Abstract
Repetitive thoughts and behavior are considered integral and core components of autistic disorder. Results from recent studies suggest that the types of repetitive thoughts and behavior of adults with autism and those with obsessive-compulsive disorder (OCD) may be different. Serotonin reuptake inhibitors (SRIs), the primary drug treatment for patients with OCD, may reduce the repetitive phenomena of some autistic patients. Two controlled studies of the nonselective SRI clomipramine have shown the drug to be more efficacious than the relatively selective norepinephrine reuptake inhibitor desipramine and placebo in children with autism. One controlled study of the selective SRI fluvoxamine found it to be significantly better than placebo for reducing repetitive phenomena and aggression in adults with autistic disorder. Additional research is needed.
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REFERENCES
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Baron-Cohen, S. (1989). Do autistic children have obsessions and compulsions? British Journal of Clinical Psychology, 28, 193–200.
Baron-Cohen, S., & Wheelwright, S. (1999). “Obsession” in children with autism or Asperger's syndrome. British Journal of Psychiatry, 175, 484–490.
Branford, D., Bhaumik, S., & Naik, B. (1998). Selective serotonin re-uptake inhibitors for the treatment of perseverative and maladaptive behaviours of people with intellectual disability. Journal of Intellectual Disability Research, 42, 301–306.
Brasic, J. R., Barnett, J. Y., Kaplan, D., Sheitman, B. B., Aisemberg, P., Lafargue, R. T., Kowalik, S., Clark, A., Tsaltas, M. O., & Young, J.G. (1994). Clomipramine ameliorates adventitious movements and compulsions in prepubertal boys with autistic disorder and severe mental retardation. Neurology, 44, 1309–1312.
Brasic, J. R., Barnett, J. Y., Sheitman, B. B., Lafargue, R. T., Kowalik, S., Kaplan, D., Tsaltas, M. O., Ahmad, R., Nadrich, R. H., & Mendonca, M. F. (1998). Behavioral effects of clomipramine on prepubertal boys with autistic disorder and severe mental retardation. CNS Spectrums, 3, 39–46.
Brodkin, E. S., McDougle, C. J., Naylor, S. T., Cohen, D. J., & Price, L. H. (1997). Clomipramine in adults with pervasive developmental disorders: A prospective open-label investigation. Journal of Child and Adolescent Psychopharmacology, 7, 109–121.
Buck, O. D. (1995). Sertraline for reduction of violent behavior. American Journal of Psychiatry, 152, 953.
Chugani, D. C., Muzik, O., Behen, M., Rothermel, R., Janisse, J. J., Lee, J., & Chugani, H. T. (1999). Developmental changes in brain serotonin synthesis capacity in autistic and nonautistic children. Annals of Neurology, 45, 287–295.
Cook, E. H., Courchesne, R., Lord, C., Cox, N. J., Yan, S., Lincoln, A., Haas, R., Courchesne, E., & Leventhal, B. L. (1997). Evidence of linkage between the serotonin transporter and autistic disorder. Molecular Psychiatry, 2, 247–250.
Cook, E. H., Rowlett, R., Jaselskis, C., & Leventhal, B. L. (1992). Fluoxetine treatment of children and adults with autistic disorder and mental retardation. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 739–745.
Damore, J., Stine, J., & Brody, L. (1998). Medication-induced hypomania in Asperger's disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 248–249.
Davanzo, P. A., Belin, T. R., Widawski, M. H., & King, B. H. (1998). Paroxetine treatment of aggression and self-injury in persons with mental retardation. American Journal on Mental Retardation, 102, 427–437.
DeLong, G. R., Teague, L. A., & Kamran, M. M. (1998). Effects of fluoxetine treatment in young children with idiopathic autism. Developmental Medicine and Child Neurology, 40, 551–562.
Fatemi, S. H., Realmuto, G. M., Khan, L., & Thuras, P. (1998). Fluoxetine in treatment of adolescent patients with autism: A longitudinal open trial. Journal of Autism and Developmental Disorders, 28, 303–307.
Foa, E. B. (1979). Failures in treating obsessive-compulsives. Behavioral Research and Therapy, 7, 169–176.
Garber, H. J., McGonigle, J. J., Slomka, G. T., & Monteverde, E. (1992). Clomipramine treatment of stereotypic behaviors and self-injury in patients with developmental disabilities. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1157–1160.
Ghaziuddin, M., Tsai, L., & Ghaziuddin, N. (1991). Fluoxetine in autism with depression. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 508–509.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., & Charney, D. S. (1989b). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): Part II. Validity. Archives of General Psychiatry, 46, 1012–1016.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989a). The Yale-Brown Obsessive Compulsive Scale (YBOCS): Part I. Development, use, and reliability. Archives of General Psychiatry 46, 1006–1011.
Gordon, C. T., Rapoport, J. L., Hamburger, S. D., State, R. C., & Mannheim, G. B. (1992). Differential response of seven subjects with autistic disorder to clomipramine and desipramine. American Journal of Psychiatry, 149, 363–366.
Gordon, C. T., State, R. C., Nelson, J. E., Hamburger, S. D., & Rapoport, J. L. (1993). A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder. Archives of General Psychiatry, 50, 441–447.
Guy, W. (1976). ECDEU Assessment manual for psychopharmacology, U.S. Dept of Health, Education, and Welfare, Publication 76–338, Washington DC.
Hamdan-Allen, G. (1991). Brief report: Trichotillomania in an autistic male. Journal of Autism and Developmental Disorder, 21, 79–82.
Harvey, R. J., & Cooray, S. E. (1995). The effective treatment of severe repetitive behaviour with fluvoxamine in a 20 year old autistic female. International Clinical Psychopharmacology, 10, 210–203.
