Autism spectrum disorders: a meta-analysis of executive function
Autism spectrum disorders: a meta-analysis of executive function
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DOI：
10.1038/mp.2017.75
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发表时间：
2018-05-01
影响因子：
11
通讯作者：
Guastella, A. J.
中科院分区：
文献类型：
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作者：
Demetriou, E. A.;Lampit, A.;Guastella, A. J.
自闭症谱系障碍（ASD）在整个发展过程中执行功能障碍的证据仍然混合，确定其作用对于指导诊断和干预至关重要。本荟萃分析的主要目的是分析ASD中的执行功能（EF）表现、EF子域的分级、EF测量的临床效用以及多个调节因素（例如，年龄、性别、诊断、测量特征）的影响。检索Embase、Medline和PsychINFO数据库，以识别自DSM-III（1980）中纳入自闭症以来至2016年6月底发表的同行评审研究，这些研究比较了ASD与神经型对照的EF。使用随机效应模型，并使用亚组分析对调节因子进行测试。主要结果测量是EF和调节因子的Hedges效应量。临床敏感性通过重叠百分比统计（OL%）确定。根据PRISMA（系统性综述和荟萃分析的首选报告项目）指南报告结果。共纳入了235项研究，包括14081例受试者（N，ASD = 6816，对照= 7265）。发现EF降低的总体效应量中等（Hedges g = 0.48，95%置信区间（CI）0.43-0.53），每个领域的效应量相似。大多数主持人的比较并不显着，虽然执行功能障碍的整体效果已逐渐减少，因为引入ASD。只有少数EF指标达到临床灵敏度。这项研究证实了ASD中广泛的执行功能障碍在整个发展过程中相对稳定。将执行功能障碍细分为单个亚领域的观点不被支持，诊断的敏感性也不被支持。开发可行的EF测量方法，重点关注诊断和治疗研究的临床敏感性，应成为优先事项。
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.