What are we targeting when we treat autism spectrum disorder? A systematic review of 406 clinical trials

Autism ◽  
2019 ◽  
Vol 24 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Umberto Provenzani ◽  
Laura Fusar-Poli ◽  
Natascia Brondino ◽  
Stefano Damiani ◽  
Marco Vercesi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorder ◽  
Clinical Trials ◽  
Outcome Measures ◽  
Rating Scale ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Social Responsiveness ◽  
Comprehensive Overview ◽  
Core Symptoms

The number of trials aimed at evaluating treatments for autism spectrum disorder has been increasing progressively. However, it is not clear which outcome measures should be used to assess their efficacy, especially for treatments which target core symptoms. The present review aimed to provide a comprehensive overview regarding the outcome measures used in clinical trials for people with autism spectrum disorder. We systematically searched the Web of KnowledgeSM database between 1980 and 2016 to identify published controlled trials investigating the efficacy of interventions in autism spectrum disorder. We included 406 trials in the final database, from which a total of 327 outcome measures were identified. Only seven scales were used in more than 5% of the studies, among which only three measured core symptoms (Autism Diagnostic Observation Schedule, Childhood Autism Rating Scale, and Social Responsiveness Scale). Of note, 69% of the tools were used in the literature only once. Our systematic review has shown that the evaluation of efficacy in intervention trials for autism spectrum disorder relies on heterogeneous and often non-specific tools for this condition. The fragmentation of tools may significantly hamper the comparisons between studies and thus the discovery of effective treatments for autism spectrum disorder. Greater consensus regarding the choice of these measures should be reached.

scholarly journals Treatment Effect of Bumetanide in Children With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Tiantian Wang ◽  
Ling Shan ◽  
Chunyue Miao ◽  
Zhida Xu ◽  
Feiyong Jia
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorder ◽  
Therapeutic Effect ◽  
Rating Scale ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Children With Asd ◽  
Core Symptoms ◽  
Positive Effect

Background: The therapeutic effect of bumetanide on autism spectrum disorder (ASD) seems to be controversial. To obtain better evidence on the efficacy of bumetanide, a systematic review and meta-analysis were performed.Methods: Randomized, placebo-controlled trials (RCTs) of bumetanide treatment in children with ASD were identified through systematic review from database inception to January 17, 2021. Subsequently, a meta-analysis was carried out to examine the effect of bumetanide on the severity of symptoms of ASD as assessed by the Childhood Autism Rating Scale (CARS) and Social Responsive Scale (SRS); core symptoms according to criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 of the American Psychiatric Association [social affect (SA), restricted, repetitive patterns of behavior, interests, or activities (RRB) and sensory symptoms]; and the therapeutic effect as assessed by Clinical Global Impressions-Efficacy (CGI-E).Results: In total, six RCTs involving 496 participants with ASD were identified in our study. The results showed that bumetanide could significantly improve the severity of the ASD symptoms measured by CARS and SRS. There was also evidence that bumetanide had positive effect on the core symptoms of ASD such as the SA and RRB, but there was no statistically significant effect on sensory symptoms. A significant positive effect on CGI-E scores in ASD patients was also observed.Conclusion: Our meta-analysis provided some support that bumetanide could improve the symptoms of children with ASD. However, additional large-scale longitudinal studies that provide clearer information and better control for confounding factors are needed to confirm our findings.

scholarly journals Response (minimum clinically relevant change) in ASD symptoms after an intervention according to CARS-2: consensus from an expert elicitation procedure

2021 ◽  
Author(s):  
Lucie Jurek ◽  
Matias Balthazar ◽  
Sheffali Gulati ◽  
Neda Novakovic ◽  
María Núñez ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Rating Scale ◽  
Expert Knowledge ◽  
Scientific Evidence ◽  
Autism Spectrum ◽  
Expert Elicitation ◽  
Spectrum Disorder ◽  
Initial Finding ◽  
Elicitation Process ◽  
Core Symptoms

AbstractThe lack of consensual measures to monitor core change in Autism Spectrum Disorder (ASD) or response to interventions leads to difficulty to prove intervention efficacy on ASD core symptoms. There are no universally accepted outcome measures developed for measuring changes in core symptoms. However, the CARS (Childhood Autism Rating Scale) is one of the outcomes recommended in the EMA Guideline on the clinical development of medicinal products for the treatment of ASD. Unfortunately, there is currently no consensus on the response definition for CARS among individuals with ASD. The aim of this elicitation process was to determine an appropriate definition of a response on the CARS2 scale for interventions in patients with Autism Spectrum Disorder (ASD). An elicitation process was conducted following the Sheffield Elicitation Framework (SHELF). Five experts in the field of ASD and two experts in expert knowledge elicitation participated in an 1-day elicitation workshop. Experts in ASD were previously trained in the SHELF elicitation process and received a dossier of scientific evidence concerning the topic. The response definition was set as the mean clinically relevant improvement averaged over all patients, levels of functioning, age groups ***and clinicians. Based on the scientific evidence and expert judgment, a normal probability distribution was agreed to represent the state of knowledge of this response with expected value 4.03 and standard deviation 0.664. Considering the remaining uncertainty of the estimation and the available literature, a CARS-2 improvement of 4.5 points has been defined as a threshold to conclude to a response after an intervention. A CARS-2 improvement of 4.5 points could be used to evaluate interventions' meaningfulness in indivudals. This initial finding represents an important new benchmark and may aid decision makers in evaluating the efficacy of interventions in ASD.

