Article Figures & Data
Figures
- FIGURE 1
Disposition of articles identified for review. aNumbers do not tally because studies could be excluded for multiple reasons. bOne study4 addresses an antipsychotic and an SRI.
Tables
Category Criteria Study population Adolescents or young adults (ages 13–30 years) with ASD (autistic disorder, Asperger syndrome, PDD-NOS) or families/caregivers of individuals with ASD between the ages of 13 and 30 years Interventions Interventions aimed at ameliorating core symptoms of ASD, affecting independent functioning, adaptive behavior, or the transition process, or targeting family outcomes Comparators Placebo Other intervention Outcomes Social skills/interaction, language and communication, repetitive and other maladaptive behaviors, motor outcomes, psychological distress, adaptive skills development, academic skills development, and family outcomes, including family distress and family satisfaction Time period Studies published from 1980–present with no limits on timing of outcomes Setting Any setting, including educational, residential, and clinic Publication languages English only Admissible evidence (study design and other criteria) Admissible design Controlled trials, observational studies including prospective and retrospective cohort studies, prospective and retrospective case series Study size At least 20 total individuals between 13 and 30 years of age with ASD or family members of such individuals Other criteria Original research studies that provide sufficient detail regarding methods and results to enable use and adjustment of the data and results Patient populations must include adolescents or young adults (13–30 years of age) with ASD or families/caregivers of individuals with ASD between the ages of 13 and 30 years Studies must address 1 or more of the following: (1) treatment modality aimed at modifying ASD core symptoms, common comorbidities, family-related outcomes, or assisting with transitional issues; and (2) outcomes (including harms) related to interventions for ASD Studies must include extractable data on relevant outcomes, including data presented in text or tables (versus solely in figures) Studies must present aggregate data (versus only data for each individual participant) PDD-NOS, pervasive developmental disorder–not otherwise specified.
Domain Description Risk of bias Reflects issues in study design and conduct that could result in biased estimates of effect Consistency Reflects similarity of effect sizes seen across studies. Consistency cannot be assessed when only 1 study is available Directness Reflects the relationship between the intervention and the ultimate health outcome of interest Precision Reflects the level of certainty around the effect observed Characteristic RCTs (n = 5) Prospective Case Series (n = 2) Retrospective Case Series (n = 1) Total Literature (N = 8a) Intervention Antipsychoticsa 3 0 0 3 SRIsa 2 2 1 5 Opioid receptor antagonist 1 0 0 1 Treatment duration, mo >1 to ≤3 4 2 0 6 >3 to ≤6 1 0 0 1 >6 to ≤12 0 0 1 1 Study population United States 3 2 1 6 Europe 1 0 0 1 Other 1 0 0 1 Total participants 172 77 23 272 ↵a One study assessed both an antipsychotic agent and an SRI.
- TABLE 4
Key Outcomes of Studies Assessing Medication Treatments in Adolescents and Young Adults With ASD
Study (Author, Year, Country Groups, N; Enrollment/N Final; Study, Quality) Age, y, Mean ± SD IQ, Mean ± SD Outcome Measure/ Baseline Scores, Mean ± SD Outcome Measure/Posttreatment Scores, Mean ± SD Antipsychotic agents Hellings et al,4 2006; United States; G1 + G2: placebo phase, then dose risperidone, followed by crossover to the other risperidone dose, then another placebo phase; placebo I phase: 3–5 wk of placebo, n = 40; acute-dose phase: G1 low-dose (n = 39) or G2 high-dose risperidone (n = 36); placebo II phase: 3–5 wk of placebo, n = 33; maintenance phase: optimal dose risperidone, n = 32; poor quality G1 + G2: 22 ± 13.1 NR, 40/40 with intellectual disability ABC Irritability: G1 + G2, placebo I phase: 19.16 ± 9.96; G1 + G2, placebo II phase: 18.23 ± 12.36 ABC Irritability: G1, Low-dose acute phase: 11.15 ± 9.28; G2, High-dose acute phase: 13.31 ± 8.92; P = .13 G1 versus G2, P = .0002 G1 + G2 acute phase versus G1 + G2 placebo II; maintenance