Effectiveness of interventions for children and adolescents with autism spectrum disorder in high-income vs. lower middle-income countries: An overview of systematic reviews and research papers from LMIC

Abstract

BackgroundThere is a multitude of systematic reviews of interventions for children and adolescents with autism spectrum disorder (ASD). However, most reviews seem to be based on research conducted in High-Income Countries (HIC). Thus, summary findings may not directly apply to Lower Middle-Income Countries (LMIC). Therefore, we conducted a Meta-Review analyzing systematic reviews on the effectiveness of interventions for target outcomes in children and adolescents with ASD to find out whether there are differences in effectiveness between HIC and LMIC and which interventions can be considered evidence-based in LMIC.MethodsElectronic databases (PsycINFO, PubMed, Cochrane database of systematic reviews) were searched for reviews on interventions for ASD in children and adolescents from January 2011 through December 2021, which included studies not coming from HIC. Systematic reviews with qualitative and quantitative syntheses of findings were included. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria and extracted relevant data including quality and evidence assessments. Evidence for different types of interventions in HIC vs. LMIC was planned to be compared, but none of the reviews assessed potential differences. Therefore, a narrative review of the studies from LMIC was conducted including an assessment of quality and evidence.ResultsThirty-five reviews fulfilled the inclusion criteria. Eleven considered findings from HIC and LMIC. Sixty-nine percent included studies with various research designs; 63% provided a qualitative synthesis of findings; 77% percent assessed the quality of studies; 43% systematically assessed the level of evidence across studies. No review compared evidence from HIC and LMIC. A review of the studies from LMIC found some promising results, but the evidence was not sufficient due to a small number of studies, sometimes poor quality, and small sample sizes.ConclusionSystematic reviews on interventions for children and adolescents with ASD did not look for potential differences in the effectiveness of interventions in HIC and LMIC. Overall, there is very little evidence from LMIC. None of the interventions can be considered evidence-based in LMIC. Hence, additional research and mutually agreed methodological standards are needed to provide a more secure basis for evidence-based treatments in LMIC trying to establish evidence-based practices.

Executive Functioning and Language in a Pediatric Population with Autism Spectrum Disorders and Epilepsy: A Comparative Study

“…Inhibition, crucial for impulse control and concentration on specific tasks, may experience disruptions, manifesting in challenges to restrain inappropriate behaviors or disruptive conduct [ 12 , 13 , 14 ]. Cognitive flexibility, one of the fundamental factors for adapting to changes is presented as a potentially vulnerable area, affecting the ability to transition smoothly between different tasks or situations [ 13 , 14 , 15 ]. Emotional control, essential for emotional regulation, may be affected, contributing to variations in mood [ 12 ].…”

“…Morphosyntactic difficulties indicate variations in grammatical expression, while in the pragmatic domain, crucial for social communication, children affected by epilepsy may manifest obstacles in using language appropriately in social contexts, significantly affecting the quality of interactions [ 14 ]. Regarding comprehension, the interpretation of verbal instructions and text comprehension may be compromised, generating additional challenges in both academic and social environments [ 15 ].…”

“…Cognitive flexibility may also be altered, affecting the ability to transition smoothly from one task to another [ 8 , 9 , 10 , 11 ]. The presence of difficulties in emotional control has also been studied, contributing to mood variability and emotional expression [ 14 , 15 , 16 ]. Lastly, in terms of planning, the ability to organize sequences of actions and establish goals may be compromised [ 15 , 16 , 17 , 18 ], affecting the organization and supervision of materials, the pillars of task management [ 17 ].…”

Evaluation of the effectiveness of behavioral interventions for autism spectrum disorders: A systematic review of randomized controlled trials and quasi-experimental studies

“…The student is guided to give simple answers, systematically incorporated into age-appropriate repertoires (learning without errors) through prompts and consequences that function effectively as reinforcement. Therefore, when applied to ASD, ABA focuses on treating the problems of the disorder by altering social environments, identifying the factors that favor preservation over time, and favoring the learning of adaptive and functional behaviors (Pervin et al, 2022). ABA is included among a series of approaches, known as behavioral interventions, which are placed along a continuum that goes from highly structured approaches to environmental ones.…”

Mental Health Professionals’ Attitudes towards Evidence-Based Practice and usage of Evidence-Based Practices for Children with Autism Spectrum Disorder in Bangladesh and Germany

“…Comprehensive behavioral interventions were used by less than 50% of respondents in special school settings and below 20% both in public and private clinical settings. Comprehensive treatment programs are well investigated in HIC (National Research Council, 2001;, but not in LMIC (Pervin et al, 2021). The high costs of these programs are likely to prevent their application.…”