Non-pharmacological interventions for autistic children: An umbrella review

Abstract

The breadth of available non-pharmacological interventions for autistic children, with varying evidence for efficacy summarised in multiple systematic reviews, creates challenges for parents, practitioners, and policymakers in navigating the research evidence. In this article, we report the findings of an umbrella review of 58 systematic reviews of non-pharmacological interventions for autistic children (aged 0–12 years). Positive therapeutic effects were identified for Behavioural interventions, Developmental interventions, Naturalistic Developmental Behavioural Interventions, Technology-based interventions, and Cognitive Behaviour Therapy across several child and family outcomes. Positive effects for certain practices within Sensory-based interventions and ‘other’ interventions were limited to select child and family outcomes. Both inconsistent and null intervention effects were found for Treatment and Education of Autistic and related Communication-handicapped Children, and Animal-assisted interventions across outcomes. The possible influence of child (chronological age, core autism characteristics, and related skills) and delivery (agent, mode, format, and amount) characteristics on intervention effects was rarely examined, and inconsistent where reported. Twenty-seven systematic reviews (47%) were rated as ‘high’ quality. Few systematic reviews examined children’s participation and quality of life or adverse effects. The findings highlight the need for individualised evidence-based decision-making when selecting interventions for autistic children. Lay abstract What is already known about the topic? The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness. What this paper adds? This is a comprehensive umbrella review, also known as a ‘review of reviews’, which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear. Implications for practice, research, and policy The findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.

Nature-Based Interventions for Autistic Children

“…Psychosocial and behavioral interventions for children with ASD are designed to promote learning, participation, and skill development while focusing on building strengths and supporting individual growth 2 ; however, data are lacking concerning the primary purpose of all interventions, which is the subjective well-being of the population. [3][4][5] The 2021 Lancet Commission recommended that identifying effective short-term personalized interventions in randomized clinical trials (RCTs) in settings outside clinics is necessary to improve the lives of individuals with ASD. 6 Clinics are the most common intervention setting for children with ASD, followed by homes and education settings.…”

“…This taxonomy has been adopted by updated reviews. [3][4][5][7][8][9] The reference to the natural environment in conventional interventions typically pertains to familiar settings, such as homes and education settings.…”

“…The World Health Organization (WHO), in its International Classification of Functioning Disability and Health (ICF), highlights the need to address environmental factors and promote participation for individuals with ASD, 4,44 particularly within the natural environment. 45 While the physical form of the natural environment may appear similar in conventional interventions, there are contextual differences in NBIs.…”

“…Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that is characterized by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( DSM-5 ) as “persistent deficits in social communication and social interaction” with the presence of restricted, repetitive patterns of behavior, interests, or activities. Psychosocial and behavioral interventions for children with ASD are designed to promote learning, participation, and skill development while focusing on building strengths and supporting individual growth; however, data are lacking concerning the primary purpose of all interventions, which is the subjective well-being of the population . The 2021 Lancet Commission recommended that identifying effective short-term personalized interventions in randomized clinical trials (RCTs) in settings outside clinics is necessary to improve the lives of individuals with ASD .…”

“…The 2021 Lancet Commission recommended that identifying effective short-term personalized interventions in randomized clinical trials (RCTs) in settings outside clinics is necessary to improve the lives of individuals with ASD . Clinics are the most common intervention setting for children with ASD, followed by homes and education settings …”