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Efficacy of applied behavioural intervention for preschool children with autism on cognitive, behavioural, and language outcomes: a systematic review and meta-analysis


  1. 1. The Royal Children’s Hospital;
  2. 2. Murdoch Childrens Research Institute;
  3. 3. LaTrobe University, Melbourne, Australia

Objectives: To assess the effect of applied behavioural intervention (ABI) for preschool children with autism spectrum disorder (ASD) on cognitive, behaviour, and language outcomes compared with standard care.

Design: Systematic review and meta-analysis of published randomized trials (RCTs).

Setting: Tertiary and  community centres.

Participants: Three hundred and thirty-nine preschool-aged children diagnosed with ASD participated in ABI trials. ABI is a method of teaching appropriate behaviours by breaking tasks down into small discrete steps and using intensive training in a systematic way (discrete trial training). Inclusion criteria were randomized control or comparative trials where ABI interventions were delivered to the parents/caregiver and/or child. Exclusion criteria were children with physical, hearing, and/or vision impairnment and pharmacological interventions.

Method: Search strategies followed the guidelines of the Developmental, Psychosocial and Learning Problems Cochrane Review group. Fifty-nine studies were extracted from the databases. Of these, 13 studies met the inclusion criteria. For qualitative analysis the Physiotherapy Evidence Database (PEDro) Scale of quality assessment was performed by two independent raters. Data on the primary outcome cognitive development (Bayley Scale of Infant Development 2nd edn), behavioural outcomes (Vineland Adaptive Behaviour Scales), and language (Reynell Developmental Language Scale) were extracted and compared by meta-analysis calculating fixed standardized mean differences and 95% confidence intervals using the Rev Man 4.2 program.

Results: Thirteen studies met the inclusion criteria (n=339). Five of these RCTs had strong methodological quality, scoring >6 on the PEDro scale (n=139) and were used in the meta-analysis (Table B:6). All the trials were comparative studies receiving standard care rather than controlled trials, thus explaining why some comparison groups had better outcomes than the experimental groups. There is significant variability with regard to intensity (range 4-39h/wk); duration (3mo-4y); method of delivery (parent vs therapist mediated), and setting (home and preschool).

Conclusions: ABI is time consuming, of high intensity and, therefore, costly. For children with such significant disability this intervention does not yet offer any conclusive evidence of additional benefit to cognitive, behavioural, and language outcomes over standard care.

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