A longitudinal study of the effect of autistic traits on treatment response and side effects in children and adolescents with attention deficit hyperactivity disorder

Objective: To evaluate the efficacy and safety of ADHD treatment as monotherapy or with other psychotropic drugs for 12 weeks in ADHD+autistic traits or ADHD-only groups in children aged 6-12 years diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in a naturalistic course; to reveal the effect and side effect profile and to determine the factors that may be predictive in terms of effect and side effect profile. Material and Method: In our study, 84 patients aged 6-12 years who were diagnosed with ADHD and planned to be started on medication and who were admitted to Ankara University Faculty of Medicine, Child and Adolescent Mental Health and Diseases outpatient clinic were included. The treatment and follow-up of these patients were carried out in the Pediatric and Adolescent Psychiatry outpatient clinic of Ankara University Faculty of Medicine under the supervision of the researcher. The physician who followed the patient briefly informed the family about the study and the patients who volunteered to participate in the study were referred to the researcher for evaluation. The referred subjects were given detailed information about the study and signed an informed consent form. A semi-structured interview was conducted with Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version to the participants to assess comorbidities before starting medication use. In addition, all children were administered the WISC-IV Intelligence Test by an expert psychologist working at Ankara University Faculty of Medicine, Department of Child and Adolescent Mental Health and Diseases. Subsequently, the patients included in the study were administered the Sociodemographic Data Form, Conners Parent Rating Scale-Revised Long Form (CPRS-R/L) and Conners Teacher Rating Scale-Revised Long Form (CTRS-R/L) completed by parents and teachers, Autism Spectrum Screening Questionnaire (ASSQ), Weiss Functional Impairment Scale-Parent Form (WFIRS), Sensory Profile Caregiver Questionnaire (SPCQ), Sensory Profile Adolescent/Adult Questionnaire (SPA), Clinical Global Impression Scale (CGI) and Barkley Stimulant Side Effect Rating Scale were administered. Among the children included in the study, information about side effects was obtained and recorded from the parents via telephone interview 2 weeks after treatment for those who continued follow-up. In addition, the CGI scale was filled out by the researcher by asking the parents. CPRS-R/L and CTRS- R/L, CGI and Barkley Stimulant Side Effect Rating Scale were filled out again by the researcher, parent and teacher to evaluate side effects, improvement in symptoms and treatment response 4 weeks after the initiation of treatment for children who continued to follow-up. Response to treatment was accepted as a 40% or more decrease in scale scores and the medication was continued with dose adjustment. After 12 weeks, all scales given in the first interview were given again to the ADHD patients who continued to use the medication and filled in again by the researcher, parent and teacher. All analyses were performed with IBM SPSS 22.0 and the significance level was accepted as 0.05. Findings: The group with ADHD and autistic trait (AT+) showed significantly more irritability, abdominal pain and nail biting side effects than the group without (AT-). Comorbidity of ODD was found to be significantly higher in the AT+ group than in the AT- group. In both groups, CPRS-R/L, CTRS-R/L, ASSQ and WFIRS scale scores decreased after treatment. Conclusion: The side effects of irritability, abdominal pain and nail biting were significantly higher in the AT+ group compared to the AT- group. It was found that there was a significant decrease in irritability and aggressive/hostile behavior after treatment in ADHD- diagnosed AT+ and AT- groups and the severity of irritability decreased with treatment. We suggest that a careful and cautious approach should be adopted since children with ADHD diagnosed with ADHD with AT+ characteristics may be more sensitive to side effects, and that a low dose should be started when planning medication and the dose increase should be made slowly.