Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews

Abstract

ObjectiveTo assess the effectiveness of non-pharmacological interventions for the treatment of autism spectrum disorder (ASD) in children.DesignOverview of systematic reviews (SRs).ParticipantsChildren aged 12 years and under with ASD.Search methodsIn October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Epistemonikos placing no restrictions on language or date of publication.Interventions17 non-pharmacological interventions compared with placebo, no-treatment (including waiting list) or other interventions (ie, usual care, as defined by the authors of each study).Data collection and analysisWe rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty of the evidence (CoE) according to the analysis conducted by the authors of the included SRs.Main outcome measuresA multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms.Public and patient involvement statementOrganisations of parents of children with ASD participated in external revision of the final version of the report.ResultsWe identified 52 reports that were within our scope, of which 48 were excluded for various reasons. After excluding less reliable SRs, we included four SRs. Non-pharmacological interventions (ie, Early Intensive Behavioural Intervention, Applied Behaviour Analysis, Picture Exchange Communication System and Naturalistic Developmental Behavioural Interventions) may have favourable effects on some core outcomes including language, social and functioning, play or daily living skills in children with ASD (with either no GRADE assessment, very low or low CoE). In addition, we identified a lack of report for other key outcomes in the included SRs (ie, restricted, repetitive behaviour; play and sensory processing).ConclusionsSynthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed.PROSPERO registration numberCRD42020206535.

What is the overall prognosis of preschool autism spectrum disorder diagnoses? A Cochrane Review summary with commentary

“…Despite the lack of high certainty of evidence, there are a variety of treatment approaches which are used for children with ASD and co-occurring conditions. [13][14][15] The findings of an umbrella review indicate that behavioural, developmental, naturalistic developmental behavioural, and technologybased interventions, as well as cognitive behavioural therapy, have positive therapeutic effects on several outcomes in children with ASD and their families. 16 However, high-quality, well-designed, randomized controlled trials are clearly needed to improve the certainty of evidence regarding the effectiveness of interventions.…”

“…Any intervention for ASD and co‐occurring conditions should be set in a multidisciplinary management approach. Despite the lack of high certainty of evidence, there are a variety of treatment approaches which are used for children with ASD and co‐occurring conditions 13–15 . The findings of an umbrella review indicate that behavioural, developmental, naturalistic developmental behavioural, and technology‐based interventions, as well as cognitive behavioural therapy, have positive therapeutic effects on several outcomes in children with ASD and their families 16 .…”