Efficacy of Applied Behavioral Intervention in Preschool Children with Autism for Improving Cognitive, Language, and Adaptive Behavior: A Systematic Review and Meta-analysis

  • Michèle Spreckley
    Reprint requests: Michèle Spreckley, MCSP, Uncle Bobs Child Development Centre, 56 Chapman St, North Melbourne, Victoria, Australia. 3051
    Uncle Bobs Child Development Centre, Department of Developmental Medicine, The Royal Children's Hospital, Melbourne, Australia
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  • Roslyn Boyd
    Murdoch Children's Research Institute, Melbourne, Australia

    Queensland Cerebral Palsy and Rehabilitation Research Centre, Department of Paediatrics and Child Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Published:October 28, 2008DOI:https://doi.org/10.1016/j.jpeds.2008.09.012


      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).


      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).


      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.


      ABA ( Applied behavioral analysis), ABAI ( Applied behavior analysis intervention), ABI ( Applied behavior intervention), ASD ( Autism spectrum disorder), IBT ( Intensive behavioral treatment), PDD ( Pervasive developmental disorders), PEDro ( Physiotherapy Evidence Database), SMD ( Standardized mean difference)
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