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Extended-release guanfacine safe, effective for hyperactive symptoms in children with ASD

Extended-release guanfacine was safe and effective for short-term treatment of hyperactivity, impulsiveness and distractibility in children with autism spectrum disorder, according to study findings in the American Journal of Psychiatry.

“Although DSM-IV advised against giving a diagnosis of attention deficit hyperactivity disorder (ADHD) to children with [autism spectrum disorder (ASD)], DSM-5 discarded this convention. When present, hyperactivity, impulsiveness and distractibility add to the overall impairment in children with ASD. Not surprisingly, stimulants and alpha agonists are commonly used to treat ADHD symptoms in children with ASD,” Lawrence Scahill, MSN, PhD, of Emory University School of Medicine, Atlanta, and colleagues wrote.

Researchers randomly assigned 62 children with ASD and hyperactivity, impulsiveness and distractibility to extended-release guanfacine (n = 30) or placebo (n = 32) for 8 weeks. Study participants had a mean age of 8.5 years.

Children who received guanfacine exhibited a 43.6% decrease in scores on the Aberrant Behavior Checklist-hyperactivity subscale compared with a 13.2% decrease among children who received placebo.

The rate of positive response — much improved or very much improved — on the Clinical Global Impression-Improvement scale was 50% for those taking guanfacine and 9.4% for those taking placebo.

There were no group differences in working memory or motor planning before or after 8 weeks of treatment.

The most common adverse events included drowsiness, fatigue and decreased appetite.

There were no significant changes on electrocardiogram for either group, though blood pressure declined among children receiving guanfacine in the first 4 weeks but returned to baseline by week 8. Pulse rate followed a similar pattern, according to researchers.

“The results of this trial indicate that extended-release guanfacine is safe and effective for short-term treatment of hyperactivity, impulsiveness and distractibility in children with ASD. The rate of positive response on the [Clinical Global Impression–Improvement] is similar to what has been reported in previous trials of extended-release guanfacine in children with ADHD. The results of the present study extend pilot study findings of immediate-release guanfacine in this population,” the researchers concluded. – by Amanda Oldt

Disclosure: Shire Pharmaceuticals provided active extended-release guanfacine and placebo. Scahill reports serving as a consultant for Bracket, Coronado, MedAdvante, Neuren, Roche, and Shire, and serving on the speaker’s bureau for the Tourette Syndrome Association. Please see the full study for a list of all authors’ relevant financial disclosures.