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Charles T. Gordon, MD; Rosanne C. State, MD; Jean E. Nelson, MHS; Susan D. Hamburger, MA, MS; Judith L. Rapoport, MD

Arch Gen Psychiatry. 1993;50(6):441-447.

Abstract
Objective
To determine whether clomipramine hydrochloride, a serotonin reuptake blocker with unique antiobsessional properties, is differentially effective for obsessivecompulsive and stereotyped motor behaviors in autistic disorder compared with placebo and with the noradrenergic tricyclic antidepressant agent, desipramine hydrochloride.

Design
Following a 2-week, single-blind placebo washout phase, 12 autistic subjects completed a 10week, double-blind, crossover comparison of clomipramine and placebo, and 12 different subjects completed a similar comparison of clomipramine and desipramine.

Setting
Outpatient clinic.

Patients
A referral sample of 30 male and female autistic patients were enrolled, and 24 completed the study.

Measures
Key outcome measures were the Autism Relevant Subscale of the Children's Psychiatric Rating Scale, the Modified Comprehensive Psychopathological Rating Scale—Obsessive-Copulsive Disorder Subscale, and the Clinical Global Impressions Scale.

Results
Clomipramine was superior to both placebo and desipramine on ratings of autistic symptoms (including stereotypies), anger, and compulsive, ritualized behaviors (P<.05), with no differences between desipramine and placebo. Clomipramine was equal to desipramine and both tricyclic agents were superior to placebo for amelioration of hyperactivity.

Conclusion
Biological links between compulsions and stereotyped, repetitive behaviors in autistic disorder should be explored.

Author Affiliations
From the Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md.

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