Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke Global Health Institute, Duke University, Durham, NC, USA.
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa.
Dev Med Child Neurol. 2022 Sep;64(9):1063-1076. doi: 10.1111/dmcn.15258. Epub 2022 May 18.
To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes.
We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered.
From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified.
While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base.
Naturalistic developmental behavioral interventions, as well as developmental and behavioral interventions, improve child outcomes in autism spectrum disorder (ASD). If only randomized controlled trials are considered, guidelines for early intensive behavioral intervention in younger children should be revisited. The greatest intervention impacts were on proximal, intervention-specific outcomes. Inadequacies in the quality of the early ASD intervention evidence base were observed.
确定哪些干预措施有证据支持，以及这些证据的质量在患有或极有可能患有自闭症谱系障碍（ASD）的非常年幼的儿童中是否能改善儿童的结果。
我们对针对极有可能患有 ASD 的非常年幼的儿童的早期干预文献进行了综述，以综合早期干预文献。我们遵循了 Cochrane 关于如何进行综述的指南。在 2009 年 1 月至 2020 年 12 月期间，对数据库进行了全面检索，以寻找系统评价和荟萃分析。提取和总结了综述数据，并评估了方法学质量。总结了主要随机对照试验证据，并评估了偏倚风险。本综述未进行注册。
从 762 条记录中，我们共查阅了 78 篇全文，并确定了 7 项系统评价和荟萃分析，其中包括 63 项独特的研究。几种干预方法（自然发展行为干预、发展和行为干预）改善了儿童的发展结果。在设计、干预和对照组、剂量、实施者和测量方法方面存在异质性。还确定了不一致的方法学质量和潜在偏倚。
虽然许多早期干预措施对儿童的结果有影响，但研究的异质性和质量影响了我们对哪些治疗方法最有效的结论。在试验方法和设计方面的进步，以及对减轻测量偏差的日益关注，将提高 ASD 早期干预证据基础的质量。
自然发展行为干预以及发展和行为干预可改善自闭症谱系障碍（ASD）儿童的结果。如果仅考虑随机对照试验，应重新考虑针对年幼儿童的早期强化行为干预指南。最大的干预效果是对干预特定的近因结果。早期 ASD 干预证据基础的质量存在不足。
