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Pharmacological and dietary-supplement treatments for autism spectrum disorder: a systematic review and network meta-analysis / Spyridon SIAFIS in Molecular Autism, 13 (2022)
[article]
Titre : Pharmacological and dietary-supplement treatments for autism spectrum disorder: a systematic review and network meta-analysis Type de document : Texte imprimé et/ou numérique Auteurs : Spyridon SIAFIS, Auteur ; O?ulcan ÇIRAY, Auteur ; Hui WU, Auteur ; Johannes SCHNEIDER-THOMA, Auteur ; Irene BIGHELLI, Auteur ; Marc KRAUSE, Auteur ; Alessandro RODOLICO, Auteur ; Anna CERASO, Auteur ; Giacomo DESTE, Auteur ; Maximilian HUHN, Auteur ; David FRAGUAS, Auteur ; Antonia SAN JOSE CACERES, Auteur ; Dimitris MAVRIDIS, Auteur ; Tony CHARMAN, Auteur ; Declan G. MURPHY, Auteur ; Mara PARELLADA, Auteur ; Celso ARANGO, Auteur ; Stefan LEUCHT, Auteur Article en page(s) : 10 p. Langues : Anglais (eng) Mots-clés : Adolescent Adult Attention Deficit Disorder with Hyperactivity Autism Spectrum Disorder/drug therapy Child Humans Network Meta-Analysis Oxytocin/therapeutic use Risperidone/therapeutic use Adhd Anxiety Autism Caregiver stress Irritability Meta-analysis Response Restricted and repetitive behaviors Social communication Treatment Index. décimale : PER Périodiques Résumé : BACKGROUND: There is still no approved medication for the core symptoms of autism spectrum disorder (ASD). This network meta-analysis investigated pharmacological and dietary-supplement treatments for ASD. METHODS: We searched for randomized-controlled-trials (RCTs) with a minimum duration of seven days in ClinicalTrials.gov, EMBASE, MEDLINE, PsycINFO, WHO-ICTRP (from inception up to July 8, 2018), CENTRAL and PubMed (up to November 3, 2021). The co-primary outcomes were core symptoms (social-communication difficulties-SCD, repetitive behaviors-RB, overall core symptoms-OCS) measured by validated scales and standardized-mean-differences (SMDs). Associated symptoms, e.g., irritability/aggression and attention-deficit/hyperactivity disorder (ADHD) symptoms, dropouts and important side-effects, were investigated as secondary outcomes. Studies in children/adolescents and adults were analyzed separately in random-effects pairwise and network meta-analyses. RESULTS: We analyzed data for 41 drugs and 17 dietary-supplements, from 125 RCTs (n=7450 participants) in children/adolescents and 18 RCTs (n=1104) in adults. The following medications could improve at least one core symptom domain in comparison with placebo: aripiprazole (k=6 studies in analysis, SCD: SMD=0.27 95% CI [0.09, 0.44], RB: 0.48 [0.26, 0.70]), atomoxetine (k=3, RB:0.49 [0.18, 0.80]), bumetanide (k=4, RB: 0.35 [0.09, 0.62], OCS: 0.61 [0.31, 0.91]), and risperidone (k=4, SCM: 0.31 [0.06, 0.55], RB: 0.60 [0.29, 0.90]; k=3, OCS: 1.18 [0.75, 1.61]) in children/adolescents; fluoxetine (k=1, RB: 1.20 [0.45, 1.96]), fluvoxamine (k=1, RB: 1.04 [0.27, 1.81]), oxytocin (k=6, RB:0.41 [0.16, 0.66]) and risperidone (k=1, RB: 0.97 [0.21,1.74]) in adults. There were some indications of improvement by carnosine, haloperidol, folinic acid, guanfacine, omega-3-fatty-acids, probiotics, sulforaphane, tideglusib and valproate, yet imprecise and not robust. Confidence in these estimates was very low or low, except moderate for oxytocin. Medications differed substantially in improving associated symptoms, and in their side-effect profiles. LIMITATIONS: Most of the studies were inadequately powered (sample sizes of 20-80 participants), with short duration (8-13 weeks), and about a third focused on associated symptoms. Networks were mainly star-shaped, and there were indications of reporting bias. There was no optimal rating scale measuring change in core symptoms. CONCLUSIONS: Some medications could improve core symptoms, although this could be likely secondary to the improvement of associated symptoms. Evidence on their efficacy and safety is preliminary; therefore, routine prescription of medications for the core symptoms cannot be recommended. Trial registration PROSPERO-ID CRD42019125317. En ligne : http://dx.doi.org/10.1186/s13229-022-00488-4 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=477
