Que font les revues systématiques Cochrane au sujet des interventions sur les "troubles du spectre de l'autisme" ?

Aperçu: G.M.

Les "troubles du spectre de l'autisme"  (TSA) comprennent le trouble autistique, le trouble d'Asperger et le trouble envahissant du développement . Les manifestations des TSA peuvent avoir un impact important sur l'apprentissage et le fonctionnement social qui peuvent persister pendant l'âge adulte. L'objectif ici était de résumer les résultats des examens systématiques de Cochrane sur les interventions pour les TSA.

Dix-sept examens ont été inclus. Ceux-ci ont trouvé une faible preuve des avantages de l'acupuncture, du gluten et des régimes sans caséine, des interventions comportementales intensives précoces, de la musicothérapie, des interventions précoce médiées par les parents, des groupes de compétences sociales, du modèle cognitif de la  Théorie de l'esprit, de l'aripiprazole, de la rispéridone, des antidépresseurs tricycliques et du recapture sélectif des inhibiteurs de la sérotonine (SSRI); Ceci ne concerne que les adultes.  

Aucun avantage n'a été trouvé pour les thérapies sonores, les agents chélateurs, l'oxygénothérapie hyperbare, l'oméga-3, la sécrétine, la vitamine B6 / magnésium et les ISRS pour les enfants.
Des études expérimentales pour confirmer un lien entre les thérapies probables et le "trouble", puis des essais cliniques à long terme de haute qualité sont nécessaires.

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Sao Paulo Med J. 2017 Mar-Apr;135(2):192-201. doi: 10.1590/1516-3180.2017.0058200317.

What do Cochrane systematic reviews say about interventions for autism spectrum disorders?

Lyra L¹, Rizzo LE¹, Sunahara CS¹, Pachito DV², Latorraca COC³, Martimbianco ALC⁴, Riera R⁵.

Author information

1

Undergraduate Medical Student, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.

2

MD, MSc. Neurologist; Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil; and Assistant Researcher at Cochrane Brazil, São Paulo (SP), Brazil.

3

Psychologist. Postgraduate Student, Evidence-Based Health Program, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil; and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.

4

MSc, PhD. Physiotherapist and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.

5

MD, MSc, PhD. Rheumatologist and Adjunct Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp); and Assistant Coordinator, Cochrane Brazil, São Paulo (SP), Brazil.

Abstract

CONTEXT AND OBJECTIVE::

Autism spectrum disorders (ASDs) include autistic disorder, Asperger's disorder and pervasive developmental disorder. The manifestations of ASDs can have an important impact on learning and social functioning that may persist during adulthood. The aim here was to summarize the evidence from Cochrane systematic reviews on interventions for ASDs.

DESIGN AND SETTING::

Review of systematic reviews, conducted within the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo.

METHODS::

We included and summarized the results from Cochrane systematic reviews on interventions for ASDs.

RESULTS::

Seventeen reviews were included. These found weak evidence of benefits from acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups, Theory of Mind cognitive model, aripiprazole, risperidone, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI); this last only for adults. No benefits were found for sound therapies, chelating agents, hyperbaric oxygen therapy, omega-3, secretin, vitamin B6/magnesium and SSRI for children.

CONCLUSION::

Acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups and the Theory of Mind cognitive model seem to have benefits for patients with autism spectrum disorders (very low to low-quality evidence). Aripiprazole, risperidone, tricyclic antidepressants and SSRI (this last only for adults) also showed some benefits, although associated with higher risk of adverse events. Experimental studies to confirm a link between probable therapies and the disease, and then high-quality long-term clinical trials, are needed.

PMID: 28538871

DOI: 10.1590/1516-3180.2017.0058200317