Paris Nanterre University, DysCo Laboratory, F-92000, Nanterre, France.
Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100, Boulogne-Billancourt, France.
Mol Psychiatry. 2022 Sep;27(9):3647-3656. doi: 10.1038/s41380-022-01670-z. Epub 2022 Jul 5.
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.
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.
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.
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.
为了帮助自闭症谱系障碍（ASD）患者，设计了广泛的心理社会干预措施，这使得对支持这些干预措施有效性的科学证据进行汇编和分层变得具有挑战性。因此，我们对已发表的针对 ASD 核心和相关症状的心理社会干预措施的对照临床试验的荟萃分析进行了伞式综述。
重新估算了每项识别出的荟萃分析，使用随机效应模型和受限极大似然估计。批判性地评估了纳入荟萃分析的方法学质量，并根据为这项研究目的而改编的标准，通过算法评估证据的可信度。
我们共确定了 128 项来自 44 份报告的荟萃分析。超过一半的非重叠荟萃分析在名义上具有统计学意义，且/或显示出有利于心理社会干预的中等至较大的汇总效应大小。证据可信度评估指出，早期密集行为干预、发展干预、自然发展行为干预和家长介导干预的疗效在学龄前儿童的至少一个结局上得到了提示性证据的支持。可能的结局包括社交沟通障碍、整体认知能力和适应行为。结果还表明，家长介导干预可显著改善学龄早期儿童的破坏性行为。社交技能小组的疗效在改善学龄儿童和青少年的社交沟通障碍和整体 ASD 症状方面得到了提示性证据的支持。仅有四项荟萃分析在一项仅限于低检测偏倚风险的随机对照试验的敏感性分析中具有统计学意义的汇总效应大小。
本伞式综述证实，一些心理社会干预措施在生命的不同阶段显示出改善与 ASD 相关症状的希望。然而，仍需要更多设计良好的随机对照试验来更清楚地了解这些干预措施的疗效。为了促进传播关于 ASD 个体心理社会干预的科学知识，我们建立了一个开放获取和互动的网站，分享在本伞式综述过程中收集的信息和生成的结果。
PROSPERO 注册号 CRD42020212630。
