Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada.
Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.
Acta Psychiatr Scand. 2018 Nov;138(5):379-400. doi: 10.1111/acps.12918. Epub 2018 Jun 14.
Evidence-based guidance of clinical decision-making for the management of Autism Spectrum Disorder (ASD) is lacking, particularly for co-occurring psychiatric symptoms. This review evaluates treatment evidence for six common symptom targets in children/adolescents with ASD and provides a resource to facilitate application of the evidence to clinical practice.
A systematic search identified randomized controlled trials (RCTs) and high-quality systematic reviews published between 2007 and 2016, focused on: social interaction/communication impairment, stereotypic/repetitive behaviours, irritability/agitation, attention-deficit/hyperactivity disorder symptoms, mood or anxiety symptoms, and sleep difficulties. We then completed qualitative evaluation of high-quality systematic reviews/meta-analyses and quantitative evaluation of recently published RCTs not covered by prior comprehensive systematic reviews.
Recently published RCTs focused on social interaction and communication impairment (trials = 32) using psychosocial interventions. Interventions for irritability/agitation (trials = 16) were mainly pharmacological. Few RCTs focused on other symptom targets (trials = 2-5/target). Integration of these results with our qualitative review indicated that few established treatment modalities exist, and available evidence is limited by small studies with high risk of bias.
Given the current evidence-base, treatment targets must be clearly defined, and a systematic approach to intervention trials in children/adolescents with ASD must be undertaken with careful consideration of the limitations of safety/efficacy data.
缺乏基于循证的自闭症谱系障碍（ASD）管理临床决策指导，尤其是针对共病精神症状。本综述评估了六种常见症状目标在 ASD 儿童/青少年中的治疗证据，并提供了一个资源，以促进将证据应用于临床实践。
系统检索了 2007 年至 2016 年间发表的随机对照试验（RCT）和高质量系统评价，重点关注：社交互动/沟通障碍、刻板/重复行为、易激惹/激越、注意力缺陷/多动障碍症状、情绪或焦虑症状以及睡眠困难。然后，我们对高质量系统评价/荟萃分析进行了定性评估，并对先前全面系统评价未涵盖的最近发表的 RCT 进行了定量评估。
最近发表的 RCT 主要集中在使用心理社会干预治疗社交互动和沟通障碍（试验=32）。针对易激惹/激越的干预（试验=16）主要是药物治疗。其他症状目标（试验=2-5/目标）的 RCT 较少。将这些结果与我们的定性综述相结合表明，现有的治疗方法有限，可用证据受到高偏倚风险的小型研究的限制。
鉴于目前的证据基础，必须明确治疗目标，并必须以系统的方法开展 ASD 儿童/青少年干预试验，同时要谨慎考虑安全性/疗效数据的局限性。
