Efficacy of Applied Behavioral Intervention in Preschool Children with Autism for Improving Cognitive, Language, and Adaptive Behavior: A Systematic Review and Meta-analysis
Received 24 March 2008; received in revised form 7 July 2008; accepted 2 September 2008. published online 28 October 2008.
Refers to article:
Establishing a Translational Science for Autistic Spectrum Disorders for Children and Their Families: Optimizing Function, Participation, and Well-Being
Michael E. Msall
The Journal of Pediatrics
March 2009 (Vol. 154, Issue 3, Pages 319-321) Full Text |
Full-Text PDF (78 KB)
Objective
To review the effectiveness of applied behavior intervention (ABI) programs for preschool children with autism spectrum disorder (ASD) in their cognitive, adaptive behavior, and language development.
Study design
Systematic reviews, randomized or quasirandomized controlled trials (RCT) of ABI delivered to preschool children with ASD were reviewed. Quantitative data on cognitive, language, and behavior outcomes were extracted and pooled for meta-analysis (RevMan 4.2).
Results
Thirteen studies met the inclusion criteria. Six of these were randomized comparison trials with adequate methodologic quality (PEDro ≥ 6). Meta-analysis of 4 studies concluded that, compared with standard care, ABI programs did not significantly improve the cognitive outcomes of children in the experimental group who scored a standardized mean difference (SMD) of 0.38 (95%CI −0.09 to 0.84; P = .1). There was no additional benefit over standard care for expressive language; SMD of 0.37 (95%CI −0.09 to 0.84; P = .11), for receptive language; SMD of 0.29 (95%CI −0.17 to 0.74; P = .22) or adaptive behavior; SMD of 0.30 (95%CI −0.16 to 0.77; P = .20).
Conclusions
Currently there is inadequate evidence that ABI has better outcomes than standard care for children with autism. Appropriately powered clinical trials with broader outcomes are required.
aUncle Bobs Child Development Centre, Department of Developmental Medicine, The Royal Children's Hospital, Melbourne, Australia
bMurdoch Children's Research Institute, Melbourne, Australia
cQueensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
Reprint requests: Michèle Spreckley, MCSP, Uncle Bobs Child Development Centre, 56 Chapman St, North Melbourne, Victoria, Australia. 3051
Supported by a National Health and Medical Research Council Career Development Fellowship (NHMRC 473849), and a Smart State Fellowship from the Department of Innovation, Queensland. The authors declare no potential conflict of interest.
ABSTRACT