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CNS Stimulants: Use of Stimulants
The side effects of stimulant medication include appetite suppression with possible weight loss, which, when excessive, can decrease height growth. The cardiovascular system is also stimulated, including
heart rate and blood pressure. Children on stimulant medication should be seen by their physicians at least every four to six months to monitor height, weight, and cardiovascular parameters. If weight is maintained at the
pretreatment percentile and has a steady normal increase with time, height growth does not decline. In approximately 10% of ADHD cases, stimulants may exacerbate an underlying tic disorder because of dopaminergic stimulation
(Lipkin et al. 1994).
Stimulants are commonly used in boys with FXS even before the diagnosis is made. In general, children with FXS are sensitive to stimulants, and their mood often becomes brittle, with an increase in
outbursts at higher doses. For children up to five years old, a starting dose would be 2.5 mg of methylphenidate or dextroamphetamine twice a day. For children older than five years, a methylphenidate dose of 0.2-0.3 mg/kg/dose is
usually sufficient. Higher doses of stimulants may cause a decrease in verbalizations (Gadow et al. 1995) or an increase in perseverations (Dyme et al. 1982), both of which are counterproductive in children with FXS. An occasional
male with FXS may develop motor tics on stimulants, and then an alternative medication such as clonidine should be considered.
Since ADHD symptoms in children with FXS usually begin in the preschool period, families are often ready to start medication treatment before the child is five years of age. Although stimulants can
be efficacious under five years in children with ADHD (Rappley et al. 1999), our experience in preschoolers with FXS has shown that the majority can become irritable with exacerbation of behavioral problems so it is suggested that
other medications, such as clonidine or guanfacine (described below), be tried first. In a recent survey of medication use in 177 children between 5 and 18 years with FXS, 39% of boys and 19% of girls were treated with
methylphenidate; 22% of boys and girls were treated with Adderall; 2% of boys and 3% of girls were treated with Dexedrine (Amaria et al. 2001). Similar percentages were reported for more than 100 children with FXS treated in
Chicago (Berry-Kravis 2000).
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This article is not intended to give medical advice for individual cases. Any change in medical treatment
should be done in consultation with appropriate medical personnel. This article is written for medical professionals. Some of the terms will be unfamiliar to those who are not trained in medical fields.
*This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited
by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002. It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in
the book which are not included as part of this website.
The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling
1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.
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Medical Follow-up Pharmacotherapy Future Prospects
Outline Medications Medical Conditions
References: A, B, C, D, EF, G, H, IJ, K, L, M, NOP, QR, S, T, UVWXYZ
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