Low-Dose Fluoxetine in Four Children with Autistic Spectrum Disorder Improves Self-Injurious Behavior, ADHD-Like Symptoms, and Irritability

Abstract

Autism Spectrum Disorder (ASD) is defined by the copresence of two core symptoms: alteration in social communication and repetitive behaviors and/or restricted interests. In ASD children and adults, irritability, self-injurious behavior (SIB), and Attention Deficit and Hyperactivity Disorders- (ADHD-) like symptoms are regularly observed. In these situations, pharmacological treatments are sometimes used. Selective Serotonin Reuptake Inhibitors- (SSRI-) based treatments have been the subject of several publications: case reports and controlled studies, both of which demonstrate efficacy on the symptoms mentioned above, even if no consensus has been reached concerning their usage. In this article four clinical cases of children diagnosed with ASD and who also present ADHD-like symptoms and/or SIB and/or other heteroaggressive behaviors or irritability and impulsivity treated with low doses of fluoxetine are presented.

Differential serotonin transporter (5‐HTT) and 5‐HT2 receptor density in limbic and neocortical areas of adults and children with autism spectrum disorders: implications for selective serotonin reuptake inhibitor efficacy

“…Instead of seeing significant improvement in symptoms and/or behavior, the citalopram hydrombromide group experienced adverse effects of the drug, including increased energy level and hyperactivity, insomnia, reduced concentration, impulsiveness, and stereotyped behaviors. Recently, a case report in which four children 6–12 years old with ASD were given low doses of the SSRI fluoxetine found improvement in attention‐deficit/hyperactivity disorder‐like symptoms, irritability and/or self‐injurious behavior (Lucchelli and Bertschy ). Previously, Hollander et al () found improvement in repetitive behaviors in adult ASD subjects who were administered fluoxetine while McDougle et al (), in a clinical trial using the SSRI fluvoxamine, reported improvement in aggressive behavior in adult ASD patients.…”

A Randomized Controlled Trial of Sertraline in Young Children With Autism Spectrum Disorder

“…Treatment with the SSRI fluoxetine rescued this phenotype in mice (35). Case reports of children aged 6 to 12 years treated with low-dose fluoxetine cited rapid and significant improvement in self-injurious behavior, hyperactivity, irritability, and impulsivity (36). A recent national survey reported a caregiver-perceived overall net benefit from treatment with sertraline, though significant individual response variation was also reported (37).…”

Parental experiences in the use of fluoxetine for management of ‘disruptive behaviours’ in children and youth with autism and pathological demand avoidance – a mixed methods exploratory study (Fluoxetine study)

“…This can lend a start to reformulating behaviours seen in PDA as a profound manifestation of an underlying, functionally-impairing anxiety as opposed to a new distinct subtype of autism. Lucchelli et al, (2018) found that uoxetine can decrease self-injurious behaviours, ADHD-like symptoms and irritability at low doses in children with autism, but no studies have been conducted yet on the use of uoxetine for PDA [11]. This study aims to contribute to the understanding of PDA in autism and begin to build evidence for treatment with SSRI's as we hypothesize that PDA is likely a physical manifestation of anxiety.…”