Early Intervention Focused on Social and Communicative Abilities for Autism: A Systematic Review and Meta-Analysis

Background: Interventions based on social and communicative skills have become the core of most therapies for children with Autism Spectrum Disorder (ASD), as the demand for such interventions has increased for this population (Wang, Parrila and Cui, 2012). Social reciprocity allows children to participate in shared activities, while improving joint attention and other communicative and social behaviours with peers (Kasari, Gulsrud & Wong, 2010). A wide range of focused practice models have been developed with the aim of helping children with ASD to enhance their social and communicative skills and reduce the number of symptoms in this area. However, comparisons of these models are limited. The quality and effectiveness of these therapies should be further studied to have a better understanding on the subject and suggest best practices.

Objectives: The aim of this study is to conduct a systematic review and meta-analysis to explore the effects of early intervention focused practices in children with ASD on the following 6 abilities: imitation; eye contact; joint attention; pointing; gestures; and play. Furthermore, the analysis aims to identify the most effective interventions according to the characteristics of the participants and the programs, as well as the participation of caregivers.

Methods: Six systematic searches, one for each target ability, were conducted in Medline, PsycINFO, CINAHL and ERIC, to identify peer-reviewed publications from 2000 to April 2017 using ASD and social-communicative intervention-related terms. Inclusion criteria required that studies include participants of 0-6 years of age and described intervention programs, excluding systematic reviews and meta-analyses. A quality review was performed to screen the references, using the EBP inclusion criteria checklist. Meta-analytical methods were implemented, including quality assessment, sensitivity analysis, meta-regression and meta-analysis of studies of different metrics.

Results: 1418 non-duplicate citations were retrieved, and 54 studies were eligible for inclusion in the meta-analysis. Results suggest that socio-communicative interventions lead to positive, medium to large effects in terms of acquisition of imitation (0.48), eye contact (0.88), joint attention (0.57), gestures (0.68), pointing (0.67) and play (0.52) skills. The effects are greater in programs with naturalistic approaches based on behavioural child development, with effect sizes approaching 0.6, and also in those in which caregivers play an active role in therapy conjointly with the main therapist (0.64). Meta-regression analyses show larger effects with younger participants and higher levels of cognitive development, language and dosage intervention.

Conclusions: Naturalistic and behavioural-based development programs are the most effective to improve socio-communicative skills. In addition, if intervention begins as early as possible and caregivers actively participate in high intensity therapy, better outcomes should be expected. As cognitive and language development is a key factor for intervention outcome, further research should be conducted to identify interventions that are effective for children with severe delays. Professionals and caregivers should take into account these results, in order to provide children with ASD the most effective interventions possible. Furthermore, as caregivers’ role in therapy seems to be important, this suggests that early intervention programs should be adapted to the characteristics and needs of each child with ASD.