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Efficacy of psychosocial interventions for Autism spectrum disorder: an umbrella review

Abstract

Introduction

The wide range of psychosocial interventions designed to assist people with Autism Spectrum Disorder (ASD) makes it challenging to compile and hierarchize the scientific evidence that supports the efficacy of these interventions. Thus, we performed an umbrella review of published meta-analyses of controlled clinical trials that investigated the efficacy of psychosocial interventions on both core and related ASD symptoms.

Methods

Each meta-analysis that was identified was re-estimated using a random-effects model with a restricted maximum likelihood estimator. The methodological quality of included meta-analyses was critically appraised and the credibility of the evidence was assessed algorithmically according to criteria adapted for the purpose of this study.

Results

We identified a total of 128 meta-analyses derived from 44 reports. More than half of the non-overlapping meta-analyses were nominally statistically significant and/or displayed a moderate-to-large pooled effect size that favored the psychosocial interventions. The assessment of the credibility of evidence pointed out that the efficacy of early intensive behavioral interventions, developmental interventions, naturalistic developmental behavioral interventions, and parent-mediated interventions was supported by suggestive evidence on at least one outcome in preschool children. Possible outcomes included social communication deficits, global cognitive abilities, and adaptive behaviors. Results also revealed highly suggestive indications that parent-mediated interventions improved disruptive behaviors in early school-aged children. The efficacy of social skills groups was supported by suggestive evidence for improving social communication deficits and overall ASD symptoms in school-aged children and adolescents. Only four meta-analyses had a statistically significant pooled effect size in a sensitivity analysis restricted to randomized controlled trials at low risk of detection bias.

Discussion

This umbrella review confirmed that several psychosocial interventions show promise for improving symptoms related to ASD at different stages of life. However, additional well-designed randomized controlled trials are still required to produce a clearer picture of the efficacy of these interventions. To facilitate the dissemination of scientific knowledge about psychosocial interventions for individuals with ASD, we built an open-access and interactive website that shares the information collected and the results generated during this umbrella review.

Pre-registration

PROSPERO ID CRD42020212630.

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Fig. 1: PRISMA diagram of study selection results.
Fig. 2: Forest plot of the pooled effect size for each intervention type and outcome we considered in the umbrella review.

Data availability

The datasets generated during and/or analyzed during the current study are publicly available (https://github.com/CorentinJGosling/MP_2022_EBIACT_PSYCHOSOCIAL).

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CJG conceptualized and designed the study, performed study selection and data extraction, drafted data analysis and drafted the manuscript. AC conceptualized and designed the study, performed study selection and data extraction, and critically reviewed data analysis and the manuscript for important intellectual content. BCM performed study selection and data extraction, and critically reviewed data analysis and the manuscript for important intellectual content. RD conceptualized and designed the study, resolved conflicts during study selection, and critically reviewed data analysis and the manuscript for important intellectual content. JR and AS conceptualized and designed the study, and critically reviewed data analysis and the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Corentin J. Gosling.

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Gosling, C.J., Cartigny, A., Mellier, B.C. et al. Efficacy of psychosocial interventions for Autism spectrum disorder: an umbrella review. Mol Psychiatry (2022). https://doi.org/10.1038/s41380-022-01670-z

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