Parent-Mediated Interventions for Children and Adolescents With Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

Abstract

There has been increasing interest in parent-mediated interventions (PMIs) for children with autism spectrum disorders (ASDs). The objective of this systematic review and meta-analysis was to examine the effect of PMIs compared to no PMI for children with ASD aged 2–17 years. The primary outcome was adaptive functioning rated by a parent or clinician. The secondary outcomes were long-term adaptive functioning rated by the parents, adverse events, core symptoms of ASD, disruptive behavior, parental well-being, quality of life of the child rated by the parents and anxiety. The MEDLINE, PsycInfo, Embase, and CINAHL databases were searched in March 2020. The Cochrane Risk of Bias Tool was used to rate the individual studies, and the certainty in the evidence was evaluated using GRADE. We identified 30 relevant randomized controlled trials (RCTs), including 1,934 participants. A clinically relevant effect of PMIs on parent-rated adaptive functioning was found with a low certainty of evidence [Standard mean difference (SMD): 0.28 (95% CI: −0.01, 0.57)] on Vineland Adaptive Behavior Scales (VABS), whereas no clinically relevant effect was seen for clinician-rated functional level, with a very low certainty of evidence [SMD on Clinical Global Impressions (CGI)-severity scale: SMD −0.45 [95% CI: −0.87, −0.03)]. PMIs may slightly improve clinician-rated autism core symptoms [SMD: −0.35 (95% CI: −0.71, 0.02)]. Additionally, no effect of PMIs on parent-rated core symptoms of ASD, parental well-being or adverse effects was identified, all with a low certainty of evidence. There was a moderate certainty of evidence for a clinically relevant effect on disruptive behavior [SMD: 0.55 (95% Cl: 0.36, 0.74)]. The certainty in the evidence was downgraded due to serious risk of bias, lack of blinding, and serious risk of imprecision due to few participants included in meta-analyses. The present findings suggest that clinicians may consider introducing PMIs to children with ASD, but more high-quality RCTs are needed because the effects are not well-established, and the results are likely to change with future studies. The protocol for the systematic review is registered at the Danish Health Authority website (www.sst.dk).

Parent-mediated play‐based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol

“…Therefore, various play-based interventions have been developed and used to support the social communication and language needs of autistic children [11][12][13][14][15][16][17][18][19]. Although many reviews and meta-analyses have reported the characteristics and overall effectiveness of play-based interventions on autistic children's social communication and language skills [39,51,[54][55][56][64][65][66][67][68][69][70][71][72][73], to the best of the authors' knowledge, the current study will be the first to evaluate the effectiveness of parent-mediated play-based interventions conducted in non-educational settings on the social communication and language skills of preschool autistic children. Hence, the review will shed new light on the role of parental mediation in the effectiveness of play-based interventions.…”

“…Since Phase I comprises the studies that were published between 2000 and January 2021, an additional search for relevant studies published in 2021 will be carried out on the aforementioned databases and by using the same search strings (S2 Table in S1 File ). The database search will be conducted by the first author (ED) alongside a comprehensive citation search of the previous systematic review and meta-analysis on parent-mediated interventions in autism [ 39 , 51 , 54 – 56 , 64 – 73 ]. The identified studies will be merged and downloaded into Mendeley Reference Manager software for performing the title, abstract and full-text screenings.…”

“…comprehensive citation search of the previous systematic review and meta-analysis on parentmediated interventions in autism [39,51,[54][55][56][64][65][66][67][68][69][70][71][72][73]. The identified studies will be merged and downloaded into Mendeley Reference Manager software for performing the title, abstract and full-text screenings.…”

Implementation of a Parent-Mediated Discrete Trial Teaching Intervention for Children with Autism Spectrum Disorder

“…Thus, caregivers play an active role in their child's treatment and interventions can be individually adapted. Though methodologies vary, recent metaanalyses and studies demonstrate positive outcomes when involving caregivers as interventionists (Conrad et al, 2021;Nevill et al, 2018). Further, Liu and Schertz (2021) found that trained caregivers demonstrated high fidelity to intervention procedures, providing further support for reinforcing the caregiver's active role in the child's treatment.…”

Communication and Language Skills of Autistic Spectrum Disorders in Children and Their Parents' Emotions

“…In addition, literal interpretation of language and difficulty in understanding the intent of other people leads to behavioral challenges in some people with ASD and affects success in school, leisure activities, and employment ( 2 ). There has been increasing interest in parent-mediated interventions for children with ASD ( 11 ), as well as proof of their success. Reviews suggests that interventions conveyed by parents of children with ASD can improve communication of persons with ASD.…”