Reducing Repetitive Behaviors with Meds: Not the Goal?

The anti-depressant Celexa for autistic children has been found to be no more effective than a placebo. Indeed, use of the medication was found to have sufficient risks that outweigh any benefits, according to the "largest published study of medication versus dummy pills for autism," yesterday's Associated Press reported.

In the study (published in the Archives of General Psychiatry and funded by the NIH), 149 children aged 5 to 17 were randomly given either up to 20 milligrams daily of Celexa for 12 weeks or a placebo. While about one-third of the participants "showed substantial improvement," most of the children showed "little or no improvement or got worse," with adverse effects including "increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin or pruritus." Celexa (a selective serotonin reuptake inhibitor (SSRI) ) has been found to increase the "risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders."

I've read a number of book chapters and articles and heard presentations by physicians about medication for autistic children. All have had a very standard feeling, with the same medications listed, described, responses in the children duly noted, and a call for being very attentive to the particular needs and responses of one's own child (well of course!) added. With studies about the use of medications often inconclusive at best, hearing the observations of parents of their children on certain meds, and of individuals on the spectrum regarding their own experiences, is not only helpful, it's necessary. I really appreciated the responses to a recent post concerning medication and, in particular, Risperdal. It's not an easy topic to bring up and parents are certainly in need of information.

It's noted (as in this Wall Street Journal article) that Celexa has been used "'to reduce repetitive behaviors that are a key characteristic of autism and are a significant reason why this class of antidepressants is prescribed." My son has been taking another SSRI, Zoloft, for some time. "Reducing repetitive behaviors" was not the reason an SSRI was prescribed for him: He started taking this particular medication to help him deal with anxiety, which we'd often noted as preceding self-injurious behaviors, but not for helping to "manage" repetitive vocalizing or pacing or the like.

I recognize I'm talking about a different medication. The "repetitive behaviors" that my son has are not dangerous to him or anyone else, and often serve as ways for him to self-calm and to alleviate his anxiety. Perhaps "reducing repetitive behaviors" (provided, again, that they are not dangerous to anyone, including the individual engaged in them) isn't something that needs to be targeted?