Aperçu: G.M.
La
preuve du dysfonctionnement de l'exécution dans les troubles du spectre
de l'autisme (TSA) à travers le développement reste mitigée et
l'établissement de son rôle est essentiel pour guider le diagnostic et
l'intervention. Les
principaux objectifs de cette méta-analyse sont d'analyser la
performance de la fonction exécutive (FE) dans le TSA, la segmentation de la FE en sous-domaines, l'utilité clinique des mesures FE et
l'influence de plusieurs modérateurs (par exemple, l'âge, le genre, le
diagnostic, les caractéristiques de mesure ).
Au total, 235 études comprenant 14 081 participants ont été incluses (N, TSA= 6816, Control = 7265).
La
majorité des comparaisons des modérateurs n'étaient pas significatives,
bien que l'effet global du dysfonctionnement de l'exécutif ait
progressivement diminué depuis l'introduction du TSA. Seul un petit nombre de mesures FE ont atteint une sensibilité clinique.
Cette étude confirme un large dysfonctionnement exécutif dans les TSA qui est relativement stable à travers le développement. La segmentation du dysfonctionnement exécutif en sous-domaines
n'est pas pertinente, de même que la sensibilité diagnostique.
Le
développement de mesures réalisables FE axées sur la sensibilité
clinique pour les études de diagnostic et de traitement devrait être une
priorité.
Mol Psychiatry. 2017 Apr 25. doi: 10.1038/mp.2017.75.
Autism spectrum disorders: a meta-analysis of executive function
Demetriou EA1, Lampit A2, Quintana DS1,3, Naismith SL2, Song YJC1, Pye JE2, Hickie I1, Guastella AJ1.
Author information
- 1
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, Sydney, NSW, Australia.
- 2
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.
- 3
- Norment, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
Evidence of executive dysfunction in autism
spectrum disorders (ASD) across development remains mixed and
establishing its role is critical for guiding diagnosis and
intervention. The primary objectives of this meta-analysis is to analyse
executive function (EF) performance in ASD, the fractionation across EF
subdomains, the clinical utility of EF measures and the influence of
multiple moderators (for example, age, gender, diagnosis, measure
characteristics). The Embase, Medline and PsychINFO databases were
searched to identify peer-reviewed studies published since the inclusion
of Autism in
DSM-III (1980) up to end of June 2016 that compared EF in ASD with
neurotypical controls. A random-effects model was used and moderators
were tested using subgroup analysis. The primary outcome measure was
Hedges' g effect size for EF and moderator factors. Clinical sensitivity
was determined by the overlap percentage statistic (OL%). Results were
reported according to the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines. A total of 235 studies
comprising 14 081 participants were included (N, ASD=6816,
Control=7265). A moderate overall effect size for reduced EF (Hedges'
g=0.48, 95% confidence interval (CI) 0.43-0.53) was found with similar
effect sizes across each domain. The majority of moderator comparisons
were not significant although the overall effect of executive
dysfunction has gradually reduced since the introduction of ASD. Only a
small number of EF measures achieved clinical sensitivity. This study
confirms a broad executive dysfunction in ASD that is relatively stable
across development. The fractionation of executive dysfunction into
individual subdomains was not supported, nor was diagnostic sensitivity.
Development of feasible EF measures focussing on clinical sensitivity
for diagnosis and treatment studies should be a priority.Molecular
Psychiatry advance online publication, 25 April 2017;
doi:10.1038/mp.2017.75.
- PMID: 28439105
- DOI: 10.1038/mp.2017.75
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