

http://www.sagepublications.com

Additional services and information for Journal of Attention Disorders can be found at:

Email Alerts: http://jad.sagepub.com/cgi/alerts

Subscriptions: http://jad.sagepub.com/subscriptions

Reprints: http://www.sagepub.com/journalsReprints.nav

Permissions: http://www.sagepub.com/journalsPermissions.nav

>> OnlineFirst Version of Record - Apr 27, 2012

What is This?

Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012

443154 JAD

Articles
Journal of Attention Disorders

Atomoxetine for Treating ADHD

XX(X) 1­–6
© 2012 SAGE Publications
Reprints and permission:

Symptoms in Autism: A Systematic sagepub.com/journalsPermissions.nav

DOI: 10.1177/1087054712443154
http://jad.sagepub.com
Review

Ahmad Ghanizadeh1

Abstract
Objective: This study systematically reviews the current literature on the administration of atomoxetine for treating
children and adolescents with comorbidity on autism spectrum disorder (ASD) and ADHD. Method: PubMed/Medline
and Google Scholar databases were electronically searched to find the published trials on atomoxetine and ASD.
Results: Six articles reported the clinical trials of atomoxetine for treatment of ADHD symptoms in patients with
autism or pervasive development disorders. Only one study that was placebo-controlled crossover pilot trial reported
that it is effective. Atomoxetine may be effective in high-functioning patients with autism or patients with low severity.
Those with high severity of ASD may be more vulnerable to the adverse effects of atomoxetine. Conclusion: There
are not enough controlled clinical trials for showing the efficacy of atomoxetine for treatment of ADHD symptoms in
autism. Although evidence suggests potential efficacy of atomoxetine, the current evidences are not conclusive. (J. of
Att. Dis. 2012; XX(X) 1-XX)

Keywords
ADHD, autism, atomoxetine, treatment

Autism is a neurodevelopmental disorder whose neurobiol-
ogy is not clearly known. Autism is one of the autism spec-
trum disorders (ASD), including the Asperger’s disorder,
Rett’s disorder, childhood disintegrative disorder, and per-
vasive developmental disorder–not otherwise specified. In
addition, autism is a long-term disorder that needs long-
term management. It also affects different aspects of life,
such as interpersonal relationships, family relationships,
occupation, and education. Many of the children with
autism depend on others in their daily life. Moreover, a
spectrum of interventional managements, including educa-
tional interventions, behavioral interventions, speech and
language therapy, social skills, and medical managements,
is applied for these patients.
ADHD and autism are two distinct disorders with dif-
ferent diagnostic criteria (Ghanizadeh, 2010). However,
about half of school-age children with ASD have concur-
rent ADHD symptoms as well (Aman, Farmer, Hollway, &
Arnold, 2008; Gadow, DeVincent, & Pomeroy, 2006;
Ghanizadeh, 2012). Stimulants are most commonly used
for treating ADHD. However, there are contradictory
reports about their effects on children with autism and
ADHD symptoms. Whereas some studies reported a
higher rate of adverse effects and lack of efficacy in chil-
dren with autism and ADHD (Stigler, Desmond, Posey,
Wiegand, & McDougle, 2004), one study reported it to be
effective for treating inattention and hyperactivity in ASD
(Posey et al., 2007).
Atomoxetine selectively inhibits presynaptic norepi-
nephrine reuptake. It is approved for ADHD treatment in
children older than 6 years. Moreover, it is reported to be
more effective in older children (Kratochvil, Milton,
Vaughan, & Greenhill, 2008). Atomoxetine is an alterna-
tive for those with ADHD and anxiety disorders. Its half-
life is more than methylphenidate and reaches to 24 hr.
Besides, there is no risk of substance use disorders with ato-
moxetine (Cheng, Chen, Ko, & Ng, 2007).
Atomoxetine increases the release of dopamine and nor-
epinephrine in prefrontal cortex of animals; however, it
does not do the same in striatum leading to lower risk of
substance use disorders (Bymaster et al., 2002; Koda et al.,
2010). It is possible that the efficacy of atomoxetine is gen-
der related; it is more effective in girls than in boys (Cheng
et al., 2007). Besides, its efficacy and adverse effects are not
1
Shiraz University of Medical Sciences, School of Medicine, Hafez hospital,
Iran
Corresponding Author:
Ahmad Ghanizadeh, Shiraz University of Medical Sciences, School of
Medicine, Research Center for Psychiatry and Behavioral sciences, Hafez
Hospital, Shiraz, Iran
Email: ghanizad@sina.tums.ac.ir

Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012

2 Journal of Attention Disorders XX(X)
related to age in children and adolescents with ADHD
(Cheng et al., 2007). However, it is more effective and safer
for those with the predominantly inattentive type of ADHD.
Hyperactive/impulsive type responds to atomoxetine less
than inattentive type (Cheng et al., 2007). In addition,
severe forms of ADHD respond to atomoxetine better than
those with a milder form of ADHD. Some authors sug-
gested a tolerance to atomoxetine to exist in the children
with ADHD. Gastrointestinal problems, such as decreased
appetite and abdominal pain, sleep problems, and feeling of
fatigue, are common adverse effects of atomoxetine (Cheng
et al., 2007). Atomoxetine is associated with increased
pulse rate and blood pressure (Kratochvil et al., 2008).
Although it is reported that atomoxetine increases suicidal
idea, it does not increase suicide rate (Bangs et al., 2008).
The following possible advantages are expected for
administration of atomoxetine:
a. Atomoxetine can be taken once daily, whereas
many stimulants need to be used more than once
(Garnock-Jones & Keating, 2009).
b. Atomoxetine can be administered with or with-
out food intake (Garnock-Jones & Keating,
2009).
c. Atomoxetine does not need to be tapered (Garnock-
Jones & Keating, 2009).
d. Atomoxetine does not increase anxiety in ADHD
comorbid with anxiety disorders (Adler et al.,
2009).
e. Atomoxetine is administered for treating tic
disorders (Spencer et al., 2008). Many children
with ADHD (Ghanizadeh & Mosallaei, 2009) or
autism suffer from tic disorders, too. Moreover,
stimulants may exacerbate tic disorders.
f. On the contrary to stimulants, there is no con-
cern for misuse and abuse for atomoxetine
(Findling, 2008).
g. Atomoxetine is the first nonstimulant Food and
Drug Administration (FDA)–approved medica-
tion for treating ADHD.
h. Atomoxetine improves ADHD symptoms in
adolescents with ADHD and major depressive
disorder (Bangs et al., 2007).
i. In comparison with stimulants, atomoxetine
causes less sleep problems which are common in
ADHD and autism (Sangal et al., 2006).
j. Finally, as atomoxetine is a nonstimulant medi-
cation and many parents worry about controlled
medications, it is expected that atomoxetine be
more accepted by the parents in comparison with
stimulants.
This study aimed to systematically reviews the current
literature regarding the efficacy and safety of atomoxetine
Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012
in children and adolescents with ASD and ADHD
symptoms.
Method
The guidelines from the Preferred Reporting Items for
Systematic Reviews and Meta-Analysis (PRISMA) proto-
col was used for conducting the recent systematic review
(Liberati et al., 2009). Published trials on atomoxetine and
ASD were electronically searched thorough PubMed/
Medline and Google Scholar databases. The reference lists
were also checked for possible appropriate clinical trials.
The terms atomoxetine AND autism, atomoxetine AND
pervasive developmental disorder, tomoxetine AND autism,
and tomoxetine AND pervasive developmental disorder
were searched. The term AND was used to decrease the
overlapping articles.
Inclusion and Exclusion Criteria
The following inclusion criteria were considered: The study
design was clinical trial, in which the effect of atomoxetine
for treating symptoms of ADHD was investigated; the par-
ticipants were children, adolescents, and adults; and the
efficacy outcomes were assessed through a validated instru-
ment. However, the articles that did not report the results of
an experimental trial were excluded.
The Extraction of Data
The used protocol for data extraction includes author, pub-
lication year of study, the number of study participants, the
duration of trial, the age of study participants, atomoxetine
dosages, adverse events, and the rate of dropout due to it.
The extracted data were recorded in a data sheet.
Statistical Analysis
Although it was decided to conduct a statistical analysis, it
was not practical because only one controlled clinical trial
was found.
Results
In the present study, 15 articles were retrieved through an
electronic search (Figure 1). However, 11 articles were
excluded of which 7 were not experimental studies (Aman,
2004; Hazell, 2007; McCarthy, 2007; Murray, 2010; Myers,
2007; Polanczyk, Bigarella, Hutz, & Rohde, 2010; Rajapakse
& Pringsheim, 2010), and 1 article was irrelevant (Academy
of Medicine Singapore-Ministry of Health Clinical Practice
Guidelines Workgroup on Autism Spectrum Disorders,
2010). One article reported a case repot of a 22-year-old
man who took atomoxetine (40 mg/day) for 1 month. The
Ghanizadeh
15 potentially suitable titles
retrieved for more detailed
evaluation
9 excluded:
7 not a clinical trial
1 retrospective study
1 case report
6 articles with clinical trial
4 open clinical trials without control group
1 retrospective study
1 articles with a pilot trial of
placebo-controlled crossover
design
Figure 1. Flowchart of trial selection process
results revealed that atomoxetine had reduced hyperactivity
