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Res Dev Disabil. 2014 Jun;35(6):1412-24. doi: 10.1016/j.ridd.2014.03.006. Epub 2014 Apr 16.

A review of atomoxetine effects in young people with developmental disabilities.

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The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States. Electronic address:
Division of Neurodevelopmental and Behavioral Pediatrics at the University of Rochester, Box 671, 601 Elmwood Avenue, Rochester, NY 14642, United States.
The Nisonger Center UCEDD, Ohio State University, McCampbell Hall, 1581 Dodd Dr., Columbus, OH 43210, United States.
Department of Psychiatry at the Western Psychiatric Institute and Clinic, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
Center for Biostatistics, Ohio State University, 2012 Kenny Road, Columbus, OH 43221, United States.


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.


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 the emergence of irritability with ATX treatment. Effects of ATX on cognition in DD are virtually unstudied.


Atomoxetine (Strattera); Autism spectrum disorders; Developmental disabilities; Review

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