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The Use of Methylphenidate in Autism
822
LEITERS TO EDITOR
that we are uncertain whether our findings can be generalized to that clinical population. However, our results do suggest that IQ and mental age may be important variables moderating clinical response to the stimulants in developmentally disabled children. It is possible that greater attention to these factors may help to explain some of the apparently conflicting results in the literature on stimulants with autistic children. REFERENCES
Aman, M. G. (1982), Stimulant drug effects in developmental disorders and hyperactivity. J. Autism Dev. Disord., 12:385-398. Birmaher, B., Quintana, H., & Greenhill, L. L. (1988), Methylphenidate treatment of hyperactive autistic children. J. Am. Acad. Child Adolesc. Psychiatry, 27:248-251. Geller, B., Guttmacher, L. B. & Bleeg, M. (1981), Coexistence of childhood onset pervasive developmental disorder and attention deficit disorder with hyperactivity. Am. J. Psychiatry, 138:388389. Hoshino, Y., Kumashiro, H., Kaneko, M. & Takahashi, Y. (1977), The effects of methylphenidate on early infantile autism and its relation to serum serotonin levels. Folia Psychiatrica et Neurologica Japonica, 31:605-614. Strayhorn, J. M., Rapp, N., Donina, W. & Strain, P. S. (1988), Randomized trial of methylphenidate for an autistic child. J. Am. Acad. Child Ado/esc. Psychiatry, 27:244-247. Vitriol, C. & Farber, B. (1981), Stimulant medication in certain childhood disorders. Am. J. Psychiatry, 138:1517-1518. Michael Aman, Ph.D. Director of Research The Nisonger Center for Mental Retardation and Developmental Disabilities Associate Professor of Psychology The Ohio State University Columbus, Ohio
Drs. Birmaher and Quintana Reply: We agree with Dr. Aman's comments. Our article on methylphenidate treatment for hyperactive autistic children (Birmaher et aI., 1988) was only a pilot uncontrolled study whose goals were to show that it is possible to give methylphenidate (MPH) to autistic children and to stimulate additional research. We recommended that, although the results were positive, the study had many shortcomings and more research needs to be done before methylphenidate will be a standard recommendation for the treatment of hyperactive autistic children. In follow-up, most of the children who participated in the study developed tolerance to MPH or had rebound of their hyperactivity during the evenings and needed to be given small doses of neuroleptics. Dr. Aman's findings that the response to MPH may be correlated with the IQ is a very interesting one. The number of patients in our study was too small to correlate IQ and response to MPH; however, it is important to notice that most of the children in our study responded to MPH without developing significant side effects. One child (L.R.) whose IQ was very low did not respond, but he also was the oldest of the group. Another child (L.M.) also had a very low IQ and he responded only when the dose of MPH was raised to 50 mg/ day. REFERENCES
Birmaher, B., Quintana, H. & Greenhill, L. (1988), Methylphenidate treatment of hyperactive autistic children. J. Am. Acad. Child Adolesc. Psychiatry, 27:248-251. Boris Birmaher, M.D. Humberto Quintana, M.D. Department of Child Psychiatry New York Psychiatric Institute New York, New York
LEITERS TO EDITOR
that we are uncertain whether our findings can be generalized to that clinical population. However, our results do suggest that IQ and mental age may be important variables moderating clinical response to the stimulants in developmentally disabled children. It is possible that greater attention to these factors may help to explain some of the apparently conflicting results in the literature on stimulants with autistic children. REFERENCES
Aman, M. G. (1982), Stimulant drug effects in developmental disorders and hyperactivity. J. Autism Dev. Disord., 12:385-398. Birmaher, B., Quintana, H., & Greenhill, L. L. (1988), Methylphenidate treatment of hyperactive autistic children. J. Am. Acad. Child Adolesc. Psychiatry, 27:248-251. Geller, B., Guttmacher, L. B. & Bleeg, M. (1981), Coexistence of childhood onset pervasive developmental disorder and attention deficit disorder with hyperactivity. Am. J. Psychiatry, 138:388389. Hoshino, Y., Kumashiro, H., Kaneko, M. & Takahashi, Y. (1977), The effects of methylphenidate on early infantile autism and its relation to serum serotonin levels. Folia Psychiatrica et Neurologica Japonica, 31:605-614. Strayhorn, J. M., Rapp, N., Donina, W. & Strain, P. S. (1988), Randomized trial of methylphenidate for an autistic child. J. Am. Acad. Child Ado/esc. Psychiatry, 27:244-247. Vitriol, C. & Farber, B. (1981), Stimulant medication in certain childhood disorders. Am. J. Psychiatry, 138:1517-1518. Michael Aman, Ph.D. Director of Research The Nisonger Center for Mental Retardation and Developmental Disabilities Associate Professor of Psychology The Ohio State University Columbus, Ohio
Drs. Birmaher and Quintana Reply: We agree with Dr. Aman's comments. Our article on methylphenidate treatment for hyperactive autistic children (Birmaher et aI., 1988) was only a pilot uncontrolled study whose goals were to show that it is possible to give methylphenidate (MPH) to autistic children and to stimulate additional research. We recommended that, although the results were positive, the study had many shortcomings and more research needs to be done before methylphenidate will be a standard recommendation for the treatment of hyperactive autistic children. In follow-up, most of the children who participated in the study developed tolerance to MPH or had rebound of their hyperactivity during the evenings and needed to be given small doses of neuroleptics. Dr. Aman's findings that the response to MPH may be correlated with the IQ is a very interesting one. The number of patients in our study was too small to correlate IQ and response to MPH; however, it is important to notice that most of the children in our study responded to MPH without developing significant side effects. One child (L.R.) whose IQ was very low did not respond, but he also was the oldest of the group. Another child (L.M.) also had a very low IQ and he responded only when the dose of MPH was raised to 50 mg/ day. REFERENCES
Birmaher, B., Quintana, H. & Greenhill, L. (1988), Methylphenidate treatment of hyperactive autistic children. J. Am. Acad. Child Adolesc. Psychiatry, 27:248-251. Boris Birmaher, M.D. Humberto Quintana, M.D. Department of Child Psychiatry New York Psychiatric Institute New York, New York