Clinician- versus caregiver-rated scales as outcome measures of repetitive-restricted behaviors in clinical trials of autism: A systematic review and meta-analysis.

Researchers looked at 15 studies involving 1,567 people with autism to see if doctors and parents rate repetitive behaviors similarly when measuring treatment effects. They found good agreement overall between doctor and parent ratings, but noted that results could vary significantly between individual studies. The research quality was considered low due to limitations in the available data.

This meta-analysis examined 15 placebo-controlled randomized trials with 1,567 participants to compare how clinicians and caregivers rate repetitive-restricted behaviors (RRBs) in autism treatment studies. The analysis focused on pharmacological and dietary supplement interventions, primarily using the Yale-Brown Obsessive Compulsive Scale (clinician-rated) and Aberrant Behavior Checklist-Stereotypic Behavior (caregiver-rated). Results showed good agreement between clinician and caregiver ratings (ICC=0.84), with no significant difference in treatment effects. However, the certainty of evidence was rated as low due to imprecision and inconsistency concerns, and wide prediction intervals suggest potential discordance in future trials.

Both clinician and caregiver ratings appear valuable for assessing repetitive behavior treatments. However, practitioners should be aware that discordance between ratings may occur. The findings support using multiple perspectives in treatment evaluation, though generalizability to non-pharmacological interventions remains uncertain.

Low certainty evidence due to imprecision and inconsistency. Results may not generalize to other rating scales or intervention types beyond pharmacological and dietary supplements. Wide prediction intervals indicate potential variability in future studies.

The agreement between treatment effects measured by clinician- and caregiver-ratings of repetitive-restricted behaviors (RRBs) is important for clinical practice and research but is still unclear. Therefore, we conducted a post-hoc meta-analysis of placebo-controlled randomized-controlled trials (RCTs) investigating pharmacological and dietary-supplement treatments for autism that reported both clinician- and caregiver-ratings of RRBs. Treatment effects between medications and placebo were quantified with standardized mean differences (SMDs). The agreement between clinician- and caregiver-rated SMDs was investigated with an intraclass correlation coefficient (ICC) and random-effects meta-analysis of their difference (Δg).

A meta-regression investigated the association between clinician (dependent) and caregiver-rated SMDs (independent variable). Certainty in the evidence was evaluated using the GRADE approach. We identified 15 eligible placebo-controlled RCTs with 1567 participants, from which 13 included children/adolescents and 9 reported data for the pair of the clinician-rated Yale-Brown Obsessive Compulsive Scale (YBOCS) and the caregiver-rated Aberrant Behavior Checklist-Stereotypic Behavior (ABC-S). There was on average a good agreement between clinician- and caregiver-rated SMDs (ICC=0.84, 95% confidence intervals [0.55, 0.95]), no clear difference between them (Δg=0.08, 95%CI[-0.06, 0.21], 95% prediction intervals [-0.16, 0.31]), and the beta of the meta-regression was 0.62, 95%CI[0.27, 0.97].

The certainty of the evidence was low due to concerns in imprecision and inconsistency. Our analysis showed on average a good agreement between clinician- and caregiver-rated treatment effects in RRBs, yet discordance could be expected in future RCTs, given the wide prediction intervals. It is also not certain that these results could be generalizable to other rating scales and intervention modalities. Ethics committee approval: Not applicable as a meta-analysis of previously published studies..