Evidence for interventions.

BackgroundAutistic adults have high risk of mental ill-health and some available interventions have been associated with increased psychiatric diagnoses. Understanding prevalence of psychiatric diagnoses is important to inform the development of individualised treatment and support for autistic adults which have been identified as a research priority by the autistic community. Interventions require to be evaluated both in terms of effectiveness and regarding their acceptability to the autistic community.ObjectiveThis rapid review identified the prevalence of psychiatric disorders in autistic adults, then systematic reviews of interventions aimed at supporting autistic adults were examined. A rapid review of prevalence studies was completed concurrently with an umbrella review of interventions. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed, including protocol registration (PROSPERO#CRD42021283570).Data sourcesMEDLINE, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews.Study eligibility criteriaEnglish language; published 2011–2022; primary studies describing prevalence of psychiatric conditions in autistic adults; or systematic reviews evaluating interventions for autistic adults.Appraisal and synthesisBias was assessed using the Prevalence Critical Appraisal Instrument and AMSTAR2. Prevalence was grouped according to psychiatric diagnosis. Interventions were grouped into pharmacological, employment, psychological or mixed therapies. Strength of evidence for interventions was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Autistic researchers within the team supported interpretation.ResultsTwenty prevalence studies were identified. Many included small sample sizes or failed to compare their sample group with the general population reducing validity. Prevalence of psychiatric diagnoses was variable with prevalence of any psychiatric diagnosis ranging from 15.4% to 79%. Heterogeneity was associated with age, diagnosis method, sampling methods, and country. Thirty-two systematic reviews of interventions were identified. Four reviews were high quality, four were moderate, five were low and nineteen critically low, indicating bias. Following synthesis, no intervention was rated as ‘evidence based.’ Acceptability of interventions to autistic adults and priorities of autistic adults were often not considered.ConclusionsThere is some understanding of the scope of mental ill-health in autism, but interventions are not tailored to the needs of autistic adults, not evidence based, and may focus on promoting neurotypical behaviours rather than the priorities of autistic people.

背景 自闭症成年群体罹患精神健康问题的风险显著升高，部分现有干预措施甚至与精神疾病诊断率上升存在关联。明确精神疾病诊断的患病率，可为自闭症成年群体的个体化治疗与支持方案开发提供科学依据，这一研究方向已被自闭症社群列为重点议题。此外，干预措施需同时从有效性及自闭症群体的可接受性层面开展评估。
目的 本快速综述旨在明确自闭症成年群体的精神障碍患病率，同时对旨在支持该群体的干预措施开展系统评价。研究同步完成了患病率研究的快速综述与干预措施的伞状综述，严格遵循《系统评价与Meta分析首选报告条目》（Preferred Reporting Items for Systematic Review and Meta-Analysis, PRISMA）规范，且提前进行了方案注册（PROSPERO#CRD42021283570）。
数据来源 MEDLINE、CINAHL、PsycINFO 及 Cochrane 系统评价数据库。
研究纳入标准 语言为英语；发表时间介于2011年至2022年；纳入描述自闭症成年群体精神疾病患病率的原创研究，或评估自闭症成年群体干预措施的系统评价。
评价与综合 采用患病率研究关键评价工具（Prevalence Critical Appraisal Instrument）与AMSTAR2对研究偏倚风险进行评估。患病率数据按精神疾病诊断类型进行分组；干预措施则分为药物治疗、就业支持、心理治疗及综合疗法四类。干预措施的证据强度采用GRADE（推荐分级、评估、制定与评价，Grading of Recommendations, Assessment, Development and Evaluation）标准进行评价。研究团队中的自闭症研究者参与了结果解读工作。
结果 本研究共纳入20项患病率研究。多数研究样本量较小，且未将研究样本与普通人群进行对照，这一缺陷降低了研究的内部效度。各类精神疾病诊断的患病率存在较大异质性，任意精神疾病诊断的患病率范围为15.4%至79%。研究异质性与受试者年龄、诊断方法、抽样策略及所属国家地区相关。本研究共纳入32项干预措施系统评价，其中4项评价质量为高，4项为中等，5项为低，19项为极临界低质量，提示存在较高偏倚风险。经综合分析后，未发现任何一项干预措施被评为“有证据支持”。自闭症成年群体对干预措施的可接受性及自身的优先需求，往往未被纳入研究考量范畴。
结论 目前学界对自闭症群体精神健康问题的覆盖范围已有一定认知，但现有干预措施并未贴合自闭症成年群体的实际需求，缺乏循证依据，且可能侧重于推广神经典型行为，而非聚焦自闭症群体自身的优先诉求。