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

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Efficacy of psychosocial interventions for Autism spectrum disorder: an umbrella review
Molecular Psychiatry ( IF 9.6 ) Pub Date : 2022-07-05 , DOI: 10.1038/s41380-022-01670-z
Corentin J Gosling _{1,

2,

3} , Ariane Cartigny _{2,

4} , Baptiste C Mellier ₁ , Aleix Solanes ₅ , Joaquim Radua _{5,

6,

7} , Richard Delorme _{4,

8}

Affiliation

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.

中文翻译：

自闭症谱系障碍心理社会干预的疗效：综合回顾

介绍

旨在帮助自闭症谱系障碍 (ASD) 患者的各种社会心理干预措施使得汇编和分级支持这些干预措施有效性的科学证据具有挑战性。因此，我们对已发表的对照临床试验的荟萃分析进行了全面审查，这些试验研究了社会心理干预对核心和相关 ASD 症状的疗效。

方法

使用具有受限最大似然估计量的随机效应模型重新估计确定的每个荟萃分析。对纳入的荟萃分析的方法学质量进行了严格评估，并根据适用于本研究目的的标准对证据的可信度进行了算法评估。

结果

我们从 44 份报告中确定了总共 128 项荟萃分析。超过一半的非重叠荟萃分析在名义上具有统计学意义和/或显示出中到大的合并效应量，有利于社会心理干预。对证据可信度的评估指出，早期强化行为干预、发展干预、自然发展行为干预和父母介导干预的有效性得到了学龄前儿童至少一项结果的暗示性证据的支持。可能的结果包括社交沟通缺陷、全球认知能力和适应性行为。结果还揭示了高度暗示性的迹象，表明父母介导的干预措施改善了早期学龄儿童的破坏性行为。社交技能小组的有效性得到了改善学龄儿童和青少年社交沟通缺陷和总体 ASD 症状的暗示性证据的支持。在仅限于低检测偏倚风险的随机对照试验的敏感性分析中，只有四项荟萃分析具有统计显着的合并效应量。