Fluoxetine response in children with autistic spectrum disorders: correlation with familial major affective disorder and intellectual achievement

Abstract

One hundred and twenty‐nine children, 2 to 8 years old, with idiopathic autistic spectrum disorder diagnosed by standard instruments (Childhood Austim Ratings Scale and Autism Diagnostic Observation Schedule) were treated with fluoxetine (0.15 to 0.5mg/kg) for 5 to 76 months (mean 32 to 36 months), with discontinuation trials. Response criteria are described. Family histories were obtained using the family history method in repeated interviews. Fluoxetine response, family history of major affective disorder, and unusual intellectual achievement, pretreatment language, and hyperlexia were used to define a coherent subgroup of autistic spectrum disorder. Statistical analyses were post hoc. Of the children, 22 (17%) had an excellent response, 67 (52%) good, and 40 (31%) fair/poor. Treatment age did not correlate with response. Fluoxetine response correlated robustly with familial major affective disorder and unusual intellectual achievement, and with hyperlexia in the child. Family history of bipolar disorder and of unusual intellectual achievement correlated strongly. Five children developed bipolar disorder during follow‐up. Fluoxetine response, family history of major affective disorder (especially bipolar), unusual achievement, and hyperlexia in the children appear to define a homogeneous autistic subgroup. Bipolar disorder, unusual intellectual achievement, and autistic spectrum disorders cluster strongly in families and may share genetic determinants.

Neurofeedback for Autistic Spectrum Disorder: A Review of the Literature

“…Although there were no significant side effects, there also were no significant improvements in measures of speech or social interaction. Delong et al (2002) reported a 69% positive response rate for fluoxetine in children, aged 2-8, who were autistic. Treatment parameters were quite variable with treatment duration ranging from 5 to 76 months and doses ranging from 4 to 40 mg/day.…”

A pharmacogenetic study of escitalopram in autism spectrum disorders

“…It has been suggested that selective serotonin reuptake inhibitors (SSRIs) may be useful in the treatment of certain symptoms of subjects with ASDs (Posey, Erickson, Stigler, & McDougle, 2006) including repetitive behaviors (Hollander et al, 2005; McDougle, Epperson, Price, & Gelernter, 1998; McDougle et al, 1996), anxiety (Buchsbaum et al, 2001), irritability (Owley et al, 2005), aggression and self-injurious behavior (Hellings, Kelley, Gabrielli, Kilgore, & Shah, 1996), and more global behavior (Cook, Rowlett, Jaselskis, & Leventhal, 1992; DeLong, Ritch, & Burch, 2002; Namerow, Thomas, Bostic, Prince, & Monuteaux, 2003; Sugie et al, 2005). However, a recent large controlled trial study by King and colleagues (2009) did not find a reduction in repetitive behaviors by citalopram.…”

Distinctive behavioral and cellular responses to fluoxetine in the mouse model for Fragile X syndrome

“…A recently published meta-analysis does not support the use of SSRIs in autism (Williams et al, 2013). However, positive effects of fluoxetine on core autistic symptoms have been shown in individual cases and subgroups of autistic children and in adults with ASD (DeLong et al, 1998, 2002; Makkonen et al, 2011; Hollander et al, 2012). Anxiety and obsessive–compulsive symptoms which associate with autism can be ameliorated by fluoxetine in adult ASD (Buchsbaum et al, 2001; Hollander et al, 2012).…”

“…Although some studies suggest that fluoxetine may be beneficial for core features of ASD in adults (Williams et al, 2013) and in individual cases and subgroups of children with autism (DeLong et al, 1998, 2002; Hollander et al, 2012), a recent meta-analysis indicates that there is not enough evidence to support the use of SSRIs in autism (Williams et al, 2013). In addition, the possible side-effects of the drug treatment are a main concern in clinics.…”