Abstract | Summary | Original Article

Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior.

King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, et al., on behalf of the STAART Psychopharmacology Network

Archives of General Psychiatry, 2009; 66(6): 583-590

Question: Is citalopram (Celexa™) safe and effective in the treatment of repetitive behaviours in children with autism spectrum disorders (ASD)?

Background: Children with ASD show stereotypic behaviours, inflexibility, and repetitive play that often looks like the symptoms of obsessive compulsive disorder (OCD). Doctors often prescribe medications to treat these symptoms even though there is little evidence that they are either effective or safe in children with ASD, although they are known to be safe and effective children with OCD. Rigorous testing of these drugs is needed.

Design: This was a multicentre randomized controlled trial.

Setting: Six U.S. academic centres.

Participants: One hundred and forty-nine children aged between 5 and 17 took part in this study. All had a formal diagnosis of autistic disorder, Asperger Syndrome, or PDD-NOS. All had moderate to severe compulsive behaviours. Of this group of children, 73 were randomly assigned to receive citalopram and 76 were assigned to receive a placebo.

Intervention: This was a 12-week randomized controlled trial of citalopram vs placebo.

The participants received the lowest possible dose (2.5 mg per day) with weekly dose increases until a maximum of 20 mg per day was reached.

Main Outcome Measures: The Clinical Global Impressions Scale, and the Children’s Yale-Brown Obsessive Compulsive Scales (modified for PDDs) were used to determine if the use of the medication improved symptoms. The Safety Monitoring Uniform Report Form was used to record reports of side effects.

Main Results: The children in the treatment group who received citalopram did no better on the Clinical Global Impressions – improvement subscale than did the children receiving placebo. There was no difference in score reduction on the Children’s Yale-Brown Obsessive Compulsive Scales. The children receiving the drug were more likely to report increased energy or hyperactivity, problems controlling their impulses, poor concentration, sterotypic behaviours, diarrhea, problems sleeping, and dry or itchy skin.

Conclusions: This study concluded that citalopram is not useful in the treatment of repetitive behaviours in children with Autism Spectrum Disorder (ASD).