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Attention-Deficit/Hyperactivity Disorder in Medication Treated Preschool-Age Children Without and With Autism

Sandra L Friedman1, Justine Shults2, William Barbaresi3

  • 1University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.

Journal of Developmental and Behavioral Pediatrics : JDBP
|September 10, 2025
PubMed

Insights

Preschoolers with ADHD without autism spectrum disorder (ASD) and those with ADHD and ASD showed more similarities than differences. Stimulant medications were more effective for children with ADHD but not ASD.

Area of Science:

  • Pediatric Neurology
  • Developmental Psychology
  • Pharmacology

Background:

  • Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are common neurodevelopmental conditions in children.
  • Preschool-aged children with ADHD may or may not have co-occurring ASD, impacting treatment approaches.
  • Stimulant and alpha-2-agonist (A2A) medications are commonly used to manage ADHD symptoms.

Purpose of the Study:

  • To compare preschool children with ADHD without ASD (ADHD-ASD) to those with ADHD and ASD (ADHD+ASD).
  • To evaluate the effectiveness and adverse effects of stimulant versus A2A medications in these groups.
  • To identify differences and similarities in demographics, coexisting conditions, and treatment outcomes.

Main Methods:

  • Retrospective review of electronic health records for 497 preschool children (under 72 months) treated for ADHD.
  • Comparison of ADHD-ASD and ADHD+ASD groups based on demographics, comorbidities, medication effectiveness, and adverse events.
  • Analysis of stimulant and A2A medication use, discontinuation factors, and side effects.

Main Results:

  • No significant demographic differences were found between ADHD-ASD and ADHD+ASD groups.
  • The ADHD-ASD group showed stimulant medications to be significantly more effective than A2As.
  • Children with ADHD-ASD experienced more appetite suppression and stomachaches with stimulants; no increased A2A adverse effects were linked to ASD status.

Conclusions:

  • Preschool children with ADHD-ASD and ADHD+ASD exhibit more similarities than differences.
  • Stimulant medications demonstrated superior effectiveness over A2As for the ADHD-ASD group.
  • There is substantial overlap in clinical presentation, medication response, and comorbidities between the two groups.
Abstract

Keywords:
alpha-2 adrenergic agonistsattention-deficit/hyperactivity disorderautism spectrumpreschool-agestimulants

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