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The prevalence of Autism spectrum disorder (ASD) in Australia is about one
in 50 in children under 15 years according to the latest Australian Bureau of
Statistics data and the carer’s allowance provided by the Australian government.
The three main characteristics of Autism spectrum disorder include;
compromised social interaction, impaired communication and restricted
repetitive and stereotyped patterns of behaviour.
Management of ASD includes both
pharmacological and non-pharmacological
treatments. Non pharmacological
treatment rely on enhancing the person’s
communication and academic learning
and behaviour. Examples of interventions
used are educational, behavioural and
social communication. Pharmacological
interventions address the behavioural
aspects of ASD. Both typical (first) and
second (atypical) generation antipsychotics
have been used in clinical practice.
Typical antipsychotics are associated
with extrapyramidal side effects despite
their efficacy in improving learning.
Risperidone has also been effective in
reducing aggression and irritability but is
also associated with adverse events such
as sedation and weight gain. Aripiprazole
is a relatively newer antipsychotic that has
not been widely used in ASD. This evidence
summary will summarise the latest on the
effectiveness of aripiprazole for ASD.
Characteristics of the studies
Randomised controlled trials (RCTs),
including both parallel group and cross-
over designs, of any duration including
children and adults diagnosed with ASD.
Diagnosis of ASD includes individuals
with autistic disorder, Asperger’s disorder
and pervasive developmental disorder.
Quality of the research
Studies included in the report had a low
risk or an unclear risk of bias. Attrition
bias was a major drawback.
The following databases were searched;
Cochrane Central Register of Controlled
Trials (CENTRAL; 2015, Issue 9; part of
The Cochrane Library), Ovid MEDLINE
(1946 to Oct Week 1, 2015), Embase
(1980 to Week 41, 2015; Ovid), CINAHL
Plus (1937 to current; EBSCOhost),
PsycINFO (1806 to October Week 1, 2015;
Ovid), Cochrane Database of Systematic
Reviews (CDSR; 2015, Issue 10; The
Cochrane Library), Database of Abstracts
of Reviews of Effects (DARE; 2015, Issue
2; The Cochrane Library), Conference
Proceedings Citation Index - Science
(CPCI-S; 1990 to current; Web of Science),
Autism Data (all available years), ZETOC
(limited to conference proceedings; all
available years), WorldCat (limited to
theses and dissertations; all available
years), ClinicalTrials.gov (all available
years), World Health Organisation
International Clinical Trials and Registry
Platform (WHO ICTRP; all available years).
The primary outcomes measures
include; emotional and behavioural
symptoms, , irritability, hyperactivity,
sterotypy, Inappropriate speech,
lethargy, withdrawal, aggression, clinical
improvement as measured by validated
clinician- or parent-reported scales and
extrapyramidal adverse events.
Secondary outcomes include; obsessive
compulsive behaviour, weight gain,
metabolic side effects and other side effects.
A total of 579 citations were identified
from the search strategy. Only three
The effectiveness of
Aripiprazole for ASD
BY DR HANAN KHALIL
studies evaluating aripiprazole were
included in the review with a total
number of 401 participants. Two studies
were included in the meta-analysis
and the third did not because of its
Aripiprazole showed a significant
improvement in the irritability scale
measured by the Aberrant behaviour
checklist (ABC); MD =-6.17 (-9.07 to -3.26).
There was also an Improvement on both
the hyperactivity (MD=-7.93 (-10.98 to
4.88) and the sterotypy scale (MD=-2.26
(3.55 to -1.77).
There was a significant increase in weight
gain in children and adolescents taking
aripiprazole MD= 1.13 (0.71 to 1.54).
Sedation and tremor were also increased.
Relapse rate of symptoms was only
reported in one study and was found
to be 37% in the aripiprazole group
compared to 52% in the placebo group
(HR 0.57; 95%CI 0.28 to 1.12).
Implications for practice
There is insufficient evidence addressing
the efficacy of aripiprazole for the
management of ASD. Only two small
studies were found to address the
review. Studies focussing on long term
effectiveness should provide more
evidence for its use. Constant evaluation
of the medications is appropriate to
determine its continued efficacy.
Aripiprazole is effective in the
management of the symptoms of ASD in
the short term however longer term use
of aripiprazole might be associated with
relapses of symptoms.
References located on page 41.
Professor Lisa Nissen – School of Clinical Sciences,
Queensland University of Technology
Dr Esther Lau – School of Clinical Sciences,
Queensland University of Technology
The purpose of this evidence summary is to provide
the best available evidence for the effectiveness of
aripiprazole for the management of the symptoms of
autism spectrum disorders (ASD). For the full review,
please refer to: Hirsch LE, Pringsheim T. Aripiprazole
for autism spectrum disorders (ASD). Cochrane
Database of Systematic Reviews 2016, Issue 6. Art. No.:
CD009043. DOI: 10.1002/14651858.CD009043.pub3.1
» EVIDENCE SUMMARIES
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