Psychology, Department of


Date of this Version



Arch Gen Psychiatry. 2009 June ; 66(6): 583–590. doi:10.1001/archgenpsychiatry.2009.30


Copyright © 2009 American Medical Association. Used by permission.


Context—Selective serotonin reuptake inhibitors are widely prescribed for children with autism spectrum disorders.

Objectives—To determine the efficacy and safety of citalopram hydrobromide therapy for repetitive behavior in children with autism spectrum disorders.

Design—National Institutes of Health–sponsored randomized controlled trial.

Setting—Six academic centers, including Mount Sinai School of Medicine, North Shore–Long Island Jewish Health System, University of North Carolina at Chapel Hill, University of California at Los Angeles, Yale University, and Dartmouth Medical School.

Participants—One hundred forty-nine volunteers 5 to 17 years old (mean [SD] age, 9.4 [3.1] years) were randomized to receive citalopram (n = 73) or placebo (n = 76). Participants had autistic spectrum disorders, Asperger disorder, or pervasive developmental disorder, not otherwise specified; had illness severity ratings of at least moderate on the Clinical Global Impressions, Severity of Illness Scale; and scored at least moderate on compulsive behaviors measured with the Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders.

Interventions—Twelve weeks of citalopram hydrobromide (10 mg/5 mL) or placebo. The mean (SD) maximum dosage of citalopram hydrobromide was 16.5 (6.5) mg/d by mouth (maximum, 20 mg/d).

Main Outcome Measures—Positive response was defined by a score of much improved or very much improved on the Clinical Global Impressions, Improvement subscale. An important secondary outcome was the score on the Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders. Adverse events were systematically elicited using the Safety Monitoring Uniform Report Form.

Results—There was no significant difference in the rate of positive response on the Clinical Global Impressions, Improvement subscale between the citalopram-treated group (32.9%) and the placebo group (34.2%) (relative risk, 0.96; 95% confidence interval, 0.61-1.51; P> .99). There was no difference in score reduction on the Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders from baseline (mean [SD], −2.0 [3.4] points for the citalopram-treated group and −1.9 [2.5] points for the placebo group; P=.81). Citalopram usewas significantly more likely to be associated with adverse events, particularly increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin or pruritus.

Conclusion—Results of this trial do not support the use of citalopram for the treatment of repetitive behavior in children and adolescents with autism spectrum disorders.

STAART Psychopharmacology Network Group Members: Rosemary Affeldt, MSW, LICSW; Denisse Ambler, MD; George Anderson, PhD; May-Lynn Andresen, RN; Grace Baranek, PhD; Jennifer Bartz, PhD; Karen Bearss, PhD; Terrence C. Bethea, MD; Jennifer Cowen, MA; Pegeen Cronin, PhD; Margaret DeRamus, BA; Robert Dimino, PhD; Tywanda Ellison, PhD; Nicole Feirsen, BA; Lilia Fenelon, BA; Anita Gordon, MSW; Danielle Halpern, PhD; Marisa B. Houser, MS; Cathy Jones, BA; Lawrence Kaplan, MD; Paul Kartheiser, MD; Robyn Keske, MSW, MPH; Young Shin Kim, MD, PhD; Kathy Koenig, MSN; Erin Kustan, BA; Kathleen Lapp, MD; Arthur Maerlender, PhD; Brenna McDonald, PsyD, MBA; Debra McQuade, PhD, MD; Shana Nichols, PhD; Roumen Nikolov, MD; Maryellen Pachler, MSN; Emily Quinn, MA; Idania Ramirez, MPH; Jennifer Richards, MD; Peter Robichaux, BA; Fay Robinson, BA; Jade Rusoff, BA; Bhavik Shah, MD; Latha Soorya, PhD; Linda Spritzer, BA; Erika Swanson, BA; Tara Tripp, MA; John Vidaver, MA; Shulamit Waldoks, BA; A. Ting Wang, PhD; Stacey Wasserman, MD; and Emily Williams, MEd.