(Niederhofer, Damodharan, Joji, & Corfield, 2006).
Moreover, six articles reported clinical trials of atomox-
etine for the treatment of ADHD symptoms in patients with
autism or pervasive development disorders (Table 1). In
addition, none of them included adult patients. One study
was a retrospective study (Jou, Handen, & Hardan, 2005),
four studies did not have placebo control groups and were
open-label studies (Charnsil, 2011; Posey et al., 2006;
Troost et al., 2006; Zeiner, Gjevik, & Weidle, 2011), and
only one study was a placebo-controlled clinical trial
(Arnold et al., 2006).
The only randomized controlled study reported the
response rate of 43% (Arnold et al., 2006). The response
was described as a 25% reduction in the Aberrant Behavior
Checklist (ABC)–Hyperactivity subscale score (Table 1).
Also, in comparison with placebo, a significant reduction
was observed in the score of Hyperactivity/Impulsivity sub-
scale. Mild adverse events were reported, as well. Besides,
one fifth of the sample experienced a 4% increase in heart
rate and weight loss was more common in the atomoxetine
group (Arnold et al., 2006).
The only study that reported that children with autism
did not benefit from atomoxetine to treat their ADHD
symptoms was conducted by Charnsil (Charnsil, 2011).
This study included 12 children with severe autistic disor-
der comorbid with ADHD and had administered atomox-
etine for 10 weeks. They could take concurrent treatments
other than systemic catecholaminergic drugs and alpha
blockers. Of course, the medication needed to be stable and
without any planned changes 1 month before the onset of
the study. The dosage of atomoxetine was not more than
1.2 mg/kg/day. However, the rate of drop due to adverse
effects was 25%. These adverse effects were abdominal
discomfort and irritable mood occurring during the first
2 weeks of the study. Adverse effects were reported in
11 out of 12 patients and the most common ones were
decreased appetite as well as hypersomnia. According to
Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012
3
the results, atomoxetine did not significantly decrease the
score of Hyperactivity subscale from ABC measurement
(Charnsil, 2011).
Discussion
This is the first systematic review of the efficacy and safety
of atomoxetine in children and adolescents with ASD and
ADHD symptoms. Few studies, however, have investigated
the efficacy of atomoxetine in such populations.
Except one open-label case series study (Charnsil, 2011),
all the three other case series (Zeiner et al., 2011; Posey
et al., 2006; Troost et al., 2006) as well as the only one con-
trolled trial (Arnold et al., 2006) reported atomoxetine to be
effective in reducing the ADHD symptoms. In fact, parents,
teachers, and clinicians rated it as effective. In addition, the
response rate was reported up to 75% (Posey et al., 2006).
Nevertheless, atomoxetine did not improve their function
measured using continuous performance test.
In addition, there are some limitations that should be
taken into account regarding the only published controlled
clinical trial. This study included only 13 participants, and
maximum dosage per day was 100 mg/day. Also, 1 patient
stopped atomoxetine due to the adverse effect of irritability.
Moreover, taking concomitant medication was allowed and
4 patients were concurrently taking atypical antipsychotics,
which is a marked covariant factor (Arnold et al., 2006).
Nearly all the studies reported gastrointestinal problems,
somnolence, irritability, and weight loss as the most com-
monly reported adverse effects. The rate of severe adverse
effects was very low in most studies and most of the adverse
effects were mild. Of course, gastrointestinal problems were
very common in children with autism and reached up to 70%
(Valicenti-McDermott et al., 2006). Therefore, it cannot be
concluded that these high rates of gastrointestinal problems
are certainly associated with atomoxetine. Thus, more well-
controlled studies are needed to be conducted on the issue.
In addition to the lack of efficacy of atomoxetine, there is
a speculation that the children with severe autism and ADHD
symptoms taking atomoxetine may show a higher rate of
adverse effects (Troost et al., 2006). Those uncontrolled
studies which had reported atomoxetine to be effective for
treating ADHD symptoms in autism included high function-
ing autism (Posey et al., 2006; Zeiner et al., 2011) or included
ASD, such as Asperger’s disorder (Arnold et al., 2006;
Posey et al., 2006). The study that showed the lack of effi-
cacy included autistic disorders, as well. Moreover, it did not
include ASD (Charnsil, 2011). Meanwhile, the sample size
of this study was very low. These may suggest that atomox-
etine can decrease ADHD symptoms in the children with
high functioning autism or those with low severity of autism.
Moreover, no published study was found including
participants more than 22 years old and children less than
5 years old. Therefore, these results cannot be generalized
4 Journal of Attention Disorders XX(X)

