There is a paucity of high quality evidence assessing interventions for children with both FASD and ADHD.36 There are two very small, randomized, controlled trials which examine the use of stimulant medication. The first study compared methylphenidate with placebo (n = 4). Compared with placebo, methylphenidate improved hyperactivity and impulsivity symptoms but not attention.37 Adverse effects from the methylphenidate were reported for three of the four children, and one child had to discontinue methylphenidate 12 weeks into the trial due to excessive weight loss. In the second study, usual stimulant medication was compared with placebo (n = 12). Compared with placebo, stimulants improved hyperactivity symptoms but not attention.38 Psychopharmacologic agents have also been examined in retrospective and uncontrolled studies.29,39,40 In one study, stimulant medication improved hyperactivity and impulsivity scores, but inattention was less responsive to medication.40 In a retrospective study, there was a suggestion that children with ADHD and FASD had a preferential response to dexamphetamine.29 The role of atomoxetine is being assessed in two studies including one randomized controlled trial.36
