The efficacy and safety in attention deficit hyperactivity disorder of second-generation antipsychotics and other medications for hyperactivity in children and adolescents with autism: a meta-analysis

Children and adolescents with ASD also have co-occurrence of attention deficit hyperactivity disorder (ADHD) symptoms. ADHD symptoms, especially hyperactivity, greatly increased the severity of autism symptoms. This study concentrated on two widely-used medications: the second generation of antipsychotics (SGAs) and ADHD medication, aiming to conduct a meta-analysis about their effect on hyperactivity, so it would offer some evidence for clinical medication choice. The Medline, Embase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched from inception to July 2019 for studies exploring the use of SGAs and ADHD medications in autistic children and adolescents. Double-blind, randomized controlled trials that reported hyperactivity as an outcome were included in the study. A total of thirteen trials with 712 participants were included in our meta-analysis. For SGAs, the standardized mean difference (SMD) of hyperactivity subscale in Aberrant behavior checklist scale or conners rating scales was 0.59, 95% confidence interval (CI): 0.23-0.96, I2 = 74%, Q = 15.34, P < 0.01. For ADHD medications, SMD was -0.66, with 95% CI: -0.99 to 0.33, I2 = 53%, Q = 15.02, P = 0.04. As for adverse events, in the SGAs group, somnolence had the largest effect size, risk ratio = 5.62, 95% CI: 3.20- 9.87 (I2 = 0%, Q = 2.45, P = 0.65). In ADHD group, the side effect of decreased appetite showed the largest effect size (risk ratio = 2.63, 95% CI = 0.99-7.01, I2 = 65.7%, Q = 11.66, P = 0.02). Both ADHD medications and SGAs were effective in dealing with hyperactivity in children and adolescents with autism but were shown to increase the risk of decreased appetite, somnolence, headache and nausea or vomiting. The clinical use of these medications should carefully weigh the benefits and risks.