Reference Center for Intellectual Disability from Rare Causes, Department of Child Neurology, Woman Mother and Child Hospital, Hospices Civils de Lyon, Bron, France.
Department of Pediatrics and School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
Dev Med Child Neurol. 2023 Oct;65(10):1316-1320. doi: 10.1111/dmcn.15574. Epub 2023 Mar 14.
Placebo responses are frequently observed in research studies and clinical contexts, yet there is limited knowledge about the placebo effect among children with neurodevelopmental disorders. Here, we review the placebo effect in autism spectrum disorder (ASD). Placebo responses are widely evident in ASD clinical trials and could partly operate via so-called placebo-by-proxy, whereby caregivers or clinicians indirectly shape patient outcomes. Understanding the role of placebo effects in ASD may help discern genuine treatment effects from contextual factors in clinical trials. The much less studied nocebo effect, or negative placebo, might contribute to the experience of side effects in ASD treatments but empirical data is missing. Better knowledge about placebo and nocebo mechanisms may contribute to the development of more effective research designs, such as three-armed designs that account for natural history, and improved treatments for ASD symptoms. At a clinical level, deeper knowledge about placebo and nocebo effects may optimize the delivery of care for individuals with ASD in the future. WHAT THIS PAPER ADDS: Placebo responses are evident in autism spectrum disorder (ASD) clinical trials. Placebo responses in ASD are likely dependent on a placebo-by-proxy mechanism.
安慰剂效应在研究和临床环境中经常被观察到，但儿童神经发育障碍患者对安慰剂效应的了解有限。在这里，我们回顾了自闭症谱系障碍（ASD）中的安慰剂效应。安慰剂反应在 ASD 临床试验中广泛存在，可能部分通过所谓的“代理安慰剂效应”起作用，即护理人员或临床医生间接影响患者的结果。了解安慰剂效应在 ASD 中的作用可能有助于在临床试验中辨别真正的治疗效果和环境因素。而研究较少的反安慰剂效应（即负面安慰剂效应）可能导致 ASD 治疗中出现副作用，但目前缺乏实证数据。更好地了解安慰剂和反安慰剂的作用机制可能有助于开发更有效的研究设计，例如考虑自然史的三臂设计，并改善 ASD 症状的治疗方法。在临床层面上，未来更深入地了解安慰剂和反安慰剂效应可能会优化对 ASD 患者的护理。本文的新增内容：安慰剂反应在自闭症谱系障碍（ASD）临床试验中明显存在。ASD 中的安慰剂反应可能依赖于代理安慰剂机制。
