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Social Communication Outcomes for Young Children with Autism: A Meta-Analysis
Deficits in social communication are a core feature of autism spectrum disorder (ASD) and are correlated with long-term language and communication outcomes (Mundy, Sigman, & Kasari, 1990; Sigman & Ruskin, 1999). As a result, improving social communication is the focus of many early interventions for children with ASD. Understanding the effectiveness of these early intervention is critical to implementing, evaluating, and improving widespread treatment plans for children with ASD.
Objectives:
The objectives of this meta-analysis were to answer the following questions: (1) Are early interventions effective at increasing social communication for young children with ASD? And, (2) do the effects of intervention differ depending on the dose of intervention, the person administering the intervention, or the age of the participants?
Methods:
A systematic review of the literature returned a total of 1,624 articles that were reviewed for inclusion. Studies were included if the study: (a) enrolled participants with ASD younger than 9, (b) used a group design that included a business-as-usual comparison group, (c) implemented a behavioral intervention that did not include a pharmacological component, (d) reported a pre-post outcome measure of social communication, and (e) was published in English.
Results:
A total of 21 studies met inclusion criteria. A standardized mean difference effect size estimate was used to account for the heterogeneous measures used across studies. A total of 996 participants were included in the analysis: 552 intervention participants and 444 control participants. The mean age of the participants was 3.34 years. The random effects model aggregated the effect sizes for an overall effect size of .521 (p-value < 0.001). These findings suggest that children in early interventions showed significantly higher initiations of social communication than children in control groups. Moderator analyses indicated that the length of intervention was not a significant moderator of outcomes (=0.02, p=0.570). Age of the participants significantly moderated outcomes, such that an increase of one year of age predicted an increase in the effect size of 0.289 (p=0.041); suggesting that older children benefitted more from the treatment. Lastly, a subgroup analysis examined the effect of the person who delivered the intervention. The largest effects were shown when the intervention was delivered by researchers (ES=1.206, Q=1.84, I2=0%), followed by teachers (ES=0.391, Q=2.14, I2=6.5%), a combination of researchers and parents (ES=0.373, Q=13.6, I2=70.6%), parents alone (ES=0.321, Q=17.56 I2=60.1%), and finally a combination of parents and teachers (ES=0.048, Q and I2cannot be determined from one study). The only effect size that was not statistically significant at the 0.05 level in this subgroup analysis was in the case of parents and teachers as interventionists together; however, this finding is from only one study.
Conclusions: This meta-analysis indicated positive effects of early intervention on social communication for young children with ASD. An effect size of 0.521 immediately after intervention for this population characterized by deficits in this area is a notable increase. It is particularly important given the long-term benefits of social communication behaviors. Limitations of the study and implications for research and practice will be discussed.