Table 2 Summary of Findings for each Evidence to Decision (EtD) framework criterion
| EtD Domain | Results |
|---|---|
| Equity | No included studies |
| Acceptability |
4 studies (2 cross-sectional studies [48, 50], 1 cohort study [49], 1 systematic review [54]) included in the qualitative synthesis, 3 of which specific to both our study population and intervention [49, 50, 54], one only for the study population [48]. Antipsychotics were among the most prescribed drugs, with a median prevalence of use of 17%. A trend to switch from stimulants to anti-psychotics and anti-depressants as age increased was identified [54]. Socio-demographic predictors of the use of antipsychotics in our population: adolescent age, low adaptive functioning, aggressive and self-harm behaviors, and parental concern for symptoms. Clinical predictors of use: hyperactivity, depression, obsessive-compulsive symptoms, tics, intellectual disability, psychosis [49]. Drug therapy was the most frequently interrupted treatment (20%), mainly due to a lack of efficacy and AEs. Parents considered as crucial in choosing the treatment: opinions about the causes of the ASD, parental style, lifestyle, socio-economic status, ease of access to services and care, the impact of the media, and the testimonies of other families, but not scientific evidence [48]. Low income, child’s IQ ≥ 45, lower parents’ education correlated to poor satisfaction with the number of visits, learning tests, and behavioral assessment, respectively, in an RCT of risperidone vs. placebo [50]. Quantitative synthesis: antipsychotics in children and adolescents with ASD are acceptable (DO due to any cause: 15 RCTs [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47], RR 0.61, 95% CI 0.48–0.78, moderate certainty of evidence) and well tolerated (DO due to AEs: 12 RCTs [34,35,36,37,38,39,40,41, 44,45,46,47], RR 0.99, 95% CI 0.55–1.79, low certainty of evidence). |
| Feasibility |
3 cross-sectional studies [51,52,53] investigated the feasibility of administering antipsychotics to the general population (indirect evidence). Facilitators: Nursing team, Electronic medical records, Parental or caregiver support. Barriers: Electronic medical records, workloads, Cost barriers for the choice of drug, inadequate monitoring of metabolic AEs. |