in Molecular Autism > 13 (2022) . - 10 p.[article] Pharmacological and dietary-supplement treatments for autism spectrum disorder: a systematic review and network meta-analysis [Texte imprimé et/ou numérique] / Spyridon SIAFIS, Auteur ; O?ulcan ÇIRAY, Auteur ; Hui WU, Auteur ; Johannes SCHNEIDER-THOMA, Auteur ; Irene BIGHELLI, Auteur ; Marc KRAUSE, Auteur ; Alessandro RODOLICO, Auteur ; Anna CERASO, Auteur ; Giacomo DESTE, Auteur ; Maximilian HUHN, Auteur ; David FRAGUAS, Auteur ; Antonia SAN JOSE CACERES, Auteur ; Dimitris MAVRIDIS, Auteur ; Tony CHARMAN, Auteur ; Declan G. MURPHY, Auteur ; Mara PARELLADA, Auteur ; Celso ARANGO, Auteur ; Stefan LEUCHT, Auteur . - 10 p.
Langues : Anglais (eng)
in Molecular Autism > 13 (2022) . - 10 p.
Mots-clés : Adolescent Adult Attention Deficit Disorder with Hyperactivity Autism Spectrum Disorder/drug therapy Child Humans Network Meta-Analysis Oxytocin/therapeutic use Risperidone/therapeutic use Adhd Anxiety Autism Caregiver stress Irritability Meta-analysis Response Restricted and repetitive behaviors Social communication Treatment Index. décimale : PER Périodiques Résumé : BACKGROUND: There is still no approved medication for the core symptoms of autism spectrum disorder (ASD). This network meta-analysis investigated pharmacological and dietary-supplement treatments for ASD. METHODS: We searched for randomized-controlled-trials (RCTs) with a minimum duration of seven days in ClinicalTrials.gov, EMBASE, MEDLINE, PsycINFO, WHO-ICTRP (from inception up to July 8, 2018), CENTRAL and PubMed (up to November 3, 2021). The co-primary outcomes were core symptoms (social-communication difficulties-SCD, repetitive behaviors-RB, overall core symptoms-OCS) measured by validated scales and standardized-mean-differences (SMDs). Associated symptoms, e.g., irritability/aggression and attention-deficit/hyperactivity disorder (ADHD) symptoms, dropouts and important side-effects, were investigated as secondary outcomes. Studies in children/adolescents and adults were analyzed separately in random-effects pairwise and network meta-analyses. RESULTS: We analyzed data for 41 drugs and 17 dietary-supplements, from 125 RCTs (n=7450 participants) in children/adolescents and 18 RCTs (n=1104) in adults. The following medications could improve at least one core symptom domain in comparison with placebo: aripiprazole (k=6 studies in analysis, SCD: SMD=0.27 95% CI [0.09, 0.44], RB: 0.48 [0.26, 0.70]), atomoxetine (k=3, RB:0.49 [0.18, 0.80]), bumetanide (k=4, RB: 0.35 [0.09, 0.62], OCS: 0.61 [0.31, 0.91]), and risperidone (k=4, SCM: 0.31 [0.06, 0.55], RB: 0.60 [0.29, 0.90]; k=3, OCS: 1.18 [0.75, 1.61]) in children/adolescents; fluoxetine (k=1, RB: 1.20 [0.45, 1.96]), fluvoxamine (k=1, RB: 1.04 [0.27, 1.81]), oxytocin (k=6, RB:0.41 [0.16, 0.66]) and risperidone (k=1, RB: 0.97 [0.21,1.74]) in adults. There were some indications of improvement by carnosine, haloperidol, folinic acid, guanfacine, omega-3-fatty-acids, probiotics, sulforaphane, tideglusib and valproate, yet imprecise and not robust. Confidence in these estimates was very low or low, except moderate for oxytocin. Medications differed substantially in improving associated symptoms, and in their side-effect profiles. LIMITATIONS: Most of the studies were inadequately powered (sample sizes of 20-80 participants), with short duration (8-13 weeks), and about a third focused on associated symptoms. Networks were mainly star-shaped, and there were indications of reporting bias. There was no optimal rating scale measuring change in core symptoms. CONCLUSIONS: Some medications could improve core symptoms, although this could be likely secondary to the improvement of associated symptoms. Evidence on their efficacy and safety is preliminary; therefore, routine prescription of medications for the core symptoms cannot be recommended. Trial registration PROSPERO-ID CRD42019125317. En ligne : http://dx.doi.org/10.1186/s13229-022-00488-4 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=477 Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis / I. MAVRANEZOULI in Journal of Child Psychology and Psychiatry, 61-1 (January 2020)
[article]
Titre : Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis Type de document : Texte imprimé et/ou numérique Auteurs : I. MAVRANEZOULI, Auteur ; O. MEGNIN-VIGGARS, Auteur ; C. DALY, Auteur ; S. DIAS, Auteur ; S. STOCKTON, Auteur ; R. MEISER-STEDMAN, Auteur ; D. TRICKEY, Auteur ; S. PILLING, Auteur Article en page(s) : p.18-29 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder intervention network meta-analysis Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood. METHODS: We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS: We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was as follows: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence. CONCLUSIONS: Trauma-focused cognitive behavioural therapy, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence. En ligne : http://dx.doi.org/10.1111/jcpp.13094 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=413
