title: Clinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders.
abstract: OBJECTIVE
  Hyperactivity, impulsivity, and inattention (referred to as "ADHD [attention-deficit/hyperactivity disorder] symptoms") occur in 41% to 78% of children with autism spectrum disorders (ASDs). These symptoms often affect quality of life, interfering with learning or interventions that target primary ASD symptoms. This practice pathway describes the guidelines for evaluation and treatment of children and adolescents with ASD and comorbid ADHD symptoms.
  
  
  METHODS
  Current research in this area is limited, and, therefore, these recommendations are based on a systematic literature review and expert consensus in the Autism Speaks Autism Treatment Network Psychopharmacology Committee.
  
  
  RESULTS
  The recommended practice pathway includes the Symptom Evaluation Pathway for systematic assessment of ADHD symptoms across settings; examination for comorbid sleep, medical, or psychiatric comorbidities that may contribute to symptoms; and evaluation of behavioral interventions that may ameliorate these symptoms. For children for whom medication is being considered to target the ADHD symptoms, the medication choice pathway provides guidance on the selection of the appropriate agent based on a review of available research, assessment of specific advantages and disadvantages of each agent, and dosing considerations.
  
  
  CONCLUSIONS
  These recommendations provide a framework for primary care providers treating children who have ASD and ADHD symptoms. Our systematic review of the current evidence indicates the need for more randomized controlled trials of the medications for ADHD symptoms in ASD. There will also be a need for studies of the effectiveness of these practice pathways in the future.
authors.affiliation: Department of Psychiatry, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21211, USA. mahajan@kennedykrieger.org
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Mahajan
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Bernal
authors.forename: Rebecca
authors.initials: R
authors.lastname: Panzer
authors.forename: Agnes
authors.initials: A
authors.lastname: Whitaker
authors.forename: Wendy
authors.initials: W
authors.lastname: Roberts
authors.forename: Benjamin
authors.initials: B
authors.lastname: Handen
authors.forename: Antonio
authors.initials: A
authors.lastname: Hardan
authors.forename: Evdokia
authors.initials: E
authors.lastname: Anagnostou
authors.forename: Jeremy
authors.initials: J
authors.lastname: Veenstra-VanderWeele
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000150:complications*; D019091:Critical Pathways; D005260:Female; D006801:Humans; D008297:Male