Therapies for Children With Autism Spectrum Disorders

No significant difference between citalopram and placebo arms was seen in measures of
repetitive behavior, with similar baseline scores on the Children’s Yale-Brown Obsessive
Compulsive Scale-PDD version (15.1 vs. 15.0) and similar improvements (2.0 vs. 1.9) in each
arm. The other measures of repetitive behavior, including the Repetitive Behavior Scale-Revised,
also showed similar baseline scores and similar improvements in each arm with no evidence for
an effect of citalopram (Table 18). 222 The CGI-Improvement similarly showed no significant
difference between the citalopram and the placebo arm. On the other hand, the primary measure
of challenging behavior reported in this trial, the ABC-C Irritability subscale, showed an
advantage for citalopram.
The baseline ratings were not statistically different between the citalopram and placebo arms
(13.2 and 11.2, respectively), but more improvement was seen for citalopram (3.2) than for
placebo (0.9). 222 Adverse effects in this study included a marked increase in what were termed
“activation” symptoms, including increased energy, hyperactivity, inattention, disinhibition, and
decreased sleep in the citalopram arm in comparison to the placebo arm. 222 Diarrhea and dry or
itchy skin were also more common in the citalopram arm. 222
Table 18. Outcomes of studies of SRIs for the treatment of repetitive and challenging behaviors in
ASDs
Author, year,
country
Study quality
King et al. 222
2009, US
Quality: Good
Hollander et al. 220
2005, US
Quality: Fair
Groups, N
enrollment/N
final
G1:citalopram
hydrobromide,
73/60
G2:placebo,
76/63
G1a:placebo
/fluoxetine,
placebo
segment
45(total)/20
G1b:placebo/
fluoxetine,
fluoxetine
segment
45(total)/20
G2a:fluoxetine/p
lacebo,
fluoxetine
segment
45(total)/19
G2a:fluoxetine/p
lacebo, placebo
segment
Mean
age,
years ±
SD
G1: 9.1 ±
3.2
G2: 9.6 ±
3.1
7.35
SD - NR
Mean IQ ±
SD
G1:
>70, N (%):
43(61.4)
G2:
>70, N (%):
43(60.6)
68
Outcome
measure/Baseline
scores, mean ± SD
CYBOCS-PDD:
G1:15.1 ± 1.8
G2: 15 ± 2.1
68.1 ± 26.7 CYBOCS:
Wk 0: 13.5 ± 2.9
7.35 68.1 ± 26.7 CYBOCS:
Wk 12: 12.9 ± 3.5
9.1±3.7
9.1±3.7
59.2 ± 29.1 CYBOCS:
Wk 0: 12.8 ± 2.6
59.2 ± 29.1 CYBOCS:
Wk 12: 12.2 ± 3.5
Outcome
measure/Posttreatment
scores a ,
mean ± SD
CYBOCS-PDD:
G1: 13.1 ± 3.7
G2: 13.1 ± 3.2
CYBOCS:
Wk 8: 13.0 ± 3.2
CYBOCS:
Wk 20: 11.8 ± 3.2
P0.05 for parallel
group comparison of
G2a to G1a
CYBOCS:
Wk 20: 12.4 ± 2.4
45(total)/19
a
Decrease in scores on outcome measure indicates improvement in behavior assessed. ABC-C=Aberrant Behavior Checklist-
Community Version; CYBOCS=Children’s Yale-Brown Obsessive Compulsive Scale; CYBOCS-PDD=Children’s Yale-Brown
Obsessive Compulsive Scale-Pervasive Development Disorders