Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Int Clin Psychopharmacol. 2021 May 1;36(3):109-116. doi: 10.1097/YIC.0000000000000349.
Children and adolescents with ASD also have co-occurrence of attention deficit hyperactivity disorder (ADHD) symptoms. ADHD symptoms, especially hyperactivity, greatly increased the severity of autism symptoms. This study concentrated on two widely-used medications: the second generation of antipsychotics (SGAs) and ADHD medication, aiming to conduct a meta-analysis about their effect on hyperactivity, so it would offer some evidence for clinical medication choice. The Medline, Embase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched from inception to July 2019 for studies exploring the use of SGAs and ADHD medications in autistic children and adolescents. Double-blind, randomized controlled trials that reported hyperactivity as an outcome were included in the study. A total of thirteen trials with 712 participants were included in our meta-analysis. For SGAs, the standardized mean difference (SMD) of hyperactivity subscale in Aberrant behavior checklist scale or conners rating scales was 0.59, 95% confidence interval (CI): 0.23-0.96, I2 = 74%, Q = 15.34, P < 0.01. For ADHD medications, SMD was -0.66, with 95% CI: -0.99 to 0.33, I2 = 53%, Q = 15.02, P = 0.04. As for adverse events, in the SGAs group, somnolence had the largest effect size, risk ratio = 5.62, 95% CI: 3.20- 9.87 (I2 = 0%, Q = 2.45, P = 0.65). In ADHD group, the side effect of decreased appetite showed the largest effect size (risk ratio = 2.63, 95% CI = 0.99-7.01, I2 = 65.7%, Q = 11.66, P = 0.02). Both ADHD medications and SGAs were effective in dealing with hyperactivity in children and adolescents with autism but were shown to increase the risk of decreased appetite, somnolence, headache and nausea or vomiting. The clinical use of these medications should carefully weigh the benefits and risks.
自闭症谱系障碍（ASD）儿童和青少年也伴有注意力缺陷多动障碍（ADHD）症状。ADHD 症状，尤其是多动，极大地增加了自闭症症状的严重程度。本研究集中于两种广泛使用的药物：第二代抗精神病药（SGAs）和 ADHD 药物，旨在对其治疗多动的效果进行荟萃分析，从而为临床药物选择提供一些证据。从研究开始到 2019 年 7 月，我们在 Medline、Embase、Cochrane 对照试验中心注册库和中国国家知识基础设施数据库中搜索了探索在自闭症儿童和青少年中使用 SGA 和 ADHD 药物的研究。本研究纳入了报告多动作为结局的双盲、随机对照试验。我们的荟萃分析共纳入了 13 项试验，共 712 名参与者。对于 SGA，异常行为检查表或康纳斯评定量表多动分量表的标准化均数差（SMD）为 0.59，95%置信区间（CI）为 0.23-0.96，I2 = 74%，Q = 15.34，P < 0.01。对于 ADHD 药物，SMD 为-0.66，95%CI：-0.99 至 0.33，I2 = 53%，Q = 15.02，P = 0.04。至于不良事件，在 SGA 组中，嗜睡的效应量最大，风险比=5.62，95%CI：3.20-9.87（I2 = 0%，Q = 2.45，P = 0.65）。在 ADHD 组中，食欲减退的副作用显示出最大的效应量（风险比=2.63，95%CI=0.99-7.01，I2=65.7%，Q=11.66，P=0.02）。ADHD 药物和 SGA 均能有效治疗自闭症儿童和青少年的多动，但会增加食欲减退、嗜睡、头痛和恶心或呕吐的风险。这些药物的临床应用应仔细权衡利弊。
