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Table 2 Summary of Findings (SoF) for the comparison antipsychotics versus placebo – continuous outcomes

From: Impact of antipsychotics in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis

Antipsychotics versus no antipsychotics – continuous outcomes

Population: children and adolescents with ASD

Setting: outpatients and inpatients

Intervention: antipsychotics

Comparator: no antipsychotics

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

№ of participants (studies)

Certainty of the evidence (GRADE)

Comments

Risk with no Antipsychotics

Risk with Antipsychotics

Restricted and repetitive interests and behaviors

SMD 0.21 SD lower (0.35 lower to 0.07 lower)

823 (9 RCTs)

MODERATE a

Antipsychotics probably slightly reduce restricted and repetitive interests and behaviors

Hyperactivity, inattention, oppositional, disruptive behavior

SMD 0.67 SD lower (0.92 lower to 0.42 lower)

783 (8 RCTs)

MODERATE a

Antipsychotics probably reduce Hyperactivity, inattention, oppositional, disruptive behavior disorders

Self-harm

SMD 0.14 SD lower (0.58 lower to 0.30 higher)

77 (1 RCT)

VERY LOW b,c

There are some uncertainties about the effect of Antipsychotics on self-harm

Social communication, social interaction

SMD 0.38 SD lower (0.59 lower to 0.16 lower)

854 (10 RCTs)

MODERATE a

Antipsychotics probably slightly improve social communication, social interaction

Emotional dysregulation/irritability

SMD 0.71 SD lower (0.98 lower to 0.43 lower)

879 (9 RCTs)

LOW a,d

Antipsychotics administration may result in a large reduction of emotional dysregulation/irritability

Anxiety

SMD 0.38 SD lower (0.82 lower to 0.07 higher)

77 (1 RCT)

VERY LOW b,c

There are some uncertainties about the effect of Antipsychotics on anxiety

Global functioning, global improvement

SMD 0.64 SD lower (0.96 lower to 0.33 lower)

839 (10 RCTs)

LOW e,f

Antipsychotics may influence positively Global functioning, global improvement

Obsessions, compulsions

SMD 0.30 SD lower (0.55 lower to 0.06 lower)

548 (4 RCTs)

MODERATE g

Antipsychotics probably slightly reduce obsessions, compulsions

  1. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; SMD: Standardised mean difference; RR: Risk ratio
  2. GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  3. Explanations
  4. a. Downgraded by one level because most studies showed an unclear risk of bias for selection bias and one study was at high risk for attrition bias
  5. b. Downgraded by one level because the included study was at high risk for selection bias
  6. c. Downgraded by two levels because the sample size is very small (< 400) and the 95%CI for SMD goes from considerable beneficial effects to considerable undesirable effects
  7. d. Downgraded by one level for heterogeneity (I2 = 71.0%), several confidence intervals of the included trial not overlapping and important differences in the point estimates
  8. e. Downgraded by one level because most studies showed an unclear risk for selection bias, two studies were at high risk for reporting bias and one study was at high risk for selection bias
  9. f. Downgraded by one level for heterogeneity (I2 = 75.6%), several confidence intervals of the included trial not overlapping and important differences in the point estimates
  10. g. Downgraded by one level because the 95%CI for SMD goes from considerable beneficial effects to not clinically relevant effects