phase scores only reported graphically Remington et al,5 2001; Canada; G1: clomipramine; G2: haloperidol; G3: placebo; Overall N: 37/36; fair quality Overall: 16.3 (SD NR) NR CARS: overall, 41.8 ± 7.1 CARS: G1: 37.8 ± 8.7; G2: 36.7 ± 6.1; G3: 39.4 ± 7.0; P < .05, G2 versus baseline; ABC reported only graphically McDougle et al,6 1998; United States; G1: risperidone, 15/12; G2: placebo,16/12; G2a: open-label risperidone after placebo, n = 15; fair quality G1 + G2: 28.1 ± 7.3 G1 + G2: 54.6 ± 23.9 Y-BOCS, compulsion: G1: 16.5 ± 3.58; G2: 14.29 ± 3.50; G2a: 14.27 ± 2.92; SIB-Q: G1: 47.8 ± 19.5; G2: 37.7 ± 11.9; G2a: 32.43 ± 15.89 Y-BOCS, compulsion: G1: 12.77 ± 3.63; G2: 14.35 ± 3.02; P < .001, G1 versus G2; G2a: 11.47 ± 3.64; P < .03, G2a versus baseline; SIB-Q: G1: 24.2 ± 9.5; G2: 32.8 ± 15.0; P < .001, G2 versus G1; G2a: 23.07 ± 13.45; P < .05, G2a versus baseline SRIs Remington et al,5 2001; Canada; G1: clomipramine; G2: haloperidol; G3: placebo; Overall N: 37/36; fair quality Overall: 16.3 (SD NR) NR CARS; Overall: 41.8±7.1 CARS: G1: 37.8 ± 8.7; G2: 36.7 ± 6.1; G3: 39.4 ± 7.0; P < .05, G2 versus baseline; ABC reported only graphically McDougle et al,8 1998; United States; G1: sertraline, n = 42/37; G1a: AD; G1b: AS; G1c: PDD-NOS; poor quality 26.1 ± 5.8 60.5 ± 22.7 (28 with intellectual disability) Y-BOCS, total score: G1a: 16.5 ± 6.7; G1b: 25.7 ± 4.1; G1c: 18.2 ± 4.8; Vineland Maladaptive Behavior: G1a: 27.0 ± 9.4; G1b: 19.8 ± 8.6; G1c: 28.3 ± 10.8; SIB-Q: G1a: 32.7 ± 16.5; G1b: 17.5 ± 7.7; G1c: 36.2 ± 16.4; Y-BOCS, total score: G1a: 11.5 ± 5.8; G1b: 27.8 ± 5.3; G1c: 14.8 ± 5.7; P = .005, G1 versus baseline; Vineland Maladaptive Behavior Scale: G1a: 13.8 ± 6.0; G1b: 20.2 ± 8.2; G1c: 19.5 ± 9.1; P = .0001, G1 versus baseline SIB-Q: G1a: 15.5 ± 9.5; G1b: 18.8 ± 7.7; G1c: 20.2 ± 12.8; P = .0001, G1 versus baseline Brodkin et al,9 1997; United States; G1: clomipramine, 35/33; G1a: responders, n = 18; G1b: nonresponders, n = 15; poor quality G1: 30.2 ± 7.0 G1: 64.6 ± 27.2 Y-BOCS, total score: G1a: 18.7 ± 6.8; G1b: 17.9 ± 6.2; Y-BOCS, compulsion subscale: G1a: 13.7 ± 3.3; G1b: 13.9 ± 2.5; Y-BOCS, obsession subscale: G1a: 10 ± 6.8; G1b: 6.7 ± 6.2; Brown Aggression Scale: G1a: 10.6 ± 7.4; G1b: 6.5 ± 4.1 Y-BOCS, total score: G1a: 9.1 ± 3.0; G1b: 17.3 ± 7.8; P < .001, G1 versus baseline; P < .001, G1a versus G1b; Y-BOCS, compulsion subscale: G1a: 6.9 ± 2.1; G1b: 12.5 ± 3.3; P < .001, G1 versus baseline; P < .001, G1a versus G1b; Y-BOCS, obsession subscale: G1a: 4.4 ± 2.8; G1b: 8 ± 6.6; P < .001, G1 versus baseline; P < .001, G1a versus G1b; Brown Aggression Scale: G1a: 3.7 ± 3.6; G1b: 6.4 ± 4.6; P < .001, G1 versus baseline; P < .001, G1a versus G1b McDougle et al,7 1996; United States; G1: fluvoxamine, 15/15; G2: placebo, 15/15; fair quality G1: 30.1 ± 7.1; G2: 30.1 ± 8.4 G1: 82.5 ± 26.8; G2: 77.3 ± 33.1 Y-BOCS, total score: G1: 21.4 ± 7.3; G2: 21.5 ± 6.8 Y-BOCS, total score: G1: 13.7 ± 9.1; G2: 21.9 ± 6.7; P < .003, G1 versus G2; Data for Vineland Maladaptive Behavior and Brown Aggression Scale were not reported, although statistically significant improvements were noted Cook et al,10 1992; United States; G1: fluoxetine, 23/23; poor quality 15.9 ± 6.2 NR, 19 with intellectual disability CGI-S, total: 5.7 ± 0.8; CGI-S, compulsion: 5.5 ± 1.5 CGI-S, total: 4.9 ± 1.1; P < .002, G1 versus baseline; CGI-S, compulsion: 4.7 ± 1.6; P < .005, G1 versus baseline Opioid receptor antagonist Willemsen-Swinkels et al,11 1995; the Netherlands; G1 + G2: 4-week naltrexone phase for cohorts 1 (50 mg daily) and 2 (150 mg daily) (ASD patients only); G3 + G4: 4-week placebo phase for cohorts 1 and 2 (ASD patients only); overall N: 33/31; fair quality Overall: 29 ± 6.0 NR ABC Stereotypy: G1 + G2: 9.7 ± 4.7; G3 + G4: 8.3 ± 5.2 ABC Stereotypy: G1 + G2: 10.0 ± 4.7; G3 + G4: 9.0 ± 4.8; P = .018, G1 + G2 versus G3 + G4 AD, autistic disorder; AS, Asperger syndrome; CARS, Childhood Autism Rating Scale; CGI-S, Clinical Global Impression of Severity; G, group; NR, not reported; PDD-NOS, pervasive developmental disorder–not otherwise specified; SIB-Q, Self-Injurious Behavior Questionnaire; Y-BOCS, Yale-Brown Obsessive Compulsive Scale.
In this issue
Medications for Adolescents and Young Adults With Autism Spectrum Disorders: A Systematic Review
