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Review
. 2022 Aug 30;11(17):5100.
doi: 10.3390/jcm11175100.

The Efficacy of Early Interventions for Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

Sofia Daniolou  1 , Nikolaos Pandis  2 , Hansjörg Znoj  1
Affiliations
Review

The Efficacy of Early Interventions for Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

Sofia Daniolou et al. J Clin Med. .

Abstract

The superiority of early interventions for children with autism spectrum disorders (ASDs) compared to treatment as usual (TAU) has recently been questioned. This study was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12-132 months). Early interventions led to positive outcomes for cognitive ability (g = 0.32; 95% CI: 0.05, 0.58; p = 0.02), daily living skills (g = 0.35; 95% CI: 0.08, 0.63; p = 0.01), and motor skills (g = 0.39; 95% CI: 0.16, 0.62; p = 0.001), while no positive outcomes were found for the remaining variables. However, when studies without the blinding of outcome assessment were excluded, positive outcomes of early interventions only remained for daily living skills (g = 0.28; 95% CI: 0.04, 0.52; p = 0.02) and motor skills (g = 0.40; 95% CI: 0.11, 0.69; p = 0.007). Although early intervention might not have positive impacts on children with ASDs for several outcomes compared to controls, these results should be interpreted with caution considering the great variability in participant and intervention characteristics.

Keywords: autism spectrum disorders; cognitive ability; early interventions; language; meta-analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Risk of bias assessment [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59].
Figure 3
Figure 3
Forest plots for cognitive ability results. (a) Overall effect [28,29,30,32,41,46,49,54,55,56,58,59]. (b) Results after exclusion of studies with no blinding of outcome assessment [28,29,30,41,46,49,54,55,56,58,59].
Figure 4
Figure 4
Forest plots for expressive language results. (a) Overall effect [27,28,29,30,32,34,35,36,37,38,39,40,41,42,43,44,47,48,51,52,53,54,55,57,58,59]. (b) Subgroup analysis: intensity of intervention. (c) Results after exclusion of studies with no blinding of outcome assessment [27,28,29,30,34,35,36,37,38,39,40,41,44,47,48,52,53,54,55,57,59].
Figure 5
Figure 5
Forest plots for receptive language results. (a) Overall effect [27,28,29,30,32,35,36,37,38,39,40,42,43,44,47,48,51,53,54,55,57,58,59]. (b) Subgroup analysis: intensity of intervention.
Figure 6
Figure 6
Forest plot for adaptive behavior composite. Overall effect [30,31,35,44,45,49,58].
Figure 7
Figure 7
Forest plot for communication results. Overall effect [27,28,29,30,31,34,35,38,39,44,45,47,48,50,51,55,58].
Figure 8
Figure 8
Forest plots for socialization results. (a) Overall effect [28,29,30,31,35,38,39,43,44,45,47,48,50,55,58,59]. (b) Subgroup analysis: intensity of intervention.
Figure 9
Figure 9
Forest plots for daily living skills. (a) Overall effect [29,30,45,48,50,55,58]. (b) Results after exclusion of studies with no blinding of outcome assessment [29,30,45,48,50,55].
Figure 10
Figure 10
Forest plots for motor skills. (a) Overall effect [29,30,43,45,53,54,55,58]. (b) Results after exclusion of studies with no blinding of outcome assessment [29,30,45,53,54,55].
Figure 11
Figure 11
Forest plots for follow-up data. (a) Cognitive ability [29,33,41,49]. (b) Expressive language [28,37,40,41,52]. (c) Receptive language [28,37,40]. (d) Adaptive behavior composite [33,49]. (e) Communication [28,29,33]. (f) Socialization [28,29,33]. (g) Daily living skills [29,33]. (h) Motor skills [29].
Figure 12
Figure 12
Funnel plot for publication bias.
See this image and copyright information in PMC

References

    1. Maenner M.J., Graves S.J., Peacock G., Honein M.A., Boyle C.A., Dietz P.M. Comparison of 2 Case Definitions for Ascertaining the Prevalence of Autism Spectrum Disorder Among 8-Year-Old Children. Am. J. Epidemiol. 2021;190:2198–2207. doi: 10.1093/aje/kwab106. - DOI - PMC - PubMed
    1. Sandbank M., Bottema-Beutel K., Crowley S., Cassidy M., Dunham K., Feldman J.I., Crank J., Albarran S.A., Raj S., Mahbub P., et al. Project AIM: Autism intervention meta-analysis for studies of young children. Psychol. Bull. 2020;146:1–29. doi: 10.1037/bul0000215. - DOI - PMC - PubMed
    1. Dawson G. Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Dev. Psychopathol. 2008;20:775–803. doi: 10.1017/S0954579408000370. - DOI - PubMed
    1. Landa R.J. Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders. Int. Rev. Psychiatry. 2018;30:25–39. doi: 10.1080/09540261.2018.1432574. - DOI - PMC - PubMed
    1. Schreibman L., Dawson G., Stahmer A.C., Landa R., Rogers S.J., McGee G.G., Kasari C., Ingersoll B., Kaiser A.P., Bruinsma Y., et al. Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. J. Autism Dev. Disord. 2015;45:2411–2428. doi: 10.1007/s10803-015-2407-8. - DOI - PMC - PubMed