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AofA Science Summary: Pharmacologic Treatment of Repetitive Behaviors in Autism Spectrum Disorders: Evidence of Publication Bias

Science post imageFrom Pediatrics (Journal of the AAP)

Pharmacologic Treatment of Repetitive Behaviors in Autism Spectrum Disorders: Evidence of Publication Bias

  1. Melisa Carrasco, PhDa,
  2. Fred R. Volkmar, MDb, and
  3. Michael H. Bloch, MD, MSb

+ Author Affiliations

  1. aNeuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan; and
  2. bChild Study Center and Department of Psychiatry, Yale University, New Haven, Connecticut

OBJECTIVE: The goal of this study was to examine the efficacy of serotonin receptor inhibitors (SRIs) for the treatment of repetitive behaviors in autism spectrum disorders (ASD).

METHODS: Two reviewers searched PubMed and for randomized, double-blind, placebo-controlled trials evaluating the efficacy of SRIs for repetitive behaviors in ASD. Our primary outcome was mean improvement in ratings scales of repetitive behavior. Publication bias was assessed by using a funnel plot, the Egger’s test, and a meta-regression of sample size and effect size.

RESULTS: Our search identified 5 published and 5 unpublished but completed trials eligible for meta-analysis. Meta-analysis of 5 published and 1 unpublished trial (which provided data) demonstrated a small but significant effect of SRI for the treatment of repetitive behaviors in ASD (standardized mean difference: 0.22 [95% confidence interval: 0.07–0.37], z score = 2.87, P < .005). There was significant evidence of publication bias in all analyses. When Duval and Tweedie's trim and fill method was used to adjust for the effect of publication bias, there was no longer a significant benefit of SRI for the treatment of repetitive behaviors in ASD (standardized mean difference: 0.12 [95% confidence interval: –0.02 to 0.27]). Secondary analyses demonstrated no significant effect of type of medication, patient age, method of analysis, trial design, or trial duration on reported SRI efficacy.

CONCLUSIONS: Meta-analysis of the published literature suggests a small but significant effect of SRI in the treatment of repetitive behaviors in ASD. This effect may be attributable to selective publication of trial results. Without timely, transparent, and complete disclosure of trial results, it remains difficult to determine the efficacy of available medications.


Angus Files

Well said speaking truth !!Once bitten twice shy..



We gave prozac for severe OCD flare, it did a big fat zero. Turns out he had PANDAS.

seeking truth

It is surprising to me that many who have discovered the sad way that pharma's vaccines are not all they were cracked up to be, remain willing to trust the validity of their studies for other products. Few, if any, of the pharmaceutical drugs in existence provide benefit to the consumer. Starting with the creation of aspirin - which some suggest led to the many deaths that were attributed to the spanish flu in 1918 - the safety and efficacy of drugs are not backed by sound science. The last thing I would expose the vaccine injured person to is another useless, toxic poison designed to generate profit, and little else. The studies are terribly rigged, and, contrary to what most people believe, never prove that a drug actually provides real or lasting benefit. All that must be proven - and they can run a million tests until they finally get one to give the results they want - is that the drug actually does 'something' (like reduce cholesterol). It does not prove that the demonstrated effect is significant, lasting, and of more value than the side effects produced. This is how the public is being terribly deceived and terribly damaged by toxic substances that rarely provide a genuine benefit - but always a generous profit. The same processes that invented, tested and marketed vaccines are how every other drug is created - and they are all equally useless at improving health. Putting a toxin in your body will NEVER create health, only damage.


prozac for 6 months up to 60mg was given to my non-verbal autistic son to treat his OCD, the effects were bad, he went hyper, had insomnia, he was constant on the run, not eating, finally bad headaches and the doctor was about to increases to 80mg, the caregivers went against it. that was in the mid i see little has changed...

David Foster

Where there is a Market, there will be scoundrels.

moon batchelder (@pasupatidasi)

ssri therapy only worsened the self-calm, and ocd of my autistic child. doubting the pharmacological report miracle ssri treatment as much as i do the harmlessness of vaccinations.


SSRI's can even be detrimental to people on the spectrum, as we learned the hard way. Interesting that Volkmar is willing to be critical of pharma's wares. Maybe he'll finally open his eyes to treatments that are not blessed by pharma.

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