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Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews
  1. Nicolás Meza1,
  2. Valeria Rojas2,3,
  3. Camila Micaela Escobar Liquitay4,
  4. Ignacio Pérez2,
  5. Francisca Aguilera Johnson2,
  6. Claudia Amarales Osorio2,5,
  7. Matías Irarrázaval6,7,
  8. Eva Madrid1,
  9. Juan Victor Ariel Franco8
  1. 1 Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
  2. 2 School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
  3. 3 Autism program, Hospital Dr Gustavo Fricke, Viña del Mar, Chile
  4. 4 Central Library, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  5. 5 Pediatric Neurology Unit, Hospital Carlos van Buren, Valparaíso, Chile
  6. 6 Department of Mental Health, Ministry of Health, Santiago, Chile
  7. 7 Millenium Institute for Research in Depression and Personality, Santiago, Chile
  8. 8 Associate Cochrane Centre - Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  1. Correspondence to Dr Eva Madrid, Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Vina del Mar 2540079, Valparaíso, Chile; eva.madrid{at}uv.cl

Abstract

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.

  • neurology
  • psychiatry
  • 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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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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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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