Autism Intervention Meta-Analysis of Early Childhood Studies (Project AIM): Updated Systematic Review and Secondary Analysis

BMJ

Sandbank, M., Bottema-Beutel, K., et al. (2023).

BMJ, 383, e076733.

<div>This updated systematic review and meta-analysis explores the impact of commonly recommended early childhood autism interventions on developmental outcomes in young children (i.e., under the age of 8) on the autism spectrum. For more information about the previous versions of this systematic review, please see the "Notes on this Article" section of this article summary.</div>

National Institutes of Health

<p>This systematic review is an update of the following articles:</p> <ul> <li>Sandbank, M., Bottema-Beutel, K., et al. (2020). Project AIM: Autism Intervention Meta-Analysis for Studies of Young Children. <em>Psychological Bulletin</em>, 146(1), 1-29. <a href="https://doi.org/10.1037/bul0000215" target="_blank" rel="noopener">https://doi.org/10.1037/bul0000215</a></li> <li>Sandbank, M., Bottema-Beutel, K., et al. (2020). Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis.&nbsp;<em>Journal of Speech, Language, and Hearing Research, 63</em>(5), 1537-1560. <a class="citation__doi__link" href="https://doi.org/10.1044/2020_JSLHR-19-00167" target="_blank" rel="noopener">https://doi.org/10.1044/2020_JSLHR-19-00167</a></li> </ul>

1975 to 2021

<div>Controlled group studies</div>

252

<div>Early childhood autism interventions had the following effects on developmental outcomes in young children on the autism spectrum:</div> <div> <ul> <li><strong>Behavioral interventions&nbsp;</strong>improved social emotional skills and/or challenging behavior outcomes (Hedge's g = 0.58) but did not improve social communication.</li> <li><strong>Developmental interventions&nbsp;</strong>(i.e., interventions that were primarily child-led and stressed the relational, transactional, and social underpinnings of development)&nbsp;improved social communication (Hedge's g = 0.28).</li> <li><strong>Naturalistic developmental behavioral interventions (NDBIs)</strong> had a positive impact on adaptive behavior (Hedge's g = 0.23), the diagnostic characteristics of autism (Hedge's g = 0.38), language skills (Hedge's g = 0.16), play (Hedge's g = 0.19), and social communication (Hedge's g = 0.35). NDBIs had no impact on cognition or restricted and repetitive behaviors. When effects from randomized controlled trials were isolated, significant effects were seen for the diagnostic characteristics of autism, but no significant effect was found for cognition, language, or social communication.&nbsp;</li> <li><strong>Technology-based interventions</strong> improved social communication (Hedge's g = 0.33) and outcomes for social emotional skills and/or challenging behavior (Hedge's g = 0.57). Technology-based interventions did not impact language skills.&nbsp;</li> </ul> <div>Adverse events (e.g., intense child aggression, reduced parental mental health) were poorly monitored across studies, however, many studies reported that they occurred.</div> <div>&nbsp;</div> <div>Limitations to this review include publication bias and the lack of investigation of treatment effects for interventions that did not clearly fall into one of the above treatment categories.</div> </div>