Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment
Abstract Background Numerous interventions for irritability in autism spectrum disorder (ASD) have been investigated. We aimed to appraise the magnitude of pharmacological and non-pharmacological interventions for irritability in ASD without any restrictions in terms of eligible interventions. Metho...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Molecular Autism |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13229-024-00585-6 |
| _version_ | 1797276490453221376 |
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| author | Hangnyoung Choi Jae Han Kim Hee Sang Yang Jong Yeob Kim Samuele Cortese Lee Smith Ai Koyanagi Elena Dragioti Joaquim Radua Paolo Fusar-Poli Jae Il Shin Keun-Ah Cheon Marco Solmi |
| author_facet | Hangnyoung Choi Jae Han Kim Hee Sang Yang Jong Yeob Kim Samuele Cortese Lee Smith Ai Koyanagi Elena Dragioti Joaquim Radua Paolo Fusar-Poli Jae Il Shin Keun-Ah Cheon Marco Solmi |
| author_sort | Hangnyoung Choi |
| collection | DOAJ |
| description | Abstract Background Numerous interventions for irritability in autism spectrum disorder (ASD) have been investigated. We aimed to appraise the magnitude of pharmacological and non-pharmacological interventions for irritability in ASD without any restrictions in terms of eligible interventions. Methods We systematically searched PubMed/MEDLINE, Scopus, and Web of Science until April 15, 2023. We included randomized controlled trials (RCTs) with a parallel design that examined the efficacy of interventions for the treatment of irritability in patients of any age with ASD without any restrictions in terms of eligible interventions. We performed a random-effects meta-analysis by pooling effect sizes as Hedges’ g. We classified assessed interventions as follows: pharmacological monotherapy, risperidone plus adjuvant therapy versus risperidone monotherapy, non-pharmacological intervention, and dietary intervention. We utilized the Cochrane tool to evaluate the risk of bias in each study and the GRADE approach to assess the certainty of evidence for each meta-analyzed intervention. Results Out of 5640 references, we identified 60 eligible articles with 45 different kinds of interventions, including 3531 participants, of which 80.9% were males (mean age [SD] = 8.79 [3.85]). For pharmacological monotherapy, risperidone (Hedges’ g − 0.857, 95% CI − 1.263 to − 0.451, certainty of evidence: high) and aripiprazole (Hedges’ g − 0.559, 95% CI − 0.767 to − 0.351, certainty of evidence: high) outperformed placebo. Among the non-pharmacological interventions, parent training (Hedges’ g − 0.893, 95% CI − 1.184 to − 0.602, certainty of evidence: moderate) showed a significant result. None of the meta-analyzed interventions yielded significant effects among risperidone + adjuvant therapy and dietary supplementation. However, several novel molecules in augmentation to risperidone outperformed risperidone monotherapy, yet from one RCT each. Limitations First, various tools have been utilized to measure the irritability in ASD, which may contribute to the heterogeneity of the outcomes. Second, meta-analyses for each intervention included only a small number of studies and participants. Conclusions Only risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings. Trial registration PROSPERO, CRD42021243965. |
| first_indexed | 2024-03-07T15:28:56Z |
| format | Article |
| id | doaj.art-9ca1dd0127834b6092e67cfd9aee0ce9 |
| institution | Directory Open Access Journal |
| issn | 2040-2392 |
| language | English |
| last_indexed | 2024-03-07T15:28:56Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Molecular Autism |
| spelling | doaj.art-9ca1dd0127834b6092e67cfd9aee0ce92024-03-05T16:31:51ZengBMCMolecular Autism2040-23922024-01-0115111410.1186/s13229-024-00585-6Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessmentHangnyoung Choi0Jae Han Kim1Hee Sang Yang2Jong Yeob Kim3Samuele Cortese4Lee Smith5Ai Koyanagi6Elena Dragioti7Joaquim Radua8Paolo Fusar-Poli9Jae Il Shin10Keun-Ah Cheon11Marco Solmi12Department of Child and Adolescent Psychiatry, Severance Hospital, Yonsei University College of MedicineYonsei University College of Medicine, Severance Hospital, Yonsei University Health SystemYonsei University College of Medicine, Severance Hospital, Yonsei University Health SystemYonsei University