scholarly journals S116. PRAGMATIC COMPREHENSION IN SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S78-S79
Author(s):  
Alberto Parola ◽  
Roberto Aimonetto ◽  
Francesca M Bosco
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Speech Acts ◽  
Figurative Language ◽  
Meta Analysis ◽  
Social Impairment ◽  
Effect Sizes ◽  
Large Variability ◽  
Wide Range ◽  
Pragmatic Comprehension

Abstract Background Individuals with schizophrenia (SCZ) frequently show a severe and widespread impairment in the communicative-pragmatic domain. They exhibit difficulties in the comprehension of a wide range of communicative- pragmatic expressions, such as indirect speech acts (ISA), irony, metaphors, proverb and idioms. Communicative disorders play an important role in the in the social impairment experienced by these patients, and they are frequently associated with functional and social outcome. However, results of previous studies showed large variation across different samples, communicative phenomena and type of pragmatic task investigated. As a result, the state of the evidence for communicative difficulties in SCZ is not completely clear. We performed a systematic review of previous literature assessing pragmatic comprehension in schizophrenia, and a meta-analysis of the evidence. The aim of the meta-analysis was to: 1) investigate differences in pragmatic comprehension between individuals with SCZ and HC 2) compare differences in pragmatic comprehension across different phenomena, i.e. irony, figurative language (FL, idioms, proverbs and metaphors), and ISA. Methods We used the “PRISMA Statement” guidelines for transparent reporting of a systematic review, and the study was preregistered on Prospero Register of Systematic Review. We performed a systematic literature search on the following database: PyschInfo, Pubmed and Google Scholar. 1 2020 Congress of the Schizophrenia International Research Society Selection of the studies was conducted according to the following inclusion criteria: (a) empirical study, (b) quantitative measures of pragmatic comprehension of participants with SCZ, (c) sample including at least two individuals with SCZ (d) inclusion of a comparison group. Finally, 37 studies were identified as eligible for inclusion, and among these 27 studies provided enough data to be included in the meta-analysis. We used mixed effects regression models for each relevant pragmatic phenomena, i.e. FL, irony and ISA, to calculate summary effect sizes (Cohen’s d). Results The results showed significant meta-analytic effects of schizophrenia in pragmatic comprehension of FL (22 studies, d: -1.74, 95% CIs: -2.49 -0.93, p < .001), irony (12 studies, d: -1.42, 95% CIs: -2.3 -0.5, p = .001,), and ISA (3 studies, d: -1.37, 95% CIs: -1.9 -0.8, p < .001). The standardized effect sizes were large, thus indicating that individual with SCZ have serious difficulties in the comprehension of the different communicative expressions compared to healthy individuals. The heterogeneity between studies was significant (FL: Q(32) =245.1, p < .0001, and ISA: Q(3) = 25.2, p < .0001). The rank correlation test indicated evidence for publication bias for figurative language (Kendall’s tau (K) = -0.35, p < 0.001), while was not significant for irony and ISA (Irony: K = -0.33, p = 0.13, ISA: K = -1.00, p = 0.08). Discussion Overall, we found that individuals with SCZ showed clear difficulties in the comprehension of different pragmatic expression, i.e. FL, irony and ISA, compared to healthy controls. This result is in line with previous studies indicating pragmatic impairment as a core deficit in schizophrenia. The effects were large for all the pragmatic phenomena, with figurative expressions showing the largest effect followed by irony and ISA. However, we reported the presence of publication bias for studies investigating figurative language expressions. Heterogeneity between studies was large and significant for all the three phenomena, thus suggesting a large variability across studies in the characteristic of the tasks used to investigate pragmatic ability, and in the characteristics of the experimental samples assessed.

scholarly journals Prevalence of Calf Mortality in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ephrem Tora ◽  
Mesfin Shrube ◽  
Tamirat Kaba ◽  
Wasihun Seyoum
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Dairy Industry ◽  
Economic Losses ◽  
Original Research ◽  
Pooled Prevalence ◽  
Wide Range ◽  
Calf Mortality

