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. 2017 May 16;5(5):CD011894.
doi: 10.1002/14651858.CD011894.pub2.

Family therapy for autism spectrum disorders

Debbie Spain  1 , Jacqueline Sin  2 , Eleni Paliokosta  3 , Marie Furuta  4 , Jonathan E Prunty  5 , Trudie Chalder  6 , Declan G Murphy  7 , Francesca G Happé  1
Affiliations

Family therapy for autism spectrum disorders

Debbie Spain et al. Cochrane Database Syst Rev. .

Abstract

Background: Autism spectrum disorders (ASDs) are characterised by impairments in communication and reciprocal social interaction. These impairments can impact on relationships with family members, augment stress and frustration, and contribute to behaviours that can be described as challenging. Family members of individuals with ASD can experience high rates of carer stress and burden, and poor parental efficacy. While there is evidence to suggest that individuals with ASD and family members derive benefit from psychological interventions designed to reduce stress and mental health morbidity, and enhance coping, most studies to date have targeted the needs of either individuals with ASD, or family members. We wanted to examine whether family (systemic) therapy, aimed at enhancing communication, relationships or coping, is effective for individuals with ASD and their wider family network.

Objectives: To evaluate the clinical effectiveness and acceptability of family therapy as a treatment to enhance communication or coping for individuals with ASD and their family members. If possible, we will also seek to establish the economic costs associated with family therapy for this clinical population.

Search methods: On 16 January 2017 we searched CENTRAL, MEDLINE, Embase, 10 other databases and three trials registers. We also handsearched reference lists of existing systematic reviews and contacted study authors in the field.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of family therapy for young people or adults with ASD or family members, or both, delivered via any modality and for an unspecified duration, compared with either standard care, a wait-list control, or an active intervention such as an alternative type of psychological therapy.

Data collection and analysis: Two authors independently screened each title and abstract and all full-text reports retrieved. To enhance rigour, 25% of these were independently screened by a third author.

Main results: The search yielded 4809 records. Of these, we retrieved 37 full-text reports for further scrutiny, which we subsequently excluded as they did not meet the review inclusion criteria, and identified one study awaiting classification.

Authors' conclusions: Few studies have examined the effectiveness of family therapy for ASD, and none of these are RCTs. Further research studies employing methodologically robust trial designs are needed to establish whether family therapy interventions are clinically beneficial for enhancing communication, strengthening relationships, augmenting coping and reducing mental health morbidity for individuals with ASD and family members.

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Conflict of interest statement

Debbie Spain and her institute have received funds from a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship (CDRF‐2012‐03‐059, 2013 to 2018). Jacqueline Sin's institute received funds from a NIHR Doctoral Research Fellowship (2012 to 2014), for a NIHR Post‐Doctoral Fellowship (2016 onward), and a clinical lectureship (NIHR BRC (Biomedical Research Centre)) based at Guy’s and St Thomas’s NHS Foundation Trust and King’s College London (2015 to 2017). Eleni Paliokosta – none known. Marie Furuta – none known. Jonathan E Prunty – none known. Trudie Chalder is the named supervisor on the NIHR PhD Fellowship for Debbie Spain. She has received payment for workshops held for clinicians on chronic fatigue syndrome (CFS) and receives royalties for self‐help books on CFS. She has received payment for travel, accommodation and meeting expenses to attend conferences related to cognitive‐behavioural psychotherapy. Declan G Murphy – none known. Francesca G Happé (FGH) holds positions related to her autism research for which she is not paid but which involve travel to meetings for which she is reimbursed. She also received royalties on books and chapters, and occasional honoraria for writing or presenting, but these support her autism research in general and do not conflict with, or influence, her impartial involvement in the current review. FGH supervises Debbie Spain's PhD, and her institution receives a grant from the NIHR to do so. FGH is the president and board member of the International Society for Autism Research and cofounder of the Forum for Neuroscience and Special Education. FGH's institution has received fees for her membership of the Methusalem grant review panel. Her institution has received grants from the UK Medical Research Council for a population‐based twin study of autism spectrum disorders: genetic and environmental sources of cognitive and clinical heterogeneity; from the Baily Thomas Fund for work on the transition to young adulthood in autism spectrum disorder: mental health and well‐being in a population‐based sample of twins; the Wellcome Trust for work on glutamate and gamma‐Aminobutyric acid (GABA) in adults with autism: an in vivo study using magnetic resonance spectroscopy; and has grants pending from the Economic and Social Research Council for a topic not relevant to this review. FGH's institution has received honorarium from the British Academy for a lecture she carried out in 2014 and honorarium from the Journal of Child Psychiatry and Psychology for an invited annual review article. FGH receives royalties for the publications 'Autism and Talent' and 'Autism and Other Neurodevelopmental Disorders Affecting Cognition'. She has received travel, accommodation and meeting expenses from the British Psychological Society, Simons Foundation, and the University of Leuven.

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