Selective Serotonin Reuptake Inhibitors for Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Abstract Background Effects of Selective Serotonin Reuptake Inhibitors (SSRI) for symptoms of autism spectrum disorder (ASD) or 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 restricted repetitive behaviors, obsessive-compulsive, anxiety and depressive symptoms, disruptive behaviors, global functioning, and quality of life. Methods We searched MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, WHO ICTRP, Clinical.Trials.gov. to retrieve RCT of SSRIs versus placebo in children with ASD that evaluated the outcomes of interest with a validated measurement instrument. Two authors independently extracted data, assessed risk of bias and rated the certainty of evidence. 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, and there is a lack of commonly accepted outcome measures able to identify relevant changes for patients and families. Protocol registration number:PROSPERO-CRD42020169836