scholarly journals The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-21 ◽  
Author(s):  
Boram Lee ◽  
Jihong Lee ◽  
Jin-Hong Cheon ◽  
Hyun-Kyung Sung ◽  
Seung-Hun Cho ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Rating Scale ◽  
Meta Analysis ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Efficacy And Safety ◽  
Communication Ability ◽  
Mean Differences ◽  
Core Symptoms

Objectives. We aimed to summarize and critically evaluate the available evidence regarding the efficacy and safety of acupuncture for children with autism spectrum disorder (ASD). Methods. We searched 13 databases for studies published up to December 2016. Randomized controlled trials (RCTs) evaluating the efficacy of acupuncture for children with ASD were included. Outcome measures were the overall scores on scales evaluating the core symptoms of ASD and the scores for each symptom, such as social communication ability and skills, stereotypies, language ability, and cognitive function. Effect sizes were presented as mean differences (MD). Results. Twenty-seven RCTs with 1736 participants were included. Acupuncture complementary to behavioral and educational intervention significantly decreased the overall scores on the Childhood Autism Rating Scale (CARS) (MD −8.10, 95% CI −12.80 to −3.40) and the Autism Behavior Checklist (MD −8.92, 95% CI −11.29 to −6.54); however, it was unclear which of the ASD symptoms improved. Acupuncture as a monotherapy also reduced the overall CARS score. The reported adverse events were acceptable. Conclusions. This review suggests that acupuncture may be effective and safe for pediatric ASD. However, it is not conclusive due to the heterogeneity of the acupuncture treatment methods used in the studies.

scholarly journals Comorbid Symptoms of Internet Addiction Among Adolescents with and Without Autism Spectrum Disorder: A Comparative Study

2021 ◽  
Author(s):  
Kentaro Kawabe ◽  
Fumie Horiuchi ◽  
Rie Hosokawa ◽  
Kiwamu Nakachi ◽  
Junya Soga ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Internet Addiction ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Japanese Version ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Self Report ◽  
Social Responsiveness ◽  
Related Factors

Abstract Over the last decade, research into the characteristics of problematic internet use among individuals with autism spectrum disorder (ASD) has greatly increased. We investigated Internet addiction’s prevalence and compared its related factors, among adolescents with and without ASD. Outpatients (n = 102) aged 12–15 years, completed the Basic Information Questionnaire, Internet Addiction Test, and Quick Inventory of Depressive Symptomatology Self-Report Japanese version. Their parents completed the Social Responsiveness Scale-2 and Attention Deficit Hyperactivity Disorder Rating Scale-IV. Scores of both (ASD and without ASD) groups were analyzed. Prevalence of Internet addiction was 40.0% in ASD group and 23.9% in without ASD group. Statistically related factors of Internet addiction were not found in the ASD group. However, factors of Internet addiction were related to the QIDS and ADHD-RS scores in the without ASD group. In conclusion, factors related to Internet addiction differed for ASD patients and without ASD patients.

scholarly journals Efetividade da equoterapia na abordagem do transtorno do espectro autista: Revisão sistemática de ensaios clínicos / Effectiveness of hippotherapy in autism spectrum disorder approach: A systematic review of clinical trials

2021 ◽  
Vol 4 (6) ◽  
pp. 27627-27641
Author(s):  
Josiane Lopes ◽  
Anara de Oliveira Camilo ◽  
Débora Kauane Nascimento ◽  
Gabrielle Pazzetto De Mattos ◽  
Gustavo Athayde Stockler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorder ◽  
Clinical Trials ◽  
Autism Spectrum ◽  
Spectrum Disorder

Development of a patient-centered conceptual model of the impact of living with autism spectrum disorder

Autism ◽  
2017 ◽  
Vol 22 (8) ◽  
pp. 953-969
Author(s):  
Fiona McDougall ◽  
Thomas Willgoss ◽  
Steve Hwang ◽  
Federico Bolognani ◽  
Lorraine Murtagh ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Clinical Trials ◽  
Conceptual Model ◽  
Outcome Measures ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Patient Centered ◽  
Adults With Autism ◽  
Adolescents And Adults ◽  
The Impact

The aim of this study was to generate a patient-centered conceptual model of the impact of living with autism spectrum disorder, which can be used to support the selection of outcome measures for clinical trials. Following an initial literature review to identify preliminary concepts and inform an interview guide, in-depth face-to-face interviews were conducted with adolescents and adults with autism spectrum disorder (IQ ⩾ 70) (n = 10), as well as parents of children, adolescents, and adults with autism spectrum disorder (IQ ⩾ 70) (n = 26). Data were analyzed using established qualitative research methods. The resultant conceptual model contains three interrelated domains reflecting core symptoms of autism spectrum disorder (communication deficits, socialization deficits, and restrictive, repetitive patterns of behavior), three domains reflecting associated symptoms of autism spectrum disorder (physical, cognitive, and emotional/behavioral), and three domains representing the impacts of living with autism spectrum disorder (impacts on activities of daily living, school/work, and social life). Interview respondents also cited social communication deficits as priority targets for new treatments. The conceptual model provides a patient-centered perspective of relevant concepts of autism spectrum disorder from the perspectives of people with autism spectrum disorder and their parents and offers a valuable tool for identifying valid patient-centered outcome measures for future clinical trials.

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