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Selective Serotonin Reuptake Inhibitors for Children with Autism Spectrum Disorder: A Systematic Review and
Elisabetta Trinari1, Noella Juliana Noronha2, Davide Papola3,4
1Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Insights
Selective Serotonin Reuptake Inhibitors (SSRIs) show no clear benefit for children with Autism Spectrum Disorder (ASD). Careful consideration of risks versus benefits is advised due to limited evidence and potential side effects.
Area of Science:
- Pediatric Neurology
- Psychopharmacology
- Autism Spectrum Disorder Research
Background:
- Efficacy and safety of Selective Serotonin Reuptake Inhibitors (SSRIs) for Autism Spectrum Disorder (ASD) symptoms and comorbidities remain uncertain.
- Systematic review and meta-analyses were conducted to evaluate SSRI efficacy and safety in pediatric ASD populations.
Purpose of the Study:
- To determine the efficacy and safety of SSRIs in children diagnosed with ASD.
- To assess the impact of SSRIs on clinically relevant outcomes in pediatric ASD.
Main Methods:
- Systematic literature search across seven databases for randomized controlled trials (RCTs) comparing SSRIs to placebo in children with ASD.
- Independent data extraction, risk of bias assessment, and certainty of evidence rating using the GRADE method by two authors.
Main Results:
- Seven RCTs involving 606 participants were analyzed.
- Evidence regarding SSRI effects on restricted repetitive behaviors and anxiety symptoms in ASD is very uncertain.
- Low certainty evidence suggests minimal to no effect on obsessive-compulsive symptoms and disruptive behaviors.
- Moderate certainty evidence indicates little to no difference in global functioning with a slight increase in adverse events.
- No studies evaluated SSRI effects on depressive symptoms in this population.
Conclusions:
- The limited number of studies highlights the need for further research in pediatric ASD populations.
- Current evidence does not support the use of SSRIs for children with ASD.
- Individual risk-benefit assessments are crucial pending more robust evidence.
Background:
Effects of SSRI for symptoms of ASD and comorbid conditions are uncertain. We conducted a systematic review and meta-analyses to determine the efficacy and safety of SSRIs in children with ASD on 8 clinically relevant outcomes.
Methods:
We searched 7 databases to retrieve RCT of SSRIs versus placebo in children with ASD. Two authors independently extracted data, assessed risk of bias and rated the certainty of evidence using the GRADE method.
Results:
Seven RCTs with a total of 606 participants were included. The evidence is very uncertain on the effect of SSRIs on restricted repetitive behaviors and anxiety symptoms in children with ASD. There is low certainty of the evidence suggesting that SSRIs result in little to no effect on obsessive-compulsive symptoms and disruptive behaviors, and there is moderate certainty of the evidence that SSRIs likely result in little to no difference in global functioning and a slight increase in adverse events. No studies evaluated depressive symptoms.
Conclusions:
The number of studies on this population remains limited. The current body of evidence shows no benefit of the use of SSRIs in children with ASD. Risk/benefit assessment should be carefully considered on an individual basis until further evidence is made available.
Protocol Registration Number:
PROSPERO-CRD42020169836.
Lay Abstract:
Efficacy of SSRIs in children with ASD Do SSRIs Help Children with Autism? The scope of this systematic review of the literature was to identify if medications called SSRIs (Selective Serotonin Reuptake Inhibitors) are helpful and safe for children with Autism Spectrum Disorder (ASD). These medicines are sometimes used to treat anxiety, obsessive-compulsive behaviors, or other symptoms. What Did the Study Look At? The researchers carefully examined seven studies that included 606 children with ASD. They compared the effects of SSRIs to a placebo (a pill with no active medicine). What Did They Find? The researchers found that there is not enough data to confidently judge the effect of SSRI on restricted-repetitive behaviors and anxiety symptoms in children with ASD.Data available shows that SSRIs likely don't improve obsessive-compulsive symptoms or disruptive behaviors in children with ASD.SSRIs probably don't make a noticeable difference in overall daily functioning in children with ASD.Children taking SSRIs might experience a small increase in side effects like upset stomach or sleep problems.No studies looked at how SSRIs affect depression in children with ASD. What Does This Mean for Families? Right now, there isn't strong evidence to support using SSRIs for children with ASD. Every child is unique, so if you're considering this medication, it's essential to weigh the possible risks and benefits with your doctor.More research is needed to provide better guidance for families and physicians.
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