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Acta Psychiatr Scand ; 138(5): 379-400, 2018 11.
Article in English | MEDLINE | ID: mdl-29904907

ABSTRACT

OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.


Subject(s)
Anxiety Disorders/therapy , Attention Deficit Disorder with Hyperactivity/therapy , Autism Spectrum Disorder/therapy , Communication Disorders/therapy , Mood Disorders/therapy , Practice Guidelines as Topic , Psychomotor Agitation/therapy , Sleep Wake Disorders/therapy , Stereotyped Behavior , Adolescent , Anxiety Disorders/etiology , Attention Deficit Disorder with Hyperactivity/etiology , Autism Spectrum Disorder/complications , Child , Communication Disorders/etiology , Humans , Mood Disorders/etiology , Psychomotor Agitation/etiology , Sleep Wake Disorders/etiology
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