Thursday, June 18, 2009

On the trail of an autism treatment

I was interested to learn that Dr. Evdokia Anagnostou (above) – a child neurologist at Bloorview developing a clinical research program in autism – was one of the authors of the new study showing that the antidepressant Celexa doesn’t work for repetitive behaviours in children with autism.

Celexa is one of the newer drugs in the selective serotonin-reuptake inhibitor (SSRI) class of antidepressants – which are the most commonly prescribed drugs for children with autism.

The results that showed Celexa is not useful in treating repetitive behaviours in children with autism were a surprise even to the authors of the Archives of General Psychiatry study, which was published this month.

“We couldn’t believe our eyes,” says Evdokia, who was working at the time at the Mount Sinai School of Medicine. “We all have this ‘gestalt’ that this drug is effective at decreasing repetitive behaviours, but the truth is that it doesn’t work better than placebo."

In the American study, 149 children with autism aged five to 17 received either Celexa or a placebo over three months.

Researchers wanted to know if Celexa reduced behaviours that can interfere with a child’s ability to learn – like compulsions, restricted interests and hand flapping.

The study found that about one out of three children in both the Celexa and control groups showed fewer or less severe repetitive behaviours, but there was no significant difference in improvement between the groups. And Celexa was significantly more likely to cause impulsiveness, inattention and sleep problems.

The study was the largest randomized trial of a medication to treat autism.

Evdokia was recruited to Bloorview last year and part of her autism research focuses on testing alternative compounds like fish oil.

“There’s a new movement within the research community to look at alternative compounds in a scientific way,” Evdokia says. “Parents and physicians have started using these compounds without any evidence that they’re safe or effective. We want to test them scientifically.”

This fall, she’s conducting a randomized control trial to study the impact of omega-3 fatty acids on preschoolers with autism.

Thirty-five preschoolers will receive fish oil and 35 will receive a placebo over six months. “We want to see if the omega-3 fatty acids have an impact on the core symptoms of autism – social communication deficits and repetitive behaviours – and on associated symptoms like aggression and anxiety.” Because fish oil has an excellent safety profile, “we can target the very young, where usually we are uncomfortable prescribing traditional medications.” There’s some evidence to show that fish oil can benefit children with neurodevelopmental disabilities, but the compound hasn’t been tested using statistical methods, Evdokia says.

In the meantime, if you're a parent of a child with autism taking Celexa, ask your doctor what symptoms it was intended to treat. "We found it’s not useful for treating repetitive behaviours, but Celexa is also used for anxiety, and we didn't test anxiety in this study," Evdokia notes.

Evdokia says cognitive-behavioural therapy can be helpful in reducing repetitive behaviours, but it's not covered by Ontario hospital insurance and is expensive. And there are few pediatric psychologists with experience treating this population.

Do you have a child whose treatment was affected by the findings on Celexa?