Table 1. The Characteristics of Clinical Trials of Atomoxetine for Children and Adolescents With Pervasive Developmental Disorders
and ADHD Symptoms
Main outcome
Reference DSM-IV diagnosis Design of study Sample size Intervention measure Main results Main adverse effects

Arnold et al., Autism spectrum Placebo-controlled 16 children and Crossover of Aberrant Behavior Hyperactive/impulsive One case hospitalized
2006 disorders with crossover pilot adolescents ages clinically titrated Checklist symptoms improved due to violence.
ADHD symptoms trial 5 to 15 years atomoxetine and but without efficacy The most commonly
placebo, 6 weeks on nine inattentive reported adverse
each, separated by symptoms. effects: dyspepsia,
1-week washout nausea, vomiting,
fatigue, decreased
appetite, stomach
pain, constipation, dry
mouth, dizziness, and
mood swings
Posey et al., Pervasive 8-week, open-label, 16 children and Atomoxetine 1.2 SNAP-IV, 75% of children were Two cases dropped due
2006 developmental prospective adolescents ages mg/kg/day Clinical Global rated as “much” to the adverse effect
disorders with study 6 to 14 years. Impressions- or “very much of irritability.
ADHD symptoms IQ ≥ 70 Improvement, improved.” Weight loss (0.8 kg) was
Aberrant Behavior No efficacy on the reported.
Checklist Conners’ Continuous
Performance Test
Troost et al., Pervasive 10-week open- 12 children aged 6 Atomoxetine (1.19 ± ADHD Rating Scale, Atomoxetine reduced The rate of dropout due
2006 developmental label study to 14 years 0.41 mg/kg/day) Aberrant Behavior ADHD symptoms. to adverse effects: five
disorders with Checklist patients (42%).
ADHD symptoms The most common
adverse effects:
gastrointestinal
symptoms, irritability,
sleep problems, and
fatigue
Zeiner, High functioning 10-week open- 14 boys aged 7-17 Atomoxetine up to ADHD Rating Scale Both parents and The most common
Gjevik, and boys with autism label study years 1.4 mg/kg/day teachers reported the adverse effects:
Weidle, spectrum disorders reduction of ADHD Nausea, headache
2011 and ADHD symptoms. Two cases dropped
7 patients were in from the study
the range of clinical
responders.
Charnsil, Autism with ADHD Open-label 12 children and Atomoxetine Aberrant Behavior Lack of efficacy 11 out of 12 patients
2011 symptoms adolescents with 0.98 mg/kg/day Checklist showed side effects.
the mean age of Three cases withdraw
10.3 years due to adverse effects.
Common adverse
effects: insomnia
(33.3%), decreased
appetite (55.5%), and
moodiness (33.3%)
Jou, Handen, Pervasive Retrospective 20 patients, (age, Treatment dose: Clinical Global Effective to reduce One case dropped due
and developmental study 11.5 years, 43.3 mg (SD = Impressions Scale, hyperactivity and to mood swings.
Hardan, disorders SD = 3.5) 18.1) for 19.5 Conners’ Parent inattention symptoms
2005 weeks Rating Scale
(SD = 10.5)

