This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis–based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis–based interventions improved more on the Vineland adaptive behaviour scale (MD = 7.00; 95% confidence interval = 1.95–12.06) and cognitive ability (intelligence quotient) (MD = 14.13; 95% confidence interval = 9.16–19.10) relative to comparators at 2 years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence of modest, albeit short term, effects of a range of pre-school autism interventions and the limitations of the quality of evaluation studies to date, future research should investigate which supports and interventions are most effective for children and families prioritising outcomes measures that are meaningful for the autism community and longer-term follow-up. Further systematic reviews of the existing evidence are unlikely to add to the findings presented here.

Lay abstract

Early intensive applied behaviour analysis–based interventions are designed to support young autistic children’s learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis–based interventions might lead to some changes in children’s cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.

中文翻译：

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基于自闭症幼儿应用行为分析的强化行为干预：国际协作个人参与者数据荟萃分析

这项个体参与者数据荟萃分析是对学前自闭症儿童基于早期强化应用行为分析的干预措施与常规治疗/折衷干预措施相比的有效性的最深入的评估。包括 491 名参与者的数据（最初在 10 项研究中收集）。接受早期强化应用行为分析干预的儿童在 Vineland 适应性行为量表（MD = 7.00；95% 置信区间 = 1.95–12.06）和认知能力（智商）（MD = 14.13；95% 置信区间 = 9.16）上有更大改善。 –19.10) 相对于 2 年的比较者；尽管不同研究的效果差异很大。由于证据不足，其他结果的证据尚无定论，而且关于长期影响的数据很少。所有研究都存在跨多个领域的偏倚风险，这通常是由于缺乏随机化或结果评估者采用盲法造成的。鉴于新出现的证据表明，一系列学前自闭症干预措施的效果虽然有限，但效果有限，而且迄今为止评估研究质量的局限性，未来的研究应该调查哪些支持和干预措施对儿童和家庭最有效，并优先考虑结果对自闭症社区和长期随访有意义的措施。对现有证据的进一步系统审查不太可能增加此处提出的发现。

外行摘要

基于早期强化应用行为分析的干预措施旨在支持自闭症儿童的学习和发展。不幸的是，有关这些干预措施有效性的现有证据仍不清楚。一些评论侧重于已发表的研究结果，而不是联系作者来收集和分析原始研究中个体参与者的数据。此外，大多数研究是由参与提供干预措施的团体进行的，导致解释结果时存在潜在偏差。我们的研究团队（由国际咨询小组支持）通过收集研究作者的原始参与者数据进行了独立的个体患者数据审查，以检查这些干预措施的有效性。结果表明，与标准治疗相比，基于早期强化应用行为分析的干预措施可能会导致 2 年后儿童的认知能力（智商）和日常生活技能发生一些变化。然而，所有研究的设计方式都存在问题。此外，很少有研究关注对自闭症患者最重要的结果或跟踪超过 2 岁的儿童。我们认为对现有证据的进一步系统审查不太可能增加我们审查的结果。此外，我们建议未来的研究应调查哪些类型的支持和干预措施对儿童和家庭最有效，优先考虑对自闭症社区有意义的结果措施，并尽可能包括长期随访。