in Journal of Child Psychology and Psychiatry > 61-1 (January 2020) . - p.18-29[article] Research Review: Psychological and psychosocial treatments for children and young people with post-traumatic stress disorder: a network meta-analysis [Texte imprimé et/ou numérique] / I. MAVRANEZOULI, Auteur ; O. MEGNIN-VIGGARS, Auteur ; C. DALY, Auteur ; S. DIAS, Auteur ; S. STOCKTON, Auteur ; R. MEISER-STEDMAN, Auteur ; D. TRICKEY, Auteur ; S. PILLING, Auteur . - p.18-29.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 61-1 (January 2020) . - p.18-29
Mots-clés : Post-traumatic stress disorder intervention network meta-analysis Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder that affects a significant minority of youth exposed to trauma. Previous studies have concluded that trauma-focused cognitive behavioural therapy (TF-CBT) is an effective treatment for PTSD in youth, but the relative strengths of different psychological therapies are poorly understood. METHODS: We undertook a systematic review and network meta-analyses of psychological and psychosocial interventions for children and young people with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment. RESULTS: We included 32 trials of 17 interventions and 2,260 participants. Overall, the evidence was of moderate-to-low quality. No inconsistency was detected between direct and indirect evidence. Individual forms of TF-CBT showed consistently large effects in reducing PTSD symptoms post-treatment compared with waitlist. The order of interventions by descending magnitude of effect versus waitlist was as follows: cognitive therapy for PTSD (SMD -2.94, 95%CrI -3.94 to -1.95), combined somatic/cognitive therapies, child-parent psychotherapy, combined TF-CBT/parent training, meditation, narrative exposure, exposure/prolonged exposure, play therapy, Cohen TF-CBT/cognitive processing therapy (CPT), eye movement desensitisation and reprocessing (EMDR), parent training, group TF-CBT, supportive counselling and family therapy (SMD -0.37, 95%CrI -1.60 to 0.84). Results for parent training, supportive counselling and family therapy were inconclusive. Cohen TF-CBT/CPT, group TF-CBT and supportive counselling had the largest evidence base. Results regarding changes in PTSD symptoms at follow-up and remission post-treatment were uncertain due to limited evidence. CONCLUSIONS: Trauma-focused cognitive behavioural therapy, in particular individual forms, appears to be most effective in the management of PTSD in youth. EMDR is effective but to a lesser extent. Supportive counselling does not appear to be effective. Results suggest a large positive effect for emotional freedom technique, child-parent psychotherapy, combined TF-CBT/parent training, and meditation, but further research is needed to confirm these findings as they were based on very limited evidence. En ligne : http://dx.doi.org/10.1111/jcpp.13094 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=413 Research Review: The most effective parenting program content for disruptive child behavior - a network meta-analysis / P. LEIJTEN in Journal of Child Psychology and Psychiatry, 63-2 (February 2022)
[article]
Titre : Research Review: The most effective parenting program content for disruptive child behavior - a network meta-analysis Type de document : Texte imprimé et/ou numérique Auteurs : P. LEIJTEN, Auteur ; G. J. MELENDEZ-TORRES, Auteur ; F. GARDNER, Auteur Article en page(s) : p.132-142 Langues : Anglais (eng) Mots-clés : Parenting program disruptive child behavior effective components network meta-analysis systematic review Index. décimale : PER Périodiques Résumé : BACKGROUND: Programs to support parents are the recommended strategy to reduce disruptive child behavior problems. Efforts have been made to demonstrate which program components (i.e., clusters of techniques taught) increase program effects, but these methods fail to account for the fact that components rarely operate in isolation. We examine how combinations of components cluster together to form program types and use network meta-analysis to estimate the relative effects of these program types. METHODS: We updated an existing systematic review of parenting programs for