Note: DSM-IV = Diagnostic and Statistical Manual of Mental Disorders (4th ed.); SNAP-IV = Swanson, Nolan and Pelham (SNAP) Questionnaire

to other age groups. Furthermore, all of these studies
reported the short-term efficacy and adverse effects of ato-
moxetine (no more than 10 weeks). Thus, these findings
cannot be generalized to the long-term administration of
atomoxetine in autism. Of course, the full effect of atomox-
etine in children with ADHD is expected to be achieved
after 6 to 8 weeks, and there is no long-term efficacy
(Cheng et al., 2007). Moreover, age is a protective factor
for adverse effects of atomoxetine (Cheng et al., 2007). In
many of the studies, the children with autism were not
naïve patients (Arnold et al., 2006; Charnsil, 2011). At
least regarding the children with ADHD, those who are
naïve patients respond to atomoxetine better than those
who have already received medications (Perwien et al.,
2004).
In conclusion, there is no enough evidence-based knowl-
edge regarding the efficacy of atomoxetine. Although, some
uncontrolled studies suggested its efficacy, it was not shown
in another uncontrolled study (Charnsil, 2011). Therefore,
well-controlled clinical trials considering all the limitations
of the current literature are needed to be conducted to reach
a firm conclusion.

Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012

Ghanizadeh
Acknowledgment
Research improvement center of Shiraz University of Medical
Sciences and Ms. A. Keivanshekouh are appreciated for improv-
ing the use of English in the manuscript.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, author-
ship, and/or publication of this article.
References
Academy of Medicine Singapore-Ministry of Health Clinical
Practice Guidelines Workgroup on Autism Spectrum Disor-
ders. (2010). Academy of Medicine Singapore-Ministry of
Health clinical practice guidelines: Autism Spectrum Disor-
ders in pre-school children. Singapore Medical Journal, 51,
255-263.
Adler, L. A., Liebowitz, M., Kronenberger, W., Qiao, M., Rubin, R.,
Hollandbeck, M., . . . Durell, T. (2009). Atomoxetine treat-
ment in adults with attention-deficit/hyperactivity disorder
and comorbid social anxiety disorder. Depression and Anxiety,
26, 212-221.
Aman, M. G. (2004). Management of hyperactivity and other acting-
out problems in patients with autism spectrum disorder. Semi-
nars in Pediatric Neurology, 11, 225-228.
Aman, M. G., Farmer, C. A., Hollway, J., & Arnold, L. E. (2008).
Treatment of inattention, overactivity, and impulsiveness in
autism spectrum disorders. Child & Adolescent Psychiatrc
Clinics of North America, 17, 713-738.
Arnold, L. E., Aman, M. G., Cook, A. M., Witwer, A. N., Hall, K. L.,
Thompson, S., & Ramadan. (2006). Atomoxetine for hyper-
activity in autism spectrum disorders: Placebo-controlled
crossover pilot trial. Journal American Academy of Child and
Adolescent Psychiatry, 45, 1196-1205.
Bangs, M. E., Emslie, G. J., Spencer, T. J., Ramsey, J. L., Carlson, C.,
Bartky, E. J., . . . Sumner, C. R. (2007). Efficacy and safety of
atomoxetine in adolescents with attention-deficit/hyperactivity
disorder and major depression. Journal of Child and Adoles-
cent Psychopharmacology, 17, 407-420.
Bangs, M. E., Tauscher-Wisniewski, S., Polzer, J., Zhang, S.,
Acharya, N., Desaiah, D., . . . Allen, A. J. (2008). Meta-analysis
of suicide-related behavior events in patients treated with ato-
moxetine. Journal of American Academy of Child and Adoles-