Background. Calf mortality has been a major cause of economic losses in the dairy industry in Ethiopia. The condition results in a significant drop in the number of replacing heifers and bulls for sustainable dairy business. Reports on calf mortality with a wide range of prevalence are rising in the country; however, a pooled prevalence of this condition has not been established. Thus, this systematic review and meta-analysis aimed to quantitatively estimate the pooled prevalence of calf mortality in Ethiopia. Methods. Meta-analysis was carried out to obtain the pooled prevalence of calf mortality in Ethiopia. A comprehensive literature search was carried out on PubMed, African Journals Online, CAB, Web of Science Direct, and Google Scholar. Eligible studies were selected based on predefined inclusion and exclusion criteria. Moderators such as the study area, breed of calf, study design, agroecology, and year of study article published were used as a milestone of data extraction. The random-effect model was used to estimate pooled prevalence. Publication bias and the variation in prevalence estimates attributed to heterogeneity were also assessed. Results. Twenty-five original research papers on the prevalence of calf mortality in various parts of Ethiopia were included. The reported prevalence of calf mortality was between 0.9% and 37%. The pooled prevalence of calf mortality in the country was 14.79%, and the pooled calf mortality estimate across studies for the entire period regarding 1991 to 2000, 2001 to 2010, 2011 to 2016, and 2017 to 2020 was 26.54%, 17.03%, 14.21%, and 11.23%, respectively. Analysis of study subgroups and location revealed significant variations in prevalence. High heterogeneity was observed in the pooled estimates and even after the subgroup meta-analysis. The funnel plots and Egger’s regression asymmetry coefficient (b = −1.0434) (95% CI = −1.49, −0.59; p value of 0.012) did suggest the presence of publication bias. There was also an indication of missing studies that could be incorporated by Duval and Tweedie’s trim and fill method where they might fall on a funnel plot and visualize them in an attempt to increase the plot’s symmetry. Analyses also suggest that calf breed, sample size, and study location are likely to be moderators of calf mortality prevalence in Ethiopia. Conclusion. This finding shows that calf mortality is widespread and could result in considerable economic losses for the dairy industry in Ethiopia. Inevitably, a significant reduction in calf mortality prevalence has been observed in recent years since 2010, but the reduction has not yet reached an economically tolerable level. Calf breed susceptibility contributed to the high prevalence. Therefore, interventions for increasing calf health and performance should be focused on minimizing calf mortality on farm and animal levels.

scholarly journals Low Economic Class Might Predispose Children under Five Years of Age to Stunting in Ethiopia: Updates of Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-24
Author(s):  
Mesfin Wudu Kassaw ◽  
Aschalew Afework Bitew ◽  
Alemayehu Digssie Gebremariam ◽  
Netsanet Fentahun ◽  
Murat Açık ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Public Health Problem ◽  
Wealth Index ◽  
Effect Sizes ◽  
Children Under Five ◽  
Under Five ◽  
Pooled Prevalence

Background. Malnutrition is major public health problem worldwide, particularly in developing countries including Ethiopia. In 2016, out of 667 million children under five years of age, 159 million were stunted worldwide. The prevalence of stunting has been decreasing greatly from 58% in 2000 to 44% in 2011 and 38% in 2016 in Ethiopia. However, the prevalence of stunting is still high and considered as public health problem for the country. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among children under five years of age in Ethiopia. Methodology. The databases searched were MEDLINE, Scopus, HINARI, and grey literature studies. The studies’ qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist. The JBI checklist was used in assessing the risk of bias and method of measurement for both outcome and independent variables. Especially, the study design, study participants, definition of stunting, statistical methods used to identify the associations, results/data presentations, and odds ratios (ORs) with confidence intervals (CIs) were assessed. In the statistical analysis, the funnel plot, Egger’s test, and Begg’s test were used to assess publication bias. The I2 statistic, forest plot, and Cochran’s Q-test were used to deal with heterogeneity. Results. In this review, 35 studies were included to assess the pooled prevalence of stunting. Similarly, 16 studies were used to assess the estimated effect sizes of wealth index on stunting. In this meta-analysis, the pooled prevalence of stunting was 41.5% among children under five years of age, despite its considerable heterogeneity (I2 = 97.6%, p < 0.001 , Q = 1461.93). However, no publication bias was detected (Egger’s test p = 0.26 and Begg’s test p = 0.87 ). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR: 1.33, 95% CI 1.07, 1.65 or AOR: 1.92, 95% CI 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Both of the estimated effect sizes of low and medium wealth indexes had substantial heterogeneity (I2 = 63.8%, p < 0.001 , Q = 44.21 and I2 = 78.3%, p < 0.001 , Q = 73.73) respectively). In estimating the effect, there was no publication bias (small-studies effect) (Egger and Begg’s test, p > 0.05 ). Conclusions. The pooled prevalence of stunting was great. In the subgroup analysis, the Amhara region had the highest prevalence of stunting, followed by the Oromia and Tigray regions, respectively. Low economic status was associated with stunting in Ethiopia. This relationship was found to be statistically more accurate in Oromia and Amhara regions. The government should emphasize community-based nutrition programs by scaling up more in these regions, just like the Seqota Declaration.

