Common Autism Medication is Ineffective for Repetitive Behaviors, Study Finds

Citalopram (Celexa), a medication commonly prescribed to children with autism spectrum disorders (ASD), was no more effective than a placebo at reducing repetitive behaviors, according to a multi-site clinical trial.

New information may change treatment protocols for children with autism spectrum disorders

Citalopram (Celexa), a medication commonly prescribed to children with autism spectrum disorders (ASD), was no more effective than a placebo at reducing repetitive behaviors, according to a multi-site clinical trial guided by lead author Bryan H. King, MD, director of the Department of Psychiatry and Behavioral Medicine at Seattle Children's and professor and vice chair of psychiatry at the University of Washington School of Medicine.

Because citalopram is also prescribed for patients with obsessive compulsive disorders (OCD), these study results may challenge the widely held premise that repetitive behaviors in children with ASD are similar to repetitive behaviors often found in cases of OCD. The study “Lack of Efficacy of Citalopram in Children with Autism Spectrum Disorders and High Levels of Repetitive Behavior” was published in the June 2009 issue of Archives of General Psychiatry.

“We’re continuing to learn new information about the multiple variables that may cause or contribute to autism spectrum disorders, as well as how to treat them,” said King. “Even as our understanding of autism grows, so much still remains a mystery. While our study’s findings may be frustrating news for hopeful families and clinicians, each new finding helps us to re-examine and revise treatment plans, refine future studies and build upon what we know as we search for effective treatments and eventually cures for this complex group of disorders.”

“When prescribing any medication we must always weigh the possible benefits against possible risks,” added King. “Because citalopram showed no more benefit than placebo and it may produce side effects, providers need to carefully examine whether it is appropriately prescribed for repetitive behaviors in children with an ASD.

Citalopram is in a class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), which are sometimes prescribed for children with ASD to reduce repetitive behaviors. These behaviors include hand flapping or wringing, repetitive complex body movements like spinning, swaying, or rocking back and forth, repetitive play, and inflexible daily routines.

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

Previous research has suggested that some children with ASD may have abnormalities in their serotonin, a brain chemical that, among many other functions, plays an important role in early brain development. Children with OCD may also have abnormal serotonin function, as well as repetitive or inflexible behaviors. OCD is effectively treated with SSRI s, which leads many doctors to prescribe SSRI s to reduce repetitive behaviors in children with ASD. Even though studies have shown mixed results for use in ASD, SSRI s remain among the most frequently prescribed medications for children with ASD.

This six-site, randomized controlled trial included 149 participants, ages 5-17, who had autism, Asperger disorder, or pervasive developmental disorder-not otherwise specified.

After 12 weeks of treatment, roughly one out of three children in both groups—32.9 percent of those treated with citalopram and 34.2 percent those treated with placebo—showed fewer or less severe repetitive symptoms.

Negative side effects were reported in nearly all children in the study. Symptoms reported significantly more often by the citalopram group than the placebo group included increased energy, impulsiveness, decreased concentration, hyperactivity, diarrhea, insomnia, and dry or itchy skin.

AUDIO: Listen to King discussing the study.

The research was funded by the Studies to Advance Autism Research and Treatment (STAART) network which is jointly funded by: NIMH, the National Institute of Neurological Disorders and Stroke (NINDS), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute on Deafness and Other Communication Disorders, and the National Institute of Environmental Health Sciences, all part of the NIH.

King’s research partners participating in the study included: Eric Hollander, MD, Mount Sinai School of Medicine; Linmarie Sikich, MD, University of North Carolina, Chapel Hill; James T. McCracken, MD, University of California Los Angeles; Lawrence Scahill, MSN, PhD, Yale University; Joel D. Bregman, MD, North Shore Long Island Jewish Health System; Craig L. Donnelly, MD, Dartmouth Medical School; Evdokia Anagnostou, MD, Mount Sinai School of Medicine (currently at the University of Toronto); Kimberly Dukes, PhD, DM-STAT, Boston University; Lisa Sullivan, PhD, Boston University; Deborah Hirtz, MD, at NINDS; Ann Wagner, PhD, at NIMH; Louise Ritz, MBA, at NIMH (currently at NINDS); and the STAART Psychopharmacology Network.

About Seattle Children’s

Seattle Children’s Hospital, Foundation and Research Institute together deliver superior patient care, advance new discoveries and treatments through pediatric research, and raise funds to create better futures for patients. Consistently ranked as one of the top 10 children’s hospitals in the country by U.S. News & World Report, Seattle Children’s Hospital specializes in meeting the unique physical, emotional and developmental needs of children from infancy through young adulthood. Through the collaboration of physicians in nearly 60 pediatric subspecialties, Seattle Children’s Hospital provides inpatient, outpatient, diagnostic, surgical, rehabilitative, behavioral, and emergency and outreach services to families from around the world.

Located in downtown Seattle’s biotech corridor, Seattle Children’s Research Institute is pushing the boundaries of medical research to find cures for pediatric diseases and improve outcomes for children all over the world. Internationally recognized investigators and staff at the research institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention, bioethics and much more.

Seattle Children’s Hospital and Research Foundation and Seattle Children’s Hospital Guild Association work together to gather community support and raise funds for uncompensated care, clinical care and research. The foundation receives nearly 80,000 gifts each year, from lemonade stand proceeds to corporate sponsorships. Seattle Children’s Hospital Guild Association is the largest all-volunteer fundraising network for any hospital in the country, serving as the umbrella organization for 450 groups of people who turn an activity they love into a fundraiser. Support from the foundation and guild association makes it possible for Seattle Children’s care and research teams to improve the health and well-being of all kids.

For more information, visit or follow us on Twitter, Facebook and Instagram.