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Meta-Analysis
. 2024 Aug 1;178(8):763-773.
doi: 10.1001/jamapediatrics.2024.1832.

Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children: A Meta-Analysis

Micheal Sandbank  1 , James E Pustejovsky  2 , Kristen Bottema-Beutel  3 , Nicolette Caldwell  4 , Jacob I Feldman  5 , Shannon Crowley LaPoint  6 , Tiffany Woynaroski  7   8
Affiliations
Meta-Analysis

Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children: A Meta-Analysis

Micheal Sandbank et al. JAMA Pediatr. .

Abstract

Importance: Health professionals routinely recommend intensive interventions (ie, 20-40 hours per week) for autistic children. However, primary research backing this recommendation is sparse and plagued by methodological flaws.

Objective: To examine whether different metrics of intervention amount are associated with intervention effects on any developmental domain for young autistic children.

Data sources: A large corpus of studies taken from a recent meta-analysis (with a search date of November 2021) of early interventions for autistic children.

Study selection: Studies were eligible if they reported a quasi-experimental or randomized clinical trial testing the effects of a nonpharmacological intervention on any outcome in participant samples comprising more than 50% autistic children 8 years or younger.

Data extraction and synthesis: Data were independently extracted by multiple coders. Meta-regression models were constructed to determine whether each index of intervention amount was associated with effect sizes for each intervention type, while controlling for outcome domain, outcome proximity, age of participants, study design, and risk of detection bias. Data were analyzed from June 2023 to February 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Main outcomes and measures: The primary predictor of interest was intervention amount, quantified using 3 different metrics (daily intensity, duration, and cumulative intensity). The primary outcomes of interest were gains in any developmental domain, quantified by Hedges g effect sizes.

Results: A total of 144 studies including 9038 children (mean [SD] age, 49.3 [17.2] months; mean [SD] percent males, 82.6% [12.7%]) were included in this analysis. None of the meta-regression models evidenced a significant, positive association between any index of intervention amount and intervention effect size when considered within intervention type.

Conclusions and relevance: Findings of this meta-analysis do not support the assertion that intervention effects increase with increasing amounts of intervention. Health professionals recommending interventions should be advised that there is little robust evidence supporting the provision of intensive intervention.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sandbank reported receiving personal fees from National Disability Insurance Agency, Australia for providing expert testimony on efficacy of early intervention outside the submitted work, receiving speaker fees from the New Jersey Autism Center for Excellence and Children’s Healthcare of Atlanta, and directing a university program that provided coursework necessary for certification from the Behavior Analyst Certification Board. Dr Bottema-Beutel reported receiving book royalties from Springer Publishing, travel fees from American Speech-Language Hearing Association, speaker fees from Marcus Autism Center, New Jersey Autism Center for Excellence, Meeting on Inclusive Research in Autism, University of Massachusetts, and San Diego State National Student Speech Language Hearing Association outside the submitted work. Dr Caldwell reported being president of the Arkansas Association for Behavior Analysis and receiving payment from the University of Arkansas to consult and supervise teams that provided behavioral health services to children diagnosed with autism. Dr Feldman reported receiving grants from the National Institutes of Health (NIH)/National Center for Advancing Translational Sciences and grants from NIH/National Institute on Deafness and Other Communication Disorders outside the submitted work; being the parent of an autistic child; receiving payment from Special Equestrians and Saddle Up! to provide adaptive horseback riding lessons; and being employed by the Department of Hearing and Speech Sciences at Vanderbilt University Medical Center. Dr Crowley LaPoint reported being formerly affiliated with an entity that trained students to become board-certified behavior analysts; providing Early Intensive Behavioral Intervention; being employed by the TEACCH Autism Program; and serving as an interventionist on an intervention developed at TEACCH for autistic transition-age youth. Dr Woynaroski reported receiving nonfinancial support from Vanderbilt University Medical Center; being employed by the Department of Hearing and Speech Sciences at Vanderbilt University Medical Center; being the parent of an autistic child; having previously been paid to provide traditional behavioral, naturalistic developmental behavioral, and developmental interventions to young children on the autism spectrum; and receiving grant funding from internal and external agencies, including the National Institutes of Health and the Vanderbilt Institute for Clinical and Translational Research, to study the efficacy of various interventions geared towards young children with autism. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Adjusted Effect Size Estimates as a Function of Intervention Daily Intensity, by Intervention Type
Effect size estimates are adjusted based on a model controlling for outcome type (proximal vs distal), study design (randomized clinical trial vs quasi-experimental), detection bias (low vs unclear or high), average age of participants, and the interaction of outcome domain and intervention type. Adjusted estimates are predictions for proximal outcomes, randomized clinical trial designs, low detection bias, and an average of 48 months. NDBI indicates naturalistic developmental behavioral intervention.
Figure 2.
Figure 2.. Adjusted Effect Size Estimates as a Function of Intervention Duration, by Intervention Type
Effect size estimates are adjusted based on a model controlling for outcome type (proximal vs distal), study design (randomized clinical trial vs quasi-experimental), detection bias (low vs unclear or high), average age of participants, and the interaction of outcome domain and intervention type. Adjusted estimates are predictions for proximal outcomes, randomized clinical trial designs, low detection bias, and an average of 48 months. NDBI indicates naturalistic developmental behavioral intervention.
Figure 3.
Figure 3.. Adjusted Effect Size Estimates as a Function of Intervention Cumulative Intensity, by Intervention Type
Effect size estimates are adjusted based on a model controlling for outcome type (proximal vs distal), study design (randomized clinical trial vs quasi-experimental), detection bias (low vs unclear or high), average age of participants, and the interaction of outcome domain and intervention type. Adjusted estimates are predictions for proximal outcomes, randomized clinical trial designs, low detection bias, and an average of 48 months. NDBI indicates naturalistic developmental behavioral intervention.
See this image and copyright information in PMC

References

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