College of Medicine, Severance Hospital, Yonsei University Health SystemCentre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of SouthamptonCentre for Health, Performance and Wellbeing, Anglia Ruskin UniversityParc Sanitari Sant Joan de Deu, Sant Boi de Llobregat ESResearch Laboratory Psychology of Patients, Families and Health Professionals, Department of Nursing, School of Health Sciences, University of IoanninaImaging Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), University of BarcelonaDepartment of Psychosis Studies, King’s College LondonDepartment of Pediatrics, Yonsei University College of MedicineDepartment of Child and Adolescent Psychiatry, Severance Hospital, Yonsei University College of MedicineDepartment of Psychiatry, University of OttawaAbstract Background Numerous interventions for irritability in autism spectrum disorder (ASD) have been investigated. We aimed to appraise the magnitude of pharmacological and non-pharmacological interventions for irritability in ASD without any restrictions in terms of eligible interventions. Methods We systematically searched PubMed/MEDLINE, Scopus, and Web of Science until April 15, 2023. We included randomized controlled trials (RCTs) with a parallel design that examined the efficacy of interventions for the treatment of irritability in patients of any age with ASD without any restrictions in terms of eligible interventions. We performed a random-effects meta-analysis by pooling effect sizes as Hedges’ g. We classified assessed interventions as follows: pharmacological monotherapy, risperidone plus adjuvant therapy versus risperidone monotherapy, non-pharmacological intervention, and dietary intervention. We utilized the Cochrane tool to evaluate the risk of bias in each study and the GRADE approach to assess the certainty of evidence for each meta-analyzed intervention. Results Out of 5640 references, we identified 60 eligible articles with 45 different kinds of interventions, including 3531 participants, of which 80.9% were males (mean age [SD] = 8.79 [3.85]). For pharmacological monotherapy, risperidone (Hedges’ g − 0.857, 95% CI − 1.263 to − 0.451, certainty of evidence: high) and aripiprazole (Hedges’ g − 0.559, 95% CI − 0.767 to − 0.351, certainty of evidence: high) outperformed placebo. Among the non-pharmacological interventions, parent training (Hedges’ g − 0.893, 95% CI − 1.184 to − 0.602, certainty of evidence: moderate) showed a significant result. None of the meta-analyzed interventions yielded significant effects among risperidone + adjuvant therapy and dietary supplementation. However, several novel molecules in augmentation to risperidone outperformed risperidone monotherapy, yet from one RCT each. Limitations First, various tools have been utilized to measure the irritability in ASD, which may contribute to the heterogeneity of the outcomes. Second, meta-analyses for each intervention included only a small number of studies and participants. Conclusions Only risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings. Trial registration PROSPERO, CRD42021243965.https://doi.org/10.1186/s13229-024-00585-6Autism spectrum disorderSystematic reviewMeta-analysisIrritabilityRandomized controlled trial |
| spellingShingle | Hangnyoung Choi Jae Han Kim Hee Sang Yang Jong Yeob Kim Samuele Cortese Lee Smith Ai Koyanagi Elena Dragioti Joaquim Radua Paolo Fusar-Poli Jae Il Shin Keun-Ah Cheon Marco Solmi Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment Molecular Autism Autism spectrum disorder Systematic review Meta-analysis Irritability Randomized controlled trial |
| title | Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment |
| title_full | Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment |
| title_fullStr | Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment |
| title_full_unstemmed | Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment |
| title_short | Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment |
| title_sort | pharmacological and non pharmacological interventions for irritability in autism spectrum disorder a systematic review and meta analysis with the grade assessment |
| topic | Autism spectrum disorder Systematic review Meta-analysis Irritability Randomized controlled trial |
| url | https://doi.org/10.1186/s13229-024-00585-6 |
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