Abstract
BackgroundThis paper is a systematic review and meta-analysis of the efficacy of available medications for the treatment of restricted/repetitive behavior (RRBs) in Autism Spectrum Disorder (ASD).MethodWe searched MEDLINE, Embase, PsycINFO, The Cochrane Library (Cochrane Database of Systematic Reviews (CDRS), the Cochrane Central Register of Controlled Trials (CENTRAL), database of s of Reviews of Effects (DARE)), Scopus, Epistimonikos, Clinicaltrials.gov, and included all randomized controlled trials published after 1993 that were directed at RRBs in patients with ASD of all ages. We extracted the relevant data from the published studies with a predefined data extraction form and assessed the risk of bias. The primary outcomes were change in restricted/repetitive behavior. We performed a meta-analysis using the random effect model and included studies with given mean and standard deviation. This study is registered with PROSPERO number CRD42018092660).ResultsWe identified 14 randomized controlled trials that met initial inclusion criteria. After closer inspection, nine trials – involving 552 patients in total – were included in the final analysis. The meta-analysis found no significant difference between medications (including fluvoxamine, risperidone, fluoxetine, citalopram, oxytocin, N-Acetylcysteine, buspirone) and placebo in the treatment of RRBs in ASD (P = 0.20). Similarly, the sub-group meta-analysis also showed no significant difference between Selective Serotonin Reuptake Inhibitor (SSRIs) and placebo in the treatment of RRBs in ASD (P = 0.68). There was no evidence of publication bias.ConclusionThis meta-analysis finds little support for the routine use of medications to treat restricted/repetitive behaviors in Autism Spectrum Disorder. Further research of large, balanced trials with precise assessment tools and long-term follow-up are needed.Trial registrationThe study protocol is registered in PROSPERO (Reference number: CRD42018092660).
Highlights
This paper is a systematic review and meta-analysis of the efficacy of available medications for the treatment of restricted/repetitive behavior (RRBs) in Autism Spectrum Disorder (ASD)
The meta-analysis found no significant difference between medications and placebo in the treatment of Restricted and repetitive behavior (RRB) in ASD (P = 0.20)
The sub-group metaanalysis showed no significant difference between Selective Serotonin Reuptake Inhibitor (SSRIs) and placebo in the treatment of RRBs in ASD (P = 0.68)
Summary
This paper is a systematic review and meta-analysis of the efficacy of available medications for the treatment of restricted/repetitive behavior (RRBs) in Autism Spectrum Disorder (ASD). Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by early-onset, persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities. The syndrome may include deficits in verbal and nonverbal communication, and other behavioral and Restricted and repetitive behavior (RRB) is a core feature of ASD [9, 10], which include repetitive motor phenomena (e.g., stereotypies), narrow or circumscribed interests, compulsions, and severe problematic behaviors, such as selfinjury [11]. While there are studies supporting non-medical treatment (i.e. Behavioral intervention, CBT) for reducing some types of RRB in individuals with ASD [12, 13], the pathophysiology and function of repetitive behaviors is still largely unresolved. RRB’s appear to persist across development [14]
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