Sandbank Micheal, Bottema-Beutel Kristen, Crowley Shannon, Cassidy Margaret, Feldman Jacob I, Canihuante Marcos, Woynaroski Tiffany
Special Education Department, The University of Texas at Austin.
Lynch School of Education and Human Development, Boston College, MA.
J Speech Lang Hear Res. 2020 May 22;63(5):1537-1560. doi: 10.1044/2020_JSLHR-19-00167. Epub 2020 May 8.
Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.
目的 本研究综合了干预措施对患有自闭症的幼儿（0至8岁）语言结果的影响，并评估了汇总效应因干预措施、参与者和结果特征而异的程度。方法 对为一项更大的荟萃分析（自闭症干预荟萃分析或项目AIM）收集的效应量子集进行了分析，该荟萃分析考察了针对自闭症幼儿的干预措施对语言结果的影响，这些效应量是特定于语言结果的。在控制研究内结果之间的相互关联的同时，使用稳健方差估计和元回归来计算汇总效应和调节效应。结果 从60项研究中收集了总共221个结果。干预对语言结果的汇总效应较小但显著。与接受性语言结果相比，表达性和综合性语言结果的汇总效应更大。由临床医生或由临床医生和照顾者共同实施的干预措施的汇总效应显著大于仅由照顾者实施的干预措施。参与者的治疗前语言年龄等效分数对干预效应有正向且显著的调节作用，因此当儿童样本具有较高的治疗前语言水平时，平均效应显著更大。效应不受累积干预强度、干预类型、自闭症症状、实际年龄或结果的接近程度或范围的调节。对于大多数纳入的结果，研究质量问题明显。结论 我们发现有证据表明干预可以促进患有自闭症的幼儿语言结果的改善。对于表达性和综合性语言结果、最初语言能力较高的儿童以及由临床医生或由照顾者和临床医生联合实施的干预措施，效应最大。然而，纳入研究的质量问题以及一些结果的临界显著性削弱了我们关于干预有效性和相应调节因素的结论。
