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  Cognitive, language, and behavioral outcomes in children with autism spectrum disorders exposed to early comprehensive treatment models: A meta-analysis and meta-regression

Shi, B., Wu, W., Dai, M., Zeng, J., Luo, J., Cai, L., et al. (2021). Cognitive, language, and behavioral outcomes in children with autism spectrum disorders exposed to early comprehensive treatment models: A meta-analysis and meta-regression. Frontiers in Psychiatry, 12: 691148. doi:10.3389/fpsyt.2021.691148.

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Shi, Bijun1, 2, Author
Wu, Weijia3, Author
Dai, Meixia4, Author
Zeng, Jingjing1, Author
Luo, Jingyin5, Author
Cai, Li1, Author
Wan, Bin6, Author           
Jing, Jin1, Author
1Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China, ou_persistent22              
2Department of Pediatrics, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China, ou_persistent22              
3Department of Scientific Research, Hainan Women and Children's Medical Center, Haikou, China, ou_persistent22              
4Department of Children's Healthcare and Mental Health Center, Shenzhen Children's Hospital, China, ou_persistent22              
5Children's Health Care, Hainan Women and Children's Medical Center, Haikou, China, ou_persistent22              
6Otto Hahn Group Cognitive Neurogenetics, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_3222264              


Free keywords: Autism spectrum disorders; Comprehensive treatment models; EIBI; ESDM; Outcomes; Childhood; Meta-analysis
 Abstract: Background: Early comprehensive treatment models (CTMs) have been developed as effective treatments for children with autism spectrum disorder (ASD). Numerous studies have suggested that CTMs can improve short-term outcomes, but little is known about precise outcome information in childhood. The current meta-analysis reviewed studies reporting broader outcomes in children with ASD who had ever participated in a CTM and examined the predictors of developmental gains. Methods: We searched eight databases up to June 13, 2019, for relevant trials and natural experiments. Longitudinal studies were selected if they investigated the outcomes of CTMs. Two meta-analyses were undertaken to provide a summary estimate of change in treatment outcomes and to evaluate the effect of CTMs; one used the standardized mean change between the pretest and posttest, and the other was a classical meta-analysis. Stratified and random-effects meta-regression analyses were performed to search for outcome differences among studies. Results: Eighteen intervention studies (involving 495 children with ASD) met all the inclusion criteria: 12 used early intensive behavioral intervention (EIBI), and two used the Early Start Denver Model (ESDM). Outcomes were categorized into three parts: cognitive, language and behavioral (e.g., adaptive functioning and symptomatology). 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. 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. Conclusion: The results demonstrate a positive association between CTMs and better prognosis in childhood, especially regarding symptoms, and language. However, most extant research involves small, non-randomized studies, preventing definitive conclusions from being drawn. Clearly, the outcomes of children with ASD are still far from normal, especially with respect to adaptive functioning, and the four mediating variables pertaining to treatment elements can affect their gains, including approach, implementer, intensity, and total treatment hours.


Language(s): eng - English
 Dates: 2021-04-052021-06-282021-07-26
 Publication Status: Published online
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.3389/fpsyt.2021.691148
Other: eCollection 2021
PMID: 34381389
PMC: PMC8350444
 Degree: -



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Project name : -
Grant ID : 2019B030335001
Funding program : Key-Area Research and Development Program
Funding organization : Guangdong Province
Project name : -
Grant ID : 81872639 and 82003482
Funding program : -
Funding organization : National Natural Science Foundation of China

Source 1

Title: Frontiers in Psychiatry
  Abbreviation : Front Psychiatry
Source Genre: Journal
Publ. Info: Lausanne, Switzerland : Frontiers Research Foundation
Pages: - Volume / Issue: 12 Sequence Number: 691148 Start / End Page: - Identifier: ISSN: 1664-0640
CoNE: https://pure.mpg.de/cone/journals/resource/16640640