scholarly journals The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study

2019 ◽  
Author(s):  
Kate Gibb ◽  
Anna Seeley ◽  
Terry Quinn ◽  
Najma Siddiqi ◽  
Susan Shenkin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Medical Patients ◽  
Previous Systematic Review ◽  
Wide Range ◽  
Medical Inpatients ◽  
Icd 10 ◽  
Sample Proportion ◽  
Funnel Plots

AbstractIntroductionDelirium is associated with a wide range of adverse patient safety outcomes. We sought to identify if trends in healthcare complexity were associated with changes in reported delirium in adult medical patients in the general hospital over the last four decades.MethodsWe used identical criteria to a previous systematic review, including studies using DSM and ICD-10 criteria for delirium diagnosis. Random effects meta-analysis pooled estimates across studies, meta-regression estimated temporal changes, funnel plots assessed publication bias.ResultsOverall delirium occurrence was 23% (95% CI 19%-26%) (33 studies). There was no change between 1980-2019, nor was case-mix (average age of sample, proportion with dementia) different. There was evidence of increasing publication bias over time.DiscussionThe incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may mask true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.

scholarly journals The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study

2020 ◽  
Vol 49 (3) ◽  
pp. 352-360 ◽  
Author(s):  
Kate Gibb ◽  
Anna Seeley ◽  
Terry Quinn ◽  
Najma Siddiqi ◽  
Susan Shenkin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diagnostic Criteria ◽  
Publication Bias ◽  
Meta Analysis ◽  
Medical Patients ◽  
Wide Range ◽  
Classification Of Diseases ◽  
Medical Inpatients ◽  
International Statistical Classification ◽  
Sample Proportion

Abstract Introduction Delirium is associated with a wide range of adverse patient safety outcomes, yet it remains consistently under-diagnosed. We undertook a systematic review of studies describing delirium in adult medical patients in secondary care. We investigated if changes in healthcare complexity were associated with trends in reported delirium over the last four decades. Methods We used identical criteria to a previous systematic review, only including studies using internationally accepted diagnostic criteria for delirium (the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases). Estimates were pooled across studies using random effects meta-analysis, and we estimated temporal changes using meta-regression. We investigated publication bias with funnel plots. Results We identified 15 further studies to add to 18 studies from the original review. Overall delirium occurrence was 23% (95% CI 19–26%) (33 studies) though this varied according to diagnostic criteria used (highest in DSM-IV, lowest in DSM-5). There was no change from 1980 to 2019, nor was case-mix (average age of sample, proportion with dementia) different. Overall, risk of bias was moderate or low, though there was evidence of increasing publication bias over time. Discussion The incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may have masked true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.

Identification of and Correction for Publication Bias: Comment

2019 ◽  
Author(s):  
Amanda Kvarven ◽  
Eirik Strømland ◽  
Magnus Johannesson
Keyword(s):  
Publication Bias ◽  
False Positive ◽  
Large Scale ◽  
Meta Analysis ◽  
False Positive Rate ◽  
Effect Sizes ◽  
Replication Studies ◽  
Moderate Reduction ◽  
Positive Rate ◽  
Meta Analyses

Andrews &amp; Kasy (2019) propose an approach for adjusting effect sizes in meta-analysis for publication bias. We use the Andrews-Kasy estimator to adjust the result of 15 meta-analyses and compare the adjusted results to 15 large-scale multiple labs replication studies estimating the same effects. The pre-registered replications provide precisely estimated effect sizes, which do not suffer from publication bias. The Andrews-Kasy approach leads to a moderate reduction of the inflated effect sizes in the meta-analyses. However, the approach still overestimates effect sizes by a factor of about two or more and has an estimated false positive rate of between 57% and 100%.

