Atomoxetine is indicated for the management of attention deficit/hyperactivity disorder (ADHD) in children and adolescents aged 6 to 18 years. Few studies have assessed the safety and tolerability of atomoxetine in younger patients. This retrospective cohort study included 133 children aged 3–6 years who were diagnosed with ADHD comorbid with autism spectrum disorder (ASD). The primary endpoint was the evaluation of the safety profile of atomoxetine. In total, 50 patients (37.6%) experienced adverse events (AEs), which led to treatment discontinuation in 23 patients (17.3%). The most common AEs were gastrointestinal (24.1%), aggression or hostility (12.8%), and increased hyperactivity (9.0%). In the 23 patients who discontinued treatment, all the AEs resolved after treatment ceased. Among the 110 patients who completed at least 6 months’ treatment, atomoxetine titrated to a dose of 1.2–1.8 mg/kg/day appeared to be well tolerated and effective. The Clinical Global Impression—Improvement score improved to 1 (“very much improved”) and 2 (“much improved”) in 62.4% and 20.3% of children, respectively, at their last visit. Overall, atomoxetine appeared to be well tolerated in younger children with comorbid ADHD and ASD. Nevertheless, close patient monitoring remains essential, and the study limitations necessitate caution in generalizing these findings to broader populations. Long-term prospective studies are required.

Background/Objectives: Routine screening electrocardiograms (ECGs) prior to starting medications for attention-deficit/hyperactivity disorder (ADHD) remain controversial. This real-world study assessed corrected QT (QTc) interval data from pediatric patients who had a baseline ECG performed prior to initiating treatment with ADHD medications and ≥6 months of clinical follow-up. Methods: A retrospective chart review of children aged 2–18 years diagnosed with ADHD with/without autism spectrum disorder (ASD) at child neurology clinics in Jordan (June 2019 and June 2021) was performed, and children were prescribed with ADHD medications to manage symptoms. Patients had ≥6 months of follow-up and no known cardiac disease/family history. A baseline ECG and regular clinical exams were performed for each child. Results: Of 458 patients with baseline ECGs, 362 met the study inclusion criteria. Overall, 286 (79.0%) patients were diagnosed with ASD/comorbid ADHD and 76 (21.0%) with ADHD alone; 61 (16.9%) were prescribed atomoxetine, 38 (10.5%) methylphenidate, 134 (37.0%) risperidone, and 129 (35.6%) aripiprazole. The patients’ mean ± SD age was 6.4 ± 3.5 years, and most were male (n = 268, 74.0%). The mean baseline QTc interval was 400 ± 22 ms (median, 400 ms); one patient had a QTc interval >460 ms and was excluded from initiating treatment with any ADHD medications. During the ≥6-month follow-up, none of the patients had any signs or symptoms of adverse cardiac effects. Conclusions: Routine screening ECGs prior to treatment with ADHD medications may not be necessary in healthy children with no family history of cardiac disease. However, further studies are needed to evaluate the long-term effects of ADHD medications in low-risk pediatric patients.

Background/Objectives: Chronic constipation in patients with autism spectrum disorder (ASD) may be undetected during routine care and can exacerbate ASD symptoms such as irritability and hyperactivity. This retrospective study evaluated the prevalence of radiographic findings suggestive of chronic constipation in children newly diagnosed with ASD, and it compared these findings with those based on routine clinical history and examination alone. Methods: A retrospective chart review of pediatric patients diagnosed with ASD at neurology clinics in Jordan between 2022 and 2025 was conducted. Informed consent was required for an abdominal radiographic examination at screening to initiate the standard treatment protocol at participating clinics. A more stringent version of the Leech criteria, equivalent to a total Leech score of ≥10, was applied to the radiographic images to identify patients with findings suggestive of chronic constipation. Data were extracted via retrospective chart review using a standardized data collection form. Results: Among the 455 patients who met the study eligibility criteria, the mean ± SD age was 6.7 ± 3.3 years (median, 6 years; range, 2–18 years) and 80.2% were male. Most patients had radiographic findings suggestive of chronic constipation at baseline (81.5%, n = 371/455), whereas 5.3% (24/455) had findings suggestive of constipation based on their medical history and clinical examination alone. Conclusions: Radiographic findings suggestive of chronic constipation were common in children newly diagnosed with ASD and were identified substantially more frequently than constipation identified through routine history-taking and clinical examination in the same patients. Prospective studies are warranted to determine whether the use of alternative, standardized methods as adjunct diagnostic tools can improve clinical outcomes in this population.