Table BSummary of the strength of evidence for symptoms (Key Question 1)

OutcomeComparison (# Studies)SOESummary
Pervasive Developmental Disorder
Autistic symptomsFGA vs. SGA (2 RCTs)LowNo significant difference.
SGA vs. placebo (7 RCTs)LowSignificant effect in favor of SGA on ABC (MD = -18.3; 95% CI: -27.1, -9.5) and CARS (MD = -4.9; 95% CI: -8.5, -1.4).
Clinical global impressionsSGA vs. placebo (3 RCTs)LowNo significant difference.
OC symptomsSGA vs. placebo (3 RCTs)LowSignificant effect in favor of SGA (MD = -1.7; 95% CI: -3.2, -0.3).
ADHD and Disruptive Behavior Disorder
AggressionSGA vs. placebo (5 RCTs)LowNo significant difference.
AnxietySGA vs. placebo (4 RCTs)LowNo evidence of difference.
Behavior symptomsSGA vs. placebo (7 RCTs)ModerateSignificant effect in favor of SGA for ABC (MD = -20.97; 95% CI: -31.1, -10.8), BPI (MD = -3.8; 95% CI: -6.2, -1.4), and NCBRF (MD = -6.9; 95% CI: -10.4, -3.5).
Clinical global impressionsSGA vs. placebo (7 RCTs)ModerateSignificant effect in favor of SGA for CGI–I (MD = -0.95; 95% CI: -1.7, -0.3) and CGI–S (MD = -1.3; 95% CI: -2.2, -0.5).
Bipolar Disorder
Clinical global impressionsSGA vs. placebo (6 RCTs)ModerateSignificant effect in favor of SGA (MD = -0.7; 95% CI: -0.8, -0.5).
DepressionSGA vs. placebo (4 RCTs)LowNo significant difference.
Manic symptomsSGA vs. placebo (8 RCTs)LowAll except one study significantly favored SGA (studies not pooled due to high heterogeneity).
Schizophrenia
Clinical global impressionsFGA vs. SGA (3 RCTs)LowSignificant effect in favor of SGA (MD = -0.76; 95% CI: -1.3, -0.3).
Clozapine vs. olanzapine (2 RCTs)LowNo significant difference.
Olanzapine vs. risperidone (3 RCTs)LowNo significant difference.
SGA vs. placebo (6 RCTs)ModerateSignificant effect in favor of SGA (MD = -0.5; 95% CI: -0.7, -0.3).
Positive and negative symptomsFGA vs. SGA (3 RCTs, 1 PCS)LowNo significant difference.
Clozapine vs. olanzapine (2 RCTs, 1 PCS)LowNo significant difference.
Olanzapine vs. risperidone (3 RCTs, 1 PCS)LowNo significant difference.
SGA vs. placebo (6 RCTs)ModerateSignificant effect in favor of SGA (MD = -8.7; 95% CI: -11.8, -5.6).
Tourette Syndrome
TicsSGA vs. placebo (2 RCTs)ModerateSignificant effect in favor of SGA (MD = -6.98 (95% CI: -10.3, -3.6).
Behavioral Issues
Autistic symptomsRisperidone vs. placebo (2 RCTs)LowSignificant effect in favor of risperidone in one study (MD = -27, 95% CI: NR); significance in second study NR.

ABC = Aberrant Behavior Checklist; BPI = Behavior Problem Inventory; CARS = Childhood Autism Rating Scale; CGI–I = Clinical Global Impressions–Improvement; CGI–S = Clinical Global Impressions–Severity; CI = confidence interval; FGA = first-generation antipsychotic; MD = mean difference; NCBRF = Nisonger Child Behavior Rating Scale; NR = not reported; OC = obsessive-compulsive; PCS = prospective cohort study; RCT = randomized controlled trial; SGA = second-generation antipsychotic; SOE = strength of evidence

From: Executive Summary

Cover of First- and Second-Generation Antipsychotics for Children and Young Adults
First- and Second-Generation Antipsychotics for Children and Young Adults [Internet].
Comparative Effectiveness Reviews, No. 39.
Seida JC, Schouten JR, Mousavi SS, et al.

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