Effectiveness of community-based early intervention for children with autism spectrum disorder: a meta-analysis

Allison S. Nahmias, Melanie Pellecchia, Aubyn Stahmer, David S. Mandell

Research output: Contribution to journalArticle

Abstract

Background: Research trials of early intervention (EI) programs for children with autism spectrum disorder (ASD) generally demonstrate medium-to-large gains, on average, compared with “treatment as usual,” in different developmental domains. Almost all children with ASD receive their treatment through community-based services, however, and studies suggest that evidence-based interventions rarely make their way into community practice. Understanding the effectiveness of community-based EI and factors associated with these effects is the first step in developing strategies for wide-scale implementation of effective EI. Methods: Studies of community-based EI for children with ASD were identified through a systematic search. Changes in cognitive, communication, social, and adaptive functioning from pre-treatment to post-treatment were assessed using standardized mean gain scores. Effect sizes were estimated using random effects models. Moderators of interest included type of community EI program, year of publication, intervention duration, and sample selection. Moderator effects were assessed using analysis of variance of mixed-effects models and meta-regression analyses. Results: Forty-six groups from 33 studies met inclusion criteria (1,713 participants, mean age 37.4 months, 81.1% male). There were small but statistically significant gains in each of the four domains. Hedges's g ranged from 0.21 for adaptive behavior to 0.32 for communication outcomes, after removing outliers and correcting for publication bias. EI programs associated with universities and hospitals were superior, on average, to other community EI programs for cognitive and adaptive behavior outcomes. Intervention duration was negatively associated with effect sizes for communication and adaptive behavior outcomes. Conclusions: These results indicate that there remains a large gap between outcomes observed in community settings and those reported in efficacy trials.

Original languageEnglish (US)
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
DOIs
StatePublished - Jan 1 2019

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Meta-Analysis
Psychological Adaptation
Communication
Publication Bias
Social Welfare
Therapeutics
Publications
Autism Spectrum Disorder
Analysis of Variance
Regression Analysis
Research

Keywords

  • Autism spectrum disorders
  • community programmes
  • early intervention
  • meta-analysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Effectiveness of community-based early intervention for children with autism spectrum disorder : a meta-analysis. / Nahmias, Allison S.; Pellecchia, Melanie; Stahmer, Aubyn; Mandell, David S.

In: Journal of Child Psychology and Psychiatry and Allied Disciplines, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Research trials of early intervention (EI) programs for children with autism spectrum disorder (ASD) generally demonstrate medium-to-large gains, on average, compared with “treatment as usual,” in different developmental domains. Almost all children with ASD receive their treatment through community-based services, however, and studies suggest that evidence-based interventions rarely make their way into community practice. Understanding the effectiveness of community-based EI and factors associated with these effects is the first step in developing strategies for wide-scale implementation of effective EI. Methods: Studies of community-based EI for children with ASD were identified through a systematic search. Changes in cognitive, communication, social, and adaptive functioning from pre-treatment to post-treatment were assessed using standardized mean gain scores. Effect sizes were estimated using random effects models. Moderators of interest included type of community EI program, year of publication, intervention duration, and sample selection. Moderator effects were assessed using analysis of variance of mixed-effects models and meta-regression analyses. Results: Forty-six groups from 33 studies met inclusion criteria (1,713 participants, mean age 37.4 months, 81.1{\%} male). There were small but statistically significant gains in each of the four domains. Hedges's g ranged from 0.21 for adaptive behavior to 0.32 for communication outcomes, after removing outliers and correcting for publication bias. EI programs associated with universities and hospitals were superior, on average, to other community EI programs for cognitive and adaptive behavior outcomes. Intervention duration was negatively associated with effect sizes for communication and adaptive behavior outcomes. Conclusions: These results indicate that there remains a large gap between outcomes observed in community settings and those reported in efficacy trials.",
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