International Meeting for Autism Research: A Synthesis of Existing Systematic Reviews Examining Interventions for Children and Adolescents with Autism Spectrum Disorder

A Synthesis of Existing Systematic Reviews Examining Interventions for Children and Adolescents with Autism Spectrum Disorder

Thursday, May 20, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
2:00 PM
D. B. Nicholas , Faculty of Social Work, University of Calgary, Edmonton, AB, Canada
R. MacCulloch , Department of Social Work, The Hospital for Sick Children, Toronto, ON, Canada
Background: The intervention literature identifies advances in treatments for pediatric autism; however, there is ongoing uncertainty about the relative impact of various pediatric autism treatments.  This literature is challenged by methodological limitations and a vast heterogeneity of population subtypes and interventional applications, inconsistencies in evaluation design, and unclear outcome targets.

Objectives: This study comprised a descriptive meta-study analysis of existing systematic reviews in the pediatric autism intervention literature, with a focus on the reported impacts of various types of intervention for children.  A qualitative, synthesis review was undertaken whereby interventions were thematically reviewed and grouped into domains of intervention and presented outcomes.

Methods: This synthesis comprised a meta-study examination of systematic reviews including descriptions of approaches addressed within systematic reviews, syntheses of interventional and study characteristics, and an analysis of reported outcomes.  To ascertain elements of intervention outcome and process, reviewed article content was analyzed for substantive, qualitative content and quantitative analysis.  For qualitative analysis, computer software (NVivo) was utilized to assist in coding, concept identification, and theme generation (e.g., intervention components, outcomes).  Trustworthiness (rigor) of findings was ensured through a process of peer debriefing and expert consultation with intervention leaders in autism.  Sample and other demographic information from reviewed studies was collected and collated.

Results: The search initially resulted in 405 peer-reviewed review articles. Duplicate and irrelevant articles were first removed; ultimately resulting in a database of 283 articles. Titles and abstracts of these articles were reviewed by two blinded research coordinators, and those not matching inclusion/exclusion criteria were removed, ultimately resulting in 53 reviews. The reference list of these articles was subsequently reviewed via footnote chasing. This process of footnote chasing yielded another 14 reviews that met inclusion criteria.  Accordingly, 67 reviews ultimately were included in the final review; and these reviews were subjected to coding, data extraction and synthesis analysis.  Key domains of interventions reported in systematic reviews comprised:  behavioral (20 reviews); pharmacological (18 reviews); social skills (10 reviews); diet/vitamin supplementation (5 reviews); non-conventional interventions (e.g., hippotherapy, music therapy, pet or animal therapy, robot interaction, and oxygen or hyperbaric therapy) (5 reviews); and communication-focused interventions (3 reviews).  Systematic reviews were not found within the literature in the areas of: developmental, comprehensive educational, physiological, or psychodynamic interventional approaches. 

Conclusions: The intervention literature is disparate and mixed.  On balance however, the provision of intervention for children with autism is preferable to non-intervention.  Domains with the most evidence to date, from systematic reviews, are pharmacological and behavior approaches.  It is yet difficult to contrast the effectiveness of the various interventional approaches given varying metrics, needs, outcomes and extent of methodological rigor within primary studies.  Clearly, well-designed studies and more comparative research are needed in contrasting varying approaches across ASD population subtypes.

See more of: Developmental Stages
See more of: Autism Symptoms