Eighteen intervention studies (8 between-group studies and 10 pre-post studies, involving 495 children with ASD) were included in the meta-analysis, aimed at study broader outcomes in children with ASD who had ever participated in an early comprehensive treatment model (CTM) and examined the predictors of developmental gains. «Shi B, Wu W, Dai M ym. Cognitive, Language, and Be...»1 Twelve studies used early intensive behavioral intervention (EIBI), two used the Early Start Denver Model (ESDM), and four used other interventions. Outcomes were categorized into three parts: cognitive, language and behavioral. With regard to the intervention characteristics, eight studies were implemented by therapists and parents. The intervention duration and intensity ranged from 6 to 60 months and from 15 to 40 weekly hours, respectively. the comparison conditions in the eight between-group studies, which included 6 EIBI programs and 2 ESDM programs, were treatment as usual (n = 5), different implementers (n = 2), and active comparison (n = 1).
Six studies (33 %) were assessed as "strong", suggesting low risk of bias, whereas as 2 (11 %) were assessed as "adequate", suggesting moderate risk of bias, and 10 (56 %) as "weak", suggesting high risk of bias.
The mean pre-IQ, reported in 15 studies, was 50–64; the mean pretest age was 24–49 months, and the mean age at the last assessment was 66–192 months.
Overall, most children with ASD who had ever participated in an early CTM, made gains in many areas of functioning, especially in terms of symptom- and language-related outcomes. The pooled standardized mean change ES for IQ, covering 420 participants, was 0.85 (95% CI: 0.47 to 1.22). The pooled ESs for expressive language and receptive language were 1.12 (95% CI: 0.70 to 1.53) and 1.11 (95% CI: 0.83 to 1.40), respectively. Regarding the longitudinal changes in ASD symptom severity, seven studies reported relevant data, and three of them showed a favorable effect. The pooled ES was −0.68 (95% CI: −1.24 to −0.12). For adaptive functioning, the subdomains showed heterogeneity. A medium ES was found for both communication (ES = 0.75, 95% CI: 0.47 to 1.02) and social (ES = 0.55; 95% CI: 0.17 to 0.92), whereas a trivial ES was found for daily living skills (ES = −0.05, 95% CI: −0.49 to 0.39) and composite score (ES = 0.15, 95% CI: −0.28 to 0.57).
Stratified analyses indicated that the ESDM displayed the largest effect on IQ improvement (ES 1.37, 95% CI: 0.95 to 1.80), while EIBI was more effective for symptom reduction (ES -1.27, 95% CI: -1.96 to -0.58). Further, meta-regression suggested that interventions with parent involvement, higher intensity, and longer treatment hours yielded greater improvements in IQ and social adaptive functioning, respectively.
Comments: Most extant research involves small, non-randomized studies, preventing definitive conclusions from being drawn.
Another meta-analysis «Daniolou S, Pandis N, Znoj H. The Efficacy of Earl...»2 was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12–132 months). Early interventions led to positive outcomes for cognitive ability (g = 0.32; 95% CI: 0.05, 0.58; p = 0.02), daily living skills (g = 0.35; 95% CI: 0.08, 0.63; p = 0.01), and motor skills (g = 0.39; 95% CI: 0.16, 0.62; p = 0.001), while no positive outcomes were found for the remaining variables. However, when studies without the blinding of outcome assessment were excluded, positive outcomes of early interventions only remained for daily living skills (g = 0.28; 95% CI: 0.04, 0.52; p = 0.02) and motor skills (g = 0.40; 95% CI: 0.11, 0.69; p = 0.007).
Comments: There was a large heterogeneity between the studies included in analysis.