Parent Mediated Early Intervention in Young Children with Autism Spectrum Disorder (ASD): A Systematic Review and Meta-Analysis

Background: Young children with ASD lack understanding of how to interact with another person, may not have developed language or understand other people’s communication, and may insist on routines and repetitive behaviours. This early pattern of difficulties is a challenge for parents. Therefore, helping parents to develop strategies for interaction and management of behaviour is an obvious route for early intervention. Though there is considerable support for early intervention for children with ASD, there is a need for systematic review of the quality of the evidence.

Objectives: To determine the level of current evidence for effectiveness of parent-mediated early intervention in the treatment of young children with ASD, assessing outcomes for both children with ASD and their parents. This is an update to an earlier Cochrane Collaboration review which found only 2 randomised controlled trials (RCTs) (Diggle, McConachie & Randle 2002)

Methods: We carried out in-depth literature searches in relevant databases including Ovid Medline, PsycINFO and CINAHL, for articles published between 2002 and August 2012. Relevant articles describing RCTs were then systematically evaluated for risk of bias and synthesised for child and parent outcomes using the Cochrane Collaboration guidelines for systematic reviews. In the meta-analysis, we combined numerical data (endpoint means and standard deviations) only across studies with a similar theoretical basis that used outcome measures of similar psychometric and psychological properties. Data were analysed using Review Manager Software version 5.1

Results: We identified 17 studies published from six countries (USA, UK, Australia, Canada, Thailand and China), recruiting a total of 919 child participants. Ten studies which evaluated intervention focusing on parent interaction style in facilitating children’s communication were combined in meta-analyses. The evidence for positive change in parent-child interactions is strong (Shared attention time: SMD 0.41, CI = 0.14 to 0.68, P < 0.05 and Parent synchrony: SMD 0.90, CI = 0.56 to 1.23, P < 0.05). The evidence also tends to suggest effectiveness of parent-mediated approaches in improving child language outcome (direct assessment: SMD 0.45, CI = -0.05 to 0.95, P > 0.05) and child reported communication skills (MD 5.31, CI = -6.77 to 17.39, P >0.05); and reduction in autism severity (SMD -0.31, CI = -0.65 to 0.03, P = 0.07) and parent stress (SMD -0.17, CI = -0.70 to 0.36, P > 0.05).  However, the strength of the evidence is judged ‘uncertain’, failed to reach statistical significance and likely to change with future publication of high quality RCTs.

Conclusions: Though we now have 17 RCTs for review as opposed to 2 ten years ago, the evidence of the effectiveness of parent mediated interventions is still inconclusive and requires further research