今天推薦的這篇文章2018年發表在Molecular Psychiatr期刊上，探討的是自閉症的執行功能缺陷。元分析非常適合於探討特殊被試的認知功能和大腦缺陷，這樣的文章一般也比較好發表。其中的一個重要原因是特殊被試異質性高且原始研究的樣本量都比較少，導致假陽性的概率遠高於普通被試。元分析可以增加統計檢驗力，所得結果更具可靠性。所以，如果你對特殊被試感興趣，可以考慮元分析這種方法哦！如果你想學習元分析，可以關注微信公眾號「元分析」獲取更多精彩內容。
英文題目和摘要
Autism spectrum disorders: a meta-analysis of executive function
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 14081 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.
中文摘要
在整個發展過程中，自閉症譜系障礙（ASD）的執行功能障礙的證據仍然有爭議，確立其作用對於指導診斷和幹預至關重要。這項元分析的主要目標是分析ASD的執行功能（EF）表現，EF子領域的劃分，EF指標的臨床效用以及多種調節變量的影響（例如年齡，性別，診斷，測量特徵）。檢索Embase，Medline和PsychINFO資料庫，以識別自閉症患者納入DSM-III（1980年）至2016年6月底以來發表的同行評審研究，這些研究將ASD中的EF與神經典型對照進行了比較。使用隨機效應模型，並使用亞組分析檢驗調節變量。主要結局指標是EF和調節變量的Hedges g效應量。臨床敏感性由重疊百分比統計（OL％）確定。根據PRISMA（系統綜述和元分析的首選報告項目）指南報告結果。總共納入235項研究，包括14 081名參與者（N，ASD = 6816，對照= 7265）。結果發現，EF下降的總體效應量大小適中（Hedges g = 0.48，95％置信區間（CI）0.43–0.53），每個領域的效應量大小相似。儘管自引入ASD以來，執行功能障礙的總體效應已逐漸降低，但大多數調節變量的比較並不顯著。只有少數EF指標達到了臨床敏感性。這項研究證實了ASD中存在廣泛的執行功能障礙，在整個發展過程中相對穩定。不支持將執行功能障礙分為單個亞領域，也不支持診斷敏感性。應優先發展以臨床敏感性為重點的可行的EF措施，以用於診斷和治療研究。