Objective To assess the effectiveness of non-pharmacological interventions for the treatment of autism spectrum disorder (ASD) in children.
Design Overview of systematic reviews (SRs).
Participants Children aged 12 years and under with ASD.
Search methods In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Epistemonikos placing no restrictions on language or date of publication.
Interventions 17 non-pharmacological interventions compared with placebo, no-treatment (including waiting list) or other interventions (ie, usual care, as defined by the authors of each study).
Data collection and analysis We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty of the evidence (CoE) according to the analysis conducted by the authors of the included SRs.
Main outcome measures A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms.
Public and patient involvement statement Organisations of parents of children with ASD participated in external revision of the final version of the report.
Results We identified 52 reports that were within our scope, of which 48 were excluded for various reasons. After excluding less reliable SRs, we included four SRs. Non-pharmacological interventions (ie, Early Intensive Behavioural Intervention, Applied Behaviour Analysis, Picture Exchange Communication System and Naturalistic Developmental Behavioural Interventions) may have favourable effects on some core outcomes including language, social and functioning, play or daily living skills in children with ASD (with either no GRADE assessment, very low or low CoE). In addition, we identified a lack of report for other key outcomes in the included SRs (ie, restricted, repetitive behaviour; play and sensory processing).
Conclusions Synthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed.
PROSPERO registration number CRD42020206535.
- mental disorders
- mental health recovery
Data availability statement
Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request and at our OSF registry (https://osf.io/aedxj/).
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Twitter @nicolasmezac, @micaelaescb
Contributors All authors have contributed significantly to this manuscript and agree with its content. Study concept and design: JVAF, EM, NM, VR, CAO, CME-L, MI. Acquisition of data: all authors. Analysis/Interpretation of data: NM, JVAF, EM, MI, VR. Drafting of the article: JVAF, EM, NM, CME-L, MI, CAO. Revision of article: all authors. EM will be the guarantor of the study.
Funding In an effort to address the sizeable needs of this neglected population group, the Chilean Ministry of Health (MINSAL) commissioned a group of researchers from Universidad de Valparaíso to prepare a manual for a comprehensive approach to autism spectrum in children up to the age of 12 years, based on an investigation of high-quality systematic reviews that included pharmacological and/or non-pharmacological interventions. Department of Mental Health, Chilean Ministry of Health, Grant ID 757-22 L120.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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