disruptive child behavior and identified 197 randomized trials. We modeled clusters of components in each trial arm and chose the best-fitting model. We subsequently took 20 draws from the probability distribution of the latent class for each arm, entered each draw into a network meta-analysis model and combined findings using Rubin's rules. Combined estimates were bootstrapped to rank the clusters. We estimated main models and separate models for prevention and treatment settings. RESULTS: A five-class solution fit the data best: (1) behavior management; (2) behavior management with parental self-management; (3) behavior management with psychoeducation and relationship enhancement; (4) maximal component loading and (5) no/minimal component loading (i.e. control). In the main model and in treatment settings, all four program types were effective compared to no/minimal components. In prevention settings, only behavior management and behavior management with parental self-management were effective compared to no/minimal components. Probabilistic ranking showed that overall and in treatment settings, behavior management had the largest chance, and in prevention settings, behavior management with self-management had the largest chance, of being most effective compared to no/minimal components. CONCLUSIONS: Programs with more focused content seem more likely to yield stronger effects, and different foci may be needed in treatment versus prevention settings. Next steps include identifying individual family differences in optimal program content. En ligne : http://dx.doi.org/10.1111/jcpp.13483 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=457
in Journal of Child Psychology and Psychiatry > 63-2 (February 2022) . - p.132-142[article] Research Review: The most effective parenting program content for disruptive child behavior - a network meta-analysis [Texte imprimé et/ou numérique] / P. LEIJTEN, Auteur ; G. J. MELENDEZ-TORRES, Auteur ; F. GARDNER, Auteur . - p.132-142.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 63-2 (February 2022) . - p.132-142
Mots-clés : Parenting program disruptive child behavior effective components network meta-analysis systematic review Index. décimale : PER Périodiques Résumé : BACKGROUND: Programs to support parents are the recommended strategy to reduce disruptive child behavior problems. Efforts have been made to demonstrate which program components (i.e., clusters of techniques taught) increase program effects, but these methods fail to account for the fact that components rarely operate in isolation. We examine how combinations of components cluster together to form program types and use network meta-analysis to estimate the relative effects of these program types. METHODS: We updated an existing systematic review of parenting programs for disruptive child behavior and identified 197 randomized trials. We modeled clusters of components in each trial arm and chose the best-fitting model. We subsequently took 20 draws from the probability distribution of the latent class for each arm, entered each draw into a network meta-analysis model and combined findings using Rubin's rules. Combined estimates were bootstrapped to rank the clusters. We estimated main models and separate models for prevention and treatment settings. RESULTS: A five-class solution fit the data best: (1) behavior management; (2) behavior management with parental self-management; (3) behavior management with psychoeducation and relationship enhancement; (4) maximal component loading and (5) no/minimal component loading (i.e. control). In the main model and in treatment settings, all four program types were effective compared to no/minimal components. In prevention settings, only behavior management and behavior management with parental self-management were effective compared to no/minimal components. Probabilistic ranking showed that overall and in treatment settings, behavior management had the largest chance, and in prevention settings, behavior management with self-management had the largest chance, of being most effective compared to no/minimal components. CONCLUSIONS: Programs with more focused content seem more likely to yield stronger effects, and different foci may be needed in treatment versus prevention settings. Next steps include identifying individual family differences in optimal program content. En ligne : http://dx.doi.org/10.1111/jcpp.13483 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=457