A Meta-Analysis of the Facial Feedback Literature: Effects of Facial Feedback on Emotional Experience Are Small and Variable

2017 ◽  
Author(s):  
Nicholas Alvaro Coles ◽  
Jeff T. Larsen ◽  
Heather Lench
Keyword(s):  
Publication Bias ◽  
Emotional Experience ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Detection Methods ◽  
Feedback Effects ◽  
Facial Feedback ◽  
Facial Movements ◽  
Facial Feedback Hypothesis ◽  
Variance Estimates

The facial feedback hypothesis suggests that an individual’s experience of emotion is influenced by feedback from their facial movements. To evaluate the cumulative evidence for this hypothesis, we conducted a meta-analysis on 286 effect sizes derived from 138 studies that manipulated facial feedback and collected emotion self-reports. Using random effects meta-regression with robust variance estimates, we found that the overall effect of facial feedback was significant, but small. Results also indicated that feedback effects are stronger in some circumstances than others. We examined 12 potential moderators, and three were associated with differences in effect sizes. 1. Type of emotional outcome: Facial feedback influenced emotional experience (e.g., reported amusement) and, to a greater degree, affective judgments of a stimulus (e.g., the objective funniness of a cartoon). Three publication bias detection methods did not reveal evidence of publication bias in studies examining the effects of facial feedback on emotional experience, but all three methods revealed evidence of publication bias in studies examining affective judgments. 2. Presence of emotional stimuli: Facial feedback effects on emotional experience were larger in the absence of emotionally evocative stimuli (e.g., cartoons). 3. Type of stimuli: When participants were presented with emotionally evocative stimuli, facial feedback effects were larger in the presence of some types of stimuli (e.g., emotional sentences) than others (e.g., pictures). The available evidence supports the facial feedback hypothesis’ central claim that facial feedback influences emotional experience, although these effects tend to be small and heterogeneous.

scholarly journals Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adineh Jafarzadeh ◽  
Alireza Mahboub-Ahari ◽  
Moslem Najafi ◽  
Mahmood Yousefi ◽  
Koustuv Dalal
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Supply And Demand ◽  
Random Effect ◽  
Effect Sizes ◽  
Household Surveys ◽  
Affective Factors ◽  
Urban Households ◽  
Medical Needs ◽  
Geographical Regions

Abstract Background Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates. Methods Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions. Results From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage. Conclusions Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

scholarly journals Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis

2021 ◽  
pp. 1-11
Author(s):  
Maxi Weber ◽  
Sarah Schumacher ◽  
Wiebke Hannig ◽  
Jürgen Barth ◽  
Annett Lotzin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Stress Disorder ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Long Term Outcomes ◽  
Psychological Treatments

Abstract Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

scholarly journals COVID-19 in People Living with HIV: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (7) ◽  
pp. 3554
Author(s):  
Kai Wei Lee ◽  
Sook Fan Yap ◽  
Yun Fong Ngeow ◽  
Munn Sann Lye
Keyword(s):  
Systematic Review ◽  
Laboratory Testing ◽  
Meta Analysis ◽  
Clinical Signs ◽  
Adverse Outcomes ◽  
People Living With Hiv ◽  
Common Symptom ◽  
Chest Imaging ◽  
Wide Range ◽  
Epidemiological Characteristics

