Practitioner Review: Pharmacological treatment of attention-deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: Clinically significant attention-deficit/hyperactivity disorder (ADHD) symptoms are common and impairing in children and youth with autism spectrum disorder(ASD). The aim of this systematic review and meta-analysis was to (a) evaluate the efficacy and safety of pharmacotherapy for the treatment of ADHD symptoms in ASD and (b) distil findings for clinical translation. METHODS: We searched electronic databases and clinical trial registries (1992 onwards). We selected randomized controlled trials conducted in participants <25 years of age, diagnosed with ASD that evaluated ADHD outcomes (hyperactivity/impulsivity and inattention) following treatment with stimulants (methylphenidate or amphetamines), atomoxetine, alpha-2 adrenergic receptor agonists, antipsychotics, tricyclic antidepressants, bupropion, modafinil, venlafaxine, or a combination, in comparison with placebo, any of the listed medications, or behavioral therapies. Data were pooled using a random-effects model. RESULTS: Twenty-five studies (4 methylphenidate, 4 atomoxetine, 1 guanfacine, 14 antipsychotic, 1 venlafaxine, and 1 tianeptine) were included. Methylphenidate reduced hyperactivity (parent-rated: standardized mean difference [SMD] = -.63, 95%CI = -.95,-.30; teacher-rated: SMD = -.81, 95%CI = -1.43,-.19) and inattention (parent-rated: SMD = -.36, 95%CI = -.64,-.07; teacher-rated: SMD = -.30, 95%CI = -.49,-.11). Atomoxetine reduced inattention (parent-rated: SMD = -.54, 95%CI = -.98,-.09; teacher/investigator-rated: SMD = -0.38, 95%CI = -0.75, -0.01) and parent-rated hyperactivity (parent-rated: SMD = -.49, 95%CI = -.76,-.23; teacher-rated: SMD = -.43, 95%CI = -.92, .06). Indirect evidence for significant reductions in hyperactivity with second-generation antipsychotics was also found. Quality of evidence for all interventions was low/very low. Methylphenidate was associated with a nonsignificant elevated risk of dropout due to adverse events. CONCLUSIONS: Direct pooled evidence supports the efficacy and tolerability of methylphenidate or atomoxetine for treatment of ADHD symptoms in children and youth with ASD. The current review highlights the efficacy of standard ADHD pharmacotherapy for treatment of ADHD symptoms in children and youth with ASD. Consideration of the benefits weighed against the limitations of safety/efficacy data and lack of data evaluating long-term continuation is undertaken to help guide clinical decision-making regarding treatment of co-occurring ADHD symptoms in children and youth with ASD.

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data.

AIM: There is limited evidence examining admissions in early psychosis. We sought to estimate the proportion of people with a psychiatric admission within 2 years of the first diagnosis of psychosis, and to identify associated risk factors. METHOD: We constructed a cohort of incident non-affective psychosis cases using health administrative data and identified the first psychiatric hospitalization after psychosis onset. We compared hospitalization rates across sociodemographic, clinical and service-use factors. RESULTS: One in three patients had an admission within 2 years of first diagnosis. Younger age, migrant status, diagnosis of psychosis not otherwise specified, and prior substance use were associated with increased hospitalization rates, whereas family physician involvement in diagnosis was protective. CONCLUSIONS: Adolescents, immigrants and people presenting with diagnostic instability or prior substance use issues may benefit from interventions aimed at reducing hospitalization risk. Increasing primary care access and utilization among youth with early psychosis may also reduce hospitalization rates.

Survey of Ontario veterinarians' knowledge and attitudes on pain in dogs and cats in 2012.

Appropriate management of animal pain is a critical component of optimal animal welfare in small animal veterinary clinics. An online convenience survey was used to examine the knowledge and attitudes of practicing veterinarians in Ontario about pain in dogs (n = 100) and cats (n = 139). Veterinarian participants showed strong agreement with the need for appropriate animal pain relief, and low agreement with lack of analgesic use due to cost or side effects. All of the surgical procedures included in the survey were ranked as being moderately to highly painful, but female veterinarians had higher median rankings. Importantly, 78% of veterinarians thought their knowledge about pain recognition was sufficient. Selection bias might have resulted in overestimates of attitudes about pain in comparison to the general veterinary population. However, these results suggest that knowledge and attitudes related to pain assessment and treatment in dogs and cats have improved since the last similar survey in 2001.

Sondage sur les connaissances et les attitudes des vétérinaires de l'Ontario à propos de la douleur chez les chiens et les chats en 2012. La gestion appropriée de la douleur animale est une composante critique du bien-être animal dans les cliniques vétérinaires pour petits animaux. Un sondage de convenance en ligne a été mené pour examiner les connaissances et les attitudes des vétérinaires praticiens en Ontario à propos de la douleur chez les chiens (n = 100) et les chats (n = 139). Les participants vétérinaires se sont dits fortement en accord avec le besoin d'analgésie appropriée pour soulager la douleur des animaux et très peu en accord avec l'absence d'utilisation des analgésiques en raison du coût ou des effets secondaires. Toutes les interventions chirurgicales incluses dans le sondage étaient classées comme étant modérément à très douloureuse, mais les femmes vétérinaires présentaient des classements moyens supérieurs. Fait important, 78 % des vétérinaires croyaient que leurs connaissances à propos de la reconnaissance de la douleur étaient suffisantes. Le biais de sélection pourrait s'être traduit par des surestimations des attitudes à propos de la douleur comparativement à la population vétérinaire en général. Cependant, ces résultats suggèrent que les connaissances et les attitudes se rapportant à l'évaluation de la douleur et au traitement des chiens et des chats se sont améliorées depuis le dernier sondage semblable réalisé en 2001.(Traduit par Isabelle Vallières).