cent Psychiatry, 47, 209-218.
Bymaster, F. P., Katner, J. S., Nelson, D. L., Hemrick-Luecke, S. K.,
Threlkeld, P. G., Heiligenstein, J. H., . . . Perry, K. W. (2002).
Atomoxetine increases extracellular levels of norepinephrine
and dopamine in prefrontal cortex of rat: A potential mechanism
for efficacy in attention deficit/hyperactivity disorder. Neuro-
psychopharmacology, 27, 699-711.
Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012
5
Charnsil, C. (2011). Efficacy of atomoxetine in children with
severe autistic disorders and symptoms of ADHD: An open-
label study. Journal of Attention Disorders, 15(8), 684-689.
Cheng, J. Y., Chen, R. Y., Ko, J. S., & Ng, E. M. (2007). Efficacy and
safety of atomoxetine for attention-deficit/hyperactivity disorder
in children and adolescents—Meta-analysis and meta-regression
analysis. Psychopharmacology (Berl), 194, 197-209.
Findling, R. L. (2008). Evolution of the treatment of attention-
deficit/hyperactivity disorder in children: A review. Clinical
Therapeutic, 30, 942-957.
Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD
symptom subtypes in children with pervasive developmental
disorder. Journal of Autism and Developmental Disorders, 36,
271-283.
Garnock-Jones, K. P., & Keating, G. M. (2009). Atomoxetine: A
review of its use in attention-deficit hyperactivity disorder in
children and adolescents. Paediatric Drugs, 11, 203-226.
Ghanizadeh, A. (2010). Factor analysis on ADHD and autism
spectrum disorder DSM-IV-derived items shows lack of over-
lap. European Child & Adolescent Psychiatry, 19, 797-798.
Ghanizadeh, A. (2012). Co-morbidity and factor analysis on atten-
tion deficit hyperactivity disorder and autism spectrum disor-
der DSM-IV-derived items. Journal of Research in Medical
Sciences.
Ghanizadeh, A., & Mosallaei, S. (2009). Psychiatric disorders and
behavioral problems in children and adolescents with Tourette
syndrome. Brain & Development, 31, 15-19.
Hazell, P. (2007). Drug therapy for attention-deficit/hyperactivity
disorder-like symptoms in autistic disorder. Journal of Paedi-
atrics and Child Health, 43, 19-24.
Jou, R. J., Handen, B. L., & Hardan, A. Y. (2005). Retrospective
assessment of atomoxetine in children and adolescents with
pervasive developmental disorders. Journal of Child and Ado-
lescent Psychopharmacology, 15, 325-330.
Koda, K., Ago, Y., Cong, Y., Kita, Y., Takuma, K., & Matsuda, T.
(2010). Effects of acute and chronic administration of atomox-
etine and methylphenidate on extracellular levels of noradren-
aline, dopamine and serotonin in the prefrontal cortex and
striatum of mice. Journal of Neurochemistry, 114, 259-270.
Kratochvil, C. J., Milton, D. R., Vaughan, B. S., & Greenhill, L. L.
(2008). Acute atomoxetine treatment of younger and older chil-
dren with ADHD: A meta-analysis of tolerability and efficacy.
Child & Adolescent Psychiatry & Mental Health, 2(1), 25.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C.,
Ioannidis, J. P., . . . Moher, D. (2009). The PRISMA statement
for reporting systematic reviews and meta-analyses of studies
that evaluate health care interventions: Explanation and elabo-
ration. PLoS Medicine, 6(7), e1000100.
McCarthy, J. (2007). Children with autism spectrum disorders and
intellectual disability. Current Opinion in Psychiatry, 20, 472-476.
Murray, M. J. (2010). Attention-deficit/hyperactivity disorder in
the context of autism spectrum disorders. Current Psychiatry
