It is unclear whether the administration of antipsychotics to children and adolescents with autism spectrum disorders (ASD) is acceptable, equitable, and feasible. We performed a systematic review to support a multidisciplinary panel in formulating a recommendation on antipsychotics, for the development of the Italian national guidelines for the management of ASD. A comprehensive search strategy was performed to find data related to intervention acceptability, health equity, and implementation feasibility. We used quantitative data from randomized controlled trials to perform a meta-analysis assessing the acceptability and tolerability of antipsychotics, and we estimated the certainty of the effect according to the GRADE approach. We extracted data from systematic reviews, primary studies, and grey literature, and we assessed the risk of bias and methodological quality of the published studies. Antipsychotics were acceptable (dropouts due to any cause: RR 0.61, 95% CI 0.48–0.78, moderate certainty of evidence) and well tolerated (dropouts due to adverse events: RR 0.99, 95% CI 0.55–1.79, low certainty of evidence) by children and adolescents with ASD. Parents and clinicians did not raise significant issues concerning acceptability. We did not find studies reporting evidence of reduced equity for antipsychotics in disadvantaged subgroups of children and adolescents with ASD. Workloads, cost barriers, and inadequate monitoring of metabolic adverse events were indirect evidence of concerns for feasibility. Antipsychotics in children and adolescents with ASD were likely acceptable and possibly feasible. We did not find evidence of concern for equity.

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在患有自闭症谱系障碍的儿童和青少年中使用抗精神病药的可接受性，公平性和可行性：系统评价

目前尚不清楚对自闭症谱系障碍（ASD）的儿童和青少年服用抗精神病药是否可以接受，公平和可行。我们进行了系统的审查，以支持一个多学科的小组制定抗精神病药物的建议，以制定意大利全国性ASD管理指南。执行了全面的搜索策略以查找与干预可接受性，健康公平性和实施可行性相关的数据。我们使用来自随机对照试验的定量数据进行了荟萃分析，以评估抗精神病药的可接受性和耐受性，并根据GRADE方法评估了疗效的确定性。我们从系统评价，基础研究和灰色文献中提取了数据，并且我们评估了已发表研究的偏倚风险和方法学质量。抗精神病药是可以接受的（由于任何原因引起的辍学：RR 0.61，95％CI 0.48–0.78，证据的中度确定性）并且耐受良好（由于不良事件引起的辍学：RR 0.99，95％CI 0.55-1.79，证据的低确定性）患有ASD的儿童和青少年。父母和临床医生并未提出有关可接受性的重大问题。我们没有发现报告有证据表明在ASD的儿童和青少年弱势群体中抗精神病药的公平性降低的证据。工作量，成本障碍和对代谢不良事件的监测不足，是对可行性的担忧的间接证据。在患有ASD的儿童和青少年中使用抗精神病药可能是可以接受的，也是可行的。我们没有找到关注公平的证据。