Objectives: We sought to locate all studies examining psychosocial interventions for children who have an autism spectrum disorder and intellectual disability in which direct therapy services to the child were delivered by a non-specialist provider (e.g., teacher, aide, parent, nurse, general practitioner).
Methods: We conducted an electronic database search July 2012 of Medline, EMBASE, CINAHL, African Index Medicus [AIM], AFROLIB Database, Eurasia Health, LILACS, and Index Medicus for the Western Pacific [WPRIM], and PsycINFO using the search strategies described in the review protocol that can be located at http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012002641. Articles were included if they met the following criteria: a) the study must have contained participants with autism spectrum disorders who, on average, had IQ < 70 and were under the age of 18-years-old; b) the study used a prospective group comparison design (e.g., randomized clinical trial, quasi-experimental multiple-group comparison); and c) the study involved a psychoeducational intervention in which the treatment delivered to the child was done by a non-specialist provider (e.g., teacher, aide, parent) or the intervention involved training parents to deliver the treatment to their child (i.e., a parent training intervention). Study, intervention, and outcome characteristics were double coded by two independet reviewers, and Cohen's d effect sizes were calculated for outcomes corresponding to five categories (developmental, daily skills, behavior, school performance, and family). We created harvest plots to display differential treatment effects across different conditions to examine which interventions were most effective in certain settings, when delivered by certain providers, and/or for individuals with different levels of intellectual functioning.
Results: The search yielded 13,621 hits after deduplication, of which 262 full texts were examined. We located 35 studies meeting all inclusion criteria, 20 of which were randomized control trials. The behavior analytic interventions showed significant improvements in developmental and daily skill outcomes, however, many of these programs were very intensive with respect to the number of hours of treatment and resource allocation (e.g., therapist time, therapist supervision). Cognitive adaptation and rehabilitation and parent training programs showed less promise, but had positive outcomes in developmental and behavioral outcomes, respectively. Characteristics of the studies, intervention methods, outcomes, and effects will be presented in tables and harvest plot figures.
Conclusions: Collectively, the results of this review suggest that psychosocial intervention can be effective for individuals who have autism spectrum disorders and intellectual disability when treatment services are delivered by non-specialist providers. These findings are encouraging given the increasing global awareness and desire to foster better treatments for children in developing countries.