Reports, 12, 382-388.
6 Journal of Attention Disorders XX(X)
Myers, S. M. (2007). The status of pharmacotherapy for autism
spectrum disorders. Expert Opin Pharmacother, 8, 1579-1603.
Niederhofer, H., Damodharan, S. K., Joji, R., & Corfield, A.
(2006). Atomoxetine treating patients with autistic disorder.
Autism, 10, 647-649.
Perwien, A. R., Faries, D. E., Kratochvil, C. J., Sumner, C. R.,
Kelsey, D. K., & Allen, A. J. (2004). Improvement in health-
related quality of life in children with ADHD: An analysis of
placebo controlled studies of atomoxetine. Journal of Devel-
opmental & Behavioral Pediatrics, 25, 264-271.
Polanczyk, G., Bigarella, M. P., Hutz, M. H., & Rohde, L. A.
(2010). Pharmacogenetic approach for a better drug treatment
in children. Current Pharmaceutical Design, 16, 2462-2473.
Posey, D. J., Aman, M. G., McCracken, J. T., Scahill, L.,
Tierney, E., Arnold, L. E., . . . McDougle, C. J. (2007). Positive
effects of methylphenidate on inattention and hyperactivity in
pervasive developmental disorders: An analysis of secondary
measures. Biological Psychiatry, 61, 538-544.
Posey, D. J., Wiegand, R. E., Wilkerson, J., Maynard, M., Stigler, K. A.,
& McDougle, C. J. (2006). Open-label atomoxetine for attention-
deficit/hyperactivity disorder symptoms associated with high-
functioning pervasive developmental disorders. Journal of
Child and Adolescent Psychopharmacology, 16, 599-610.
Rajapakse, T., & Pringsheim, T. (2010). Pharmacotherapeutics of
Tourette syndrome and stereotypies in autism. Seminars in
Pediatric Neurology, 17, 254-260.
Sangal, R. B., Owens, J., Allen, A. J., Sutton, V., Schuh, K.,
& Kelsey, D. (2006). Effects of atomoxetine and meth-
ylphenidate on sleep in children with ADHD. Sleep, 29,
1573-1585.
Downloaded from jad.sagepub.com at UNIV OF VIRGINIA on September 12, 2012
Spencer, T. J., Sallee, F. R., Gilbert, D. L., Dunn, D. W.,
McCracken, J. T., Coffey, B. J., . . . Mintz, M. (2008). Atomox-
etine treatment of ADHD in children with comorbid Tourette
syndrome. Journal of Attention Disorders, 11, 470-481.
Stigler, K. A., Desmond, L. A., Posey, D. J., Wiegand, R. E., &
McDougle, C. J. (2004). A naturalistic retrospective analysis of
psychostimulants in pervasive developmental disorders. Jour-
nal of Child and Adolescent Psychopharmacology, 14, 49-56.
Troost, P. W., Steenhuis, M. P., Tuynman-Qua, H. G.,
Kalverdijk, L. J., Buitelaar, J. K., Minderaa, R. B., &
Hoekstra, P. J. (2006). Atomoxetine for attention-deficit/
hyperactivity disorder symptoms in children with pervasive
developmental disorders: A pilot study. Journal of Child and
Adolescent Psychopharmacology, 16, 611-619.
Valicenti-McDermott, M., McVicar, K., Rapin, I., Wershil, B. K.,
Cohen, H., & Shinnar, S. (2006). Frequency of gastrointestinal
symptoms in children with autistic spectrum disorders and asso-
ciation with family history of autoimmune disease. Journal of
Developmental & Behavioral Pediatrics, 27, S128-S136.
Zeiner, P., Gjevik, E., & Weidle, B. (2011). Response to atomox-
etine in boys with high-functioning autism spectrum disorders
and attention deficit/hyperactivity disorder. Acta Paediatrica,
100, 1258-1261.
Bio
Ahmad Ghanizadeh, MD, is associate professor of child and
adolescent psychiatry in the Department of Psychiatry at Shiraz
University of Medical Sciences, Iran. Also, he is the director of
the Research Center of Psychiatry and Behavioral Sciences. His
research area is mainly focused on ADHD and autism.