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Disparities in the prevalence and parent-reported severity of autism and in access to health care were found for children with autism. Programs for children in general (e.g., universal screening for autism) and programs that target traditionally underserved groups of children, their families, and their health care providers should be tested and implemented to optimize case finding of children with autism and to eliminate disparities in access to care and to early intervention.

IMPORTANCE Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. OBJECTIVE To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. DESIGN, SETTING, AND PARTICIPANTS This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91

Objective Impairments associated with attention-deficit/hyperactivity disorder (ADHD) and noncompliance are prevalent in children with autism spectrum disorder (ASD). However, ADHD response to stimulants is well below rates in typically developing children, with frequent side effects. Group studies of treatments for noncompliance are rare in ASD. We examined individual and combined-effectiveness of atomoxetine (ATX) and parent training (PT) for ADHD symptoms and noncompliance. Method In a 3-site, 10-week, double-blind, 2×2 trial of ATX and PT, 128 children (ages 5–14) with ASD and ADHD symptoms were randomized to ATX, ATX+PT, placebo+PT, or placebo. ATX was adjusted to optimal dose (capped at 1.8 mg/kg/day) over 6 weeks and maintained for 4 additional weeks. Nine PT sessions were provided. Primary outcome measures were the parent-rated DSM ADHD symptoms on the Swanson, Nolan and Pelham (SNAP) scale and Home Situations Questionnaire (HSQ). Results On the SNAP, ATX, ATX+PT and placebo+PT were each superior to placebo (effect sizes 0.57–0.98), with p-values of 0.0005, 0.0004 and 0.025, respectively. For noncompliance, ATX and ATX+PT were superior to placebo (effect sizes 0.47–0.64; p values of .03 and .0028, respectively). ATX was associated with decreased appetite but otherwise well-tolerated. Conclusion Both ATX and PT resulted in significant improvement on ADHD symptoms while ATX (both alone and combined with PT) was associated with significant decreases on measures of noncompliance. ATX appears to have a better side effects profile than psychostimulants in the population with ASD.

We examined predictors of outcome (IQ, adaptive behavior, and ASD severity) after 12 and 24 months of early intensive behavioral intervention (EIBI) in 71, 20-59 months old children with autism spectrum disorder (ASD) who were enrolled in publicly-funded, community-based agencies. Predictors included social engagement (combining variables loading onto a single factor: social approach, joint attention, and imitation) and sensorimotor rituals. Younger age and higher IQ at intake predicted favorable outcomes at both 12 and 24 months. Adjusting for age, IQ, baseline predictor scores, EIBI hours, treatment site, and sensorimotor rituals, social engagement predicted superior later IQ and adaptive behavior. In contrast, sensorimotor rituals did not predict outcome. Although limited by the absence of a control group, the study indicates social engagement predicts some EIBI outcomes.

Three procedures for correcting errors made during discrimination training were examined: error statement (saying 'no'), modeling the correct response, and No Feedback. Six children with autism (age 3-7 years) were taught to match words to pictures with each of the three procedures, and the number of trials to mastery was compared across conditions. Results varied across participants. Two participants performed as well with no feedback as they did with an error correction procedure; two acquired skills slightly more quickly with an error correction procedure than with no feedback, but showed no difference between error correction procedures; one did best with error statement; and one did best with modeling. Results indicate that the choice of error correction procedure can have a large effect on rate of skill acquisition but that the optimal procedure may vary across individuals.

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This review summarizes the pharmacokinetic characteristics, pharmacodynamic properties, common side effects, and clinical advantages and disadvantages associated with atomoxetine (ATX) treatment in typically developing children and adults with ADHD. Then the clinical research to date in developmental disabilities (DD), including autism spectrum disorders (ASD), is summarized and reviewed. Of the 11 relevant reports available, only two were placebo-controlled randomized clinical trials, and both focused on a single DD population (ASD). All trials but one indicated clinical improvement in ADHD symptoms with ATX, although it was difficult to judge the magnitude and validity of reported improvement in the absence of placebo controls. Effects of ATX on co-occurring behavioral and cognitive symptoms were much less consistent. Appetite decrease, nausea, and irritability were the most common adverse events reported among children with DD; clinicians should be aware that, as with stimulants, irritability appears to occur much more commonly in persons with DD than in typically developing individuals. Splitting the dose initially, starting below the recommended starting dose, and titrating slowly may prevent or ameliorate side effects. Patience is needed for the slow build-up of benefit. Conclusions: ATX holds promise for managing ADHD symptoms in DD, but properly controlled, randomized clinical trials of atomoxetine in intellectual disability and ASD are sorely needed. Clinicians and researchers should be vigilant for emergence of irritability with ATX treatment. Effects of ATX on cognition in DD are virtually unstudied.