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Restricted and repetitive behaviors (RRBs) are core diagnostic features of autism spectrum disorders (ASD) and include interfering preoccupations, insistence on sameness, stereotypies, and unusual sensory interests. Interrupting these RRBs can cause intense anxiety, aggression, irritability, and self-injury. Overlap of RRBs with symptoms of obsessive-compulsive disorder has fueled interest in selective serotonin reuptake inhibitors (SSRIs) in ASD for decades. Investigators in Australia randomized 146 children with ASD (age range, 7.5–18 years) to receive fluoxetine (maximum doses: <40 kg, 20 mg/day; ≥40 kg, 30 mg/day) or placebo.
It took 7 years to recruit the targeted number of participants, with high drop-out rates in both active (41%) and…