Lisdexamfetamine-Induced Psychosis in a Patient With a Neurodevelopmental Disorder

Individuals diagnosed with autism spectrum disorder (ASD) often experience a higher occurrence of comorbid attention deficit hyperactivity disorder (ADHD). Stimulant medications are frequently prescribed to manage ADHD. In rare instances, the use of stimulant medications has been linked to the development of psychotic symptoms. This is a case of a 13-year-old male diagnosed with ASD and comorbid ADHD, anxiety, and depression, who presented with an abrupt onset of psychosis, which manifested about a week after the initiation of lisdexamfetamine. The psychotic symptoms subsided upon discontinuation of lisdexamfetamine; however, there was a re-emergence of severe ADHD symptoms that proved resistant to non-stimulant medications. The patient experienced significant improvement without any recurrence of psychosis after being prescribed extended-release methylphenidate. Notably, there are no established clinical guidelines to assist in selecting one stimulant over another in the treatment of ADHD comorbid with ASD. The authors recommend considering the methylphenidate class of stimulants as a first-line treatment for ADHD in individuals with ASD, citing better tolerability compared to amphetamines.