June 8, 2009

Common Medication Ineffective for Children with Autism

Photo of a boy's face

The medication citalopram is often prescribed for children with autism to reduce repetitive behaviors. But now a new clinical study shows that the drug is no more effective than a placebo and leads to more adverse effects. The finding highlights the need for rigorous trials to evaluate potential treatments for children with autism.

Autism spectrum disorders (ASD) affect about 1 in 150 children. These brain disorders can impair learning, social understanding, language and the ability to relate to others. Children with ASD also engage in repetitive behaviors, like hand flapping, spinning, swaying, repetitive play and inflexible daily routines.

Like ASD, obsessive compulsive disorder (OCD) can involve repetitive behaviors, and both types of disorders have been linked to abnormalities in the brain's serotonin system. Therefore, some physicians have speculated that a class of drug that effectively treats OCD might also work for ASD. The drug, a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), has become one of the most frequently prescribed medications for children with ASD. However, this use hasn't been approved by the U.S. Food and Drug Administration. Several clinical trials have shown that SSRIs can reduce repetitive behaviors in adults with ASD, but studies of children yielded mixed results.

In the new clinical trial, researchers in the NIH-funded Studies to Advance Autism Research and Treatment (STAART) network evaluated 149 participants, ages 5-17, who had autism or similar developmental disorders. About half were randomly assigned to receive the SSRI citalopram (Celexa), while the rest received an inactive placebo for comparison. Neither the participants nor their health care providers knew which patients received which treatment.

In the June 2009 issue of Archives of General Psychiatry, the researchers reported that roughly 1 out of 3 children in both groups showed fewer or less severe repetitive symptoms after 12 weeks of treatment. However, the children taking citalopram were more likely to have adverse effects, including hyperactivity, impulsiveness, reduced concentration, insomnia and dry skin.

According to the researchers, the results seem to challenge the underlying premise that repetitive behaviors in children with ASD are similar to the repetitive and inflexible behaviors seen with OCD. Further research is needed to study other medications commonly prescribed to children with ASD and compare the effectiveness of those treatment with placebo.

“Parents of children with autism spectrum disorders face an enormous number of treatment options, not all of which are research-based,” says Dr. Thomas R. Insel, director of NIH's National Institute of Mental Health (NIMH). “Studies like this help us to better understand which treatments are likely to be beneficial and safe.”

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