COVID-19 is a global health emergency. People living with human immunodeficiency virus (PLHIV) have concerns about whether they have a higher risk of getting the infection and suffer worse COVID-19 outcomes. Findings from studies on these questions have largely been inconsistent. We aimed to determine the epidemiological characteristics, clinical signs and symptoms, blood parameters, and clinical outcomes among PLHIV who contracted COVID-19. Relevant studies were identified through Medline, Cinahl, and PubMed databases. A random-effects model was used in meta-analyses with a 95% confidence interval. Eighty-two studies were included in the systematic review and sixty-seven studies for the meta-analysis. The pooled incidence proportion of COVID-19 among PLHIV was 0.9% (95% CI 0.6%, 1.1%) based on the data from seven cohort studies. Overall, 28.4% were hospitalised, of whom, 2.5% was severe-critical cases and 3.5% needed intensive care. The overall mortality rate was 5.3%. Hypertension was the most commonly reported comorbidity (24.0%). Fever (71.1%) was the most common symptom. Chest imaging demonstrated a wide range of abnormal findings encompassing common changes such as ground glass opacities and consolidation as well as a spectrum of less common abnormalities. Laboratory testing of inflammation markers showed that C-reactive protein, ferritin, and interleukin-6 were frequently elevated, albeit to different extents. Clinical features as well as the results of chest imaging and laboratory testing were similar in highly active antiretroviral therapy (HAART)-treated and non-treated patients. PLHIV were not found to be at higher risk for adverse outcomes of COVID-19. Hence, in COVID-19 management, it appears that they can be treated the same way as HIV negative individuals. Nevertheless, as the pandemic situation is rapidly evolving, more evidence may be needed to arrive at definitive recommendations.

scholarly journals A Systematic Review and Meta-Analysis of Immunoglobulin G Abnormalities and the Therapeutic Use of Intravenous Immunoglobulins (IVIG) in Autism Spectrum Disorder

2021 ◽  
Vol 11 (6) ◽  
pp. 488
Author(s):  
Daniel A Rossignol ◽  
Richard E Frye
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorder ◽  
Immunoglobulin G ◽  
Meta Analysis ◽  
Intravenous Immunoglobulins ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Effect Sizes ◽  
Aberrant Behavior ◽  
Children With Asd

Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting approximately 2% of children in the United States. Growing evidence suggests that immune dysregulation is associated with ASD. One immunomodulatory treatment that has been studied in ASD is intravenous immunoglobulins (IVIG). This systematic review and meta-analysis examined the studies which assessed immunoglobulin G (IgG) concentrations and the therapeutic use of IVIG for individuals with ASD. Twelve studies that examined IgG levels suggested abnormalities in total IgG and IgG 4 subclass concentrations, with concentrations in these IgGs related to aberrant behavior and social impairments, respectively. Meta-analysis supported possible subsets of children with ASD with low total IgG and elevated IgG 4 subclass but also found significant variability among studies. A total of 27 publications reported treating individuals with ASD using IVIG, including four prospective, controlled studies (one was a double-blind, placebo-controlled study); six prospective, uncontrolled studies; 2 retrospective, controlled studies; and 15 retrospective, uncontrolled studies. In some studies, clinical improvements were observed in communication, irritability, hyperactivity, cognition, attention, social interaction, eye contact, echolalia, speech, response to commands, drowsiness, decreased activity and in some cases, the complete resolution of ASD symptoms. Several studies reported some loss of these improvements when IVIG was stopped. Meta-analysis combining the aberrant behavior checklist outcome from two studies demonstrated that IVIG treatment was significantly associated with improvements in total aberrant behavior and irritability (with large effect sizes), and hyperactivity and social withdrawal (with medium effect sizes). Several studies reported improvements in pro-inflammatory cytokines (including TNF-alpha). Six studies reported improvements in seizures with IVIG (including patients with refractory seizures), with one study reporting a worsening of seizures when IVIG was stopped. Other studies demonstrated improvements in recurrent infections, appetite, weight gain, neuropathy, dysautonomia, and gastrointestinal symptoms. Adverse events were generally limited but included headaches, vomiting, worsening behaviors, anxiety, fever, nausea, fatigue, and rash. Many studies were limited by the lack of standardized objective outcome measures. IVIG is a promising and potentially effective treatment for symptoms in individuals with ASD; further research is needed to provide solid evidence of efficacy and determine the subset of children with ASD who may best respond to this treatment as well as to investigate biomarkers which might help identify responsive candidates.

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