Hellings, J. A, Kelley, L. A., Gabrielli, W. F., Kilgore, E., & Shah, P. (1996). Sertraline response in adults with mental retardation and autistic disorder. Journal of Clinical Psychiatry, 53, 333–336.
Hoder, E. L., & Cohen, D. J. (1983). Repetitive behavior patterns of childhood. In M. Levine & W. Carey (Eds.), Developmental-behavioral Pediatrics. Philadelphia: Saunders, pp. 607–622.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
Koshes, R. J. (1997). Use of fluoxetine for obsessive-compulsive behavior in adults with autism. American Journal of Psychiatry, 154, 578.
Leonard, H. L., Swedo, S. E., Rapoport, J. L., Coffey, M., & Cheslow, D. (1989). Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents. Archives of General Psychiatry, 46, 1088–1092.
Lindley, P., Marks, I., Philpott, R., & Snowden, J. (1977). Treatment of obsessive-compulsive neurosis with history of childhood autism. British Journal of Psychiatry, 130, 592–597.
McBride, P. A., Anderson, G. M., Hertzig, M. E., Snow, M. E., Thompson, S. M., Khait, V. D., Shapiro, T., & Cohen, D. J. (1998). Effects of diagnosis, race, and puberty on platelet serotonin levels in autism and mental retardation. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 767–776.
McDougle, C. J. (1997). Psychopharmacology. In Cohen, D. J., & Volkmar, F. R. (Eds.), Handbook of autism and developmental disorders (2nd ed., pp. 707–729). New York: Wiley.
McDougle, C. J. (1998). Repetitive thoughts and behavior in pervasive developmental disorders: Phenomenology and pharmacotherapy. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds), Asperger syndrome or high functioning autism? Current issues in autism series (pp. 293–316). New York: Plenum Press.
McDougle, C. J. (1999). The neurobiology and treatment of obsessive-compulsive disorder. In D. S. Charney, E. J. Nestler, & B. S. Bunney (Eds.), Neurobiology of mental illness (pp. 518–533). New York: Oxford University Press.
McDougle, C. J., Brodkin, E. S., Naylor, S. T., Carlson, D. C., Cohen, D. J., & Price, L. H. (1998). Sertraline in adults with pervasive developmental disorders: A prospective open-label investigation. Journal of Clinical Psychopharmacology, 18, 62–66.
McDougle, C. J., Kresch, L. E., Goodman, W. K., Naylor, S. T., Volkmar, F. R., Cohen, D. J., & Price, L. H. (1995). A case-controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. American Journal of Psychiatry, 152, 772–777.
McDougle, C. J., Naylor, S. T., Cohen, D. J., Volkmar, F. R., Heninger, G. R., & Price, L. H. (1996). A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Archives of General Psychiatry, 53, 1001–1008.
McDougle, C. J., Price, L. H., & Goodman, W. K. (1990). Fluvoxamine treatment of coincident autistic disorder and obsessive compulsive disorder: A case report. Journal of Autism and Developmental Disorders, 20, 537–543.
McDougle, C. J., Price, L. H., Volkmar, F. R., Goodman, W. K., Ward-O'Brien, D., Nielsen, J., Bregman, J., & Cohen, D. J. (1992). Clomipramine in autism: Preliminary evidence of efficacy. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 746–750.
Mehlinger, R., Scheftner, W. A., & Poznanski, E. (1990). Fluoxetine and autism. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 985.
Ozbayrak, K. R. (1997). Sertraline in PDD. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 7–8.
Posey, D. J., Litwiller, M., Kohburn, A., & McDougle, C. J. (1999). Paroxetine in autism. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 111–112.
Potenza, M. N., & McDougle, C. J. (1997). The role of serotonin in autism-spectrum disorders. CNS Spectrums, 2, 25–42.
Prior, M., & Macmillan, M. B. (1973). Maintenance of sameness in children with Kanner's syndrome. Journal of Autism and Childhood Schizophrenia, 3, 154–167.
Rapoport, J. L., Swedo, S. E., & Leonard, H. L. (1992). Childhood obsessive-compulsive disorder. Journal of Clinical Psychiatry, 53, 11–16.
Rumsey, J. M., Rapoport, J. L., & Sceery, W. R. (1985). Autistic children as adults: Psychiatric, social and behavioral outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 24, 465–473.
Sanchez, L. E., Campbell, M., Small, A. M., Cueva, J. E., Armenteros, J. L., & Adams, P. B. (1996). A pilot study of clomipramine in young autistic children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 537–544.
Sloman, L., & Nicolson, R. (1999). Medication in pervasive developmental disorder. Child and Adolescent Psychopharmacology News, 4, 4–9.
Snead, R. W., Boon, F., & Presberg, J. (1994). Paroxetine for self-injurious behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 909–910.
Steingard, R. J., Zimnitzky, B., DeMaso, D. R., Bauman, M. L., & Bucci, J. P. (1997). Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder. Journal of Child and Adolescent Psychopharmacology, 7, 9–15.
Todd, R. D. (1991). Fluoxetine in autism. American Journal of Psychiatry, 148, 1089.
Turner, M. (1999). Annotation: Repetitive behaviour in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, 40, 839–849.
Volkmar, F. R., Hoder, E. L., & Cohen, D. J. (1985). Compliance, “negativism,” and the effects of treatment structure in autism: A naturalistic, behavioral study. Journal of Child Psychology and Psychiatry, 26, 865–877.
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McDougle, C.J., Kresch, L.E. & Posey, D.J. Repetitive Thoughts and Behavior in Pervasive Developmental Disorders: Treatment with Serotonin Reuptake Inhibitors. J Autism Dev Disord 30, 427–435 (2000). https://doi.org/10.1023/A:1005551523657
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DOI: https://doi.org/10.1023/A:1005551523657