Early intervention for children with autistic spectrum disorder : a systematic review

Abstract

Background: Autistic spectrum disorder or autism spectrum disorder (ASD) is nowadays remained a global issue as well as in Hong Kong. Since the earlier the children with ASD get intervened, the better the result they will receive. Early Intensive Behavioral Intensive Intervention (EIBI) based on a clinic or center setting is now provided in Hong Kong. Due to the limited resources and developed diagnosis and screening tool for ASD, there exists a long waiting time for the children to get access to the services. No review on comparing early interventions based on home or preschool setting other than EIBI had been conducted for the children with ASD in Hong Kong, which are most likely benefit for the children who are on the waiting list.

Objective: (i) This systematic review is on the randomize control trials of the early interventions other than EIBI to identify interventions that can be conveyed or mediated by non-professionals in a non-clinical or center based setting that might be possible to implement in Hong Kong. (ii) To evaluate the effectiveness of the early interventions on