Efficacy of psychosocial interventions for Autism spectrum disorder: an umbrella review
Résumé
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.