Su Maw Su, Haga Chiyori
Graduate School of Health Sciences, Okayama University, Shikata cho, Kita-ku, 700-8558, Okayama city, Japan.
Heliyon. 2018 Sep 6;4(9):e00763. doi: 10.1016/j.heliyon.2018.e00763. eCollection 2018 Sep.
Autism spectrum disorder (ASD) is characterised by significant impairment in social communication and the presence of restrictive and repetitive behaviour or interest. Intervention during early childhood could decrease ASD symptoms. We aimed to identify the most effective intervention based on cognitive, developmental, and behavioural approaches and the factors that impact the effectiveness of the intervention.
We performed a systematic review and meta-analysis of existing interventions for ASD in preschool-aged children. Electronic databases were searched for related articles with randomised controlled trial (RCT) designs published between 2001 to 2015. Outcome measures were communication, behavioural and cognitive skills, reported as standardised mean differences (SMD) compared to a control group. A Random-effects model was utilised to calculate the pooled estimate effect. Between-study variability was also assessed. The registering number of this study is CRD42017035354.
Out of the initial 5174 studies that were identified, there were 14 RCTs (746 children) that were included in the final systematic review and meta-analysis. Pooled estimate effect provided by random-effects model was 0.23 (95% confidence interval, CI [0.08-0.37]) with no between-study heterogeneity ( = 0.00%, p = 0.0018). Three studies of music therapy interventions provided the greatest outcome effects with a shorter duration and lower intensity. SMD for music therapies ranged from 0.40 to 0.62 with 95% CI [0.22 to 1.85]. The quality of the health care provider, the duration, and the intensity of intervention played an important role in the effectiveness of the intervention.
Music therapy appears to be an effective tool for improving social interaction in preschool-aged children with ASD. However, more evidence-based trials are required to further validate the effectiveness of music therapy in ASD.
自闭症谱系障碍（ASD）的特征是社交沟通严重受损，以及存在局限的、重复的行为或兴趣。幼儿期进行干预可减轻ASD症状。我们旨在确定基于认知、发育和行为方法的最有效干预措施以及影响干预效果的因素。
我们对针对学龄前儿童ASD的现有干预措施进行了系统评价和荟萃分析。检索电子数据库，查找2001年至2015年间发表的具有随机对照试验（RCT）设计的相关文章。结局指标为沟通、行为和认知技能，以与对照组相比的标准化均数差（SMD）表示。采用随机效应模型计算合并估计效应。还评估了研究间的异质性。本研究的注册号为CRD42017035354。
在最初识别出的5174项研究中，有14项RCT（746名儿童）被纳入最终的系统评价和荟萃分析。随机效应模型提供的合并估计效应为0.23（95%置信区间，CI [0.08 - 0.37]），研究间无异质性（I² = 0.00%，p = 0.0018）。三项音乐治疗干预研究产生了最大的结局效应，且持续时间较短、强度较低。音乐治疗的SMD范围为0.40至0.62，95% CI [0.22至1.85]。医疗保健提供者的质量、干预的持续时间和强度在干预效果中起重要作用。
音乐治疗似乎是改善学龄前ASD儿童社交互动的有效工具。然而，需要更多基于证据的试验来进一步验证音乐治疗对ASD的有效性。
