The Cochrane database of systematic reviews

Comparing different antipsychotic medicines for autism symptoms

Updated

Abstract

Risperidone and aripiprazole may reduce symptoms of irritability in children with autism spectrum disorder compared to placebo.

  • Risperidone showed a mean difference of -7.89 in irritability symptoms, while aripiprazole had a mean difference of -6.26, based on low-certainty evidence.
  • Lurasidone likely results in little to no difference in irritability compared to placebo, with a mean difference of -1.30.
  • There is very low certainty regarding the effects of atypical antipsychotics on aggression, weight gain, and extrapyramidal side effects compared to placebo.
  • Atypical antipsychotics may improve obsessive-compulsive behaviors and reduce inappropriate speech, with low certainty evidence supporting these findings.
  • Evidence on the efficacy and safety of atypical antipsychotics in adults with autism is limited due to a lack of studies.

Simplified

Funding

Competing interests

NM: none. JVF is a Contact Editor with Cochrane Urology and Managing Editor for Cochrane Metabolic and Endocrine Disorders. This review author was not involved in the editorial process for this review. YS works for Cochrane Response part‐time as a Systematic Reviewer. She is also an Editor with Cochrane Developmental, Psychosocial and Learning Problems (DPLP) and with Cochrane Clinical Answers. This author was not involved in the editorial process for this review. VN: none. CEL: none. RR: none. KW reports an ongoing grant (commencing 1 January 2020) from Epsilon Healthcare (formerly THC Global Group Ltd), to develop an interventional product and placebo for children for an MRFF‐funded phase III multisite trial, and for which the Victorian Government are providing the investigational product; paid to Murdoch Children's Research Institute. KW reports a grant (28 November 2018 to 27 November 2019) from Tilray for a pilot trial of cannabidiol for severe behaviour problems in children with intellectual disability, with or without autism, and for which Tilray provided the investigation drug and placebo; paid to Murdoch Children's Institute. KW also reports a grant (1 June 2020 to 31 May 2023) from the National Health and Medical Research Council (NHMRC), on which she is named Chief Investigator, for a phase III trial of cannabidiol for severe behaviour disorder in children with an intellectual disability, with or without autism; paid to institutions (Monash University, Murdoch Children's Research Institute and Sydney Children's Hospital Network). KW reports being involved in an ongoing study about predictors of autism outcome that will also publish diagnostic stability outcomes, which could be eligible for inclusion in this systematic review; the study is funded by the NHMRC. KW is an Editor with DPLP. Last, KW reports being a member of the data monitoring committee for a trial for selective serotonin reuptake inhibitors for restricted and repetitive behaviours; unpaid position. KW was Principal Investigator on a randomised controlled trial where funding was provided to Monash Children's Clinical Trials Team (ACADIA), and for a trial where funding was provided to Monash Children's Clinical Trials Team (Axial Therapeutics). KW has received consultancy fees for being a member of the Scientific Committee (Human Health). KW has been co‐author of a book receiving royalties (copyright). KW has received a grant from the Australian Medical. VR works as a Child Neurologist at the Dr Gustavo Fricke Hospital and the Universidad de Valparaíso, Chile. FR: none. TP works as a Neurologist at the Alberta Children's Hospital and Foothills Medical Centre, Canada. She reports declaring opinions on the topic in her academic work at the Department of Clinical Neurosciences, University of Calgary, Canada. TP has received grants from Azrieli Accelerator (University of Calgary), and the Canadian Institutes of Health Research. EM is a contributor with the Cochrane Sustainable Healthcare Group and has published opinions on the topic, most recently in the following Cochrane Editorial: Clarke M, Born K, Johansson M, Jørgensen KJ, Levinson W, Madrid E, et al. Making wise choices about low‐value health care in the COVID‐19 pandemic. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: ED000153. DOI: 10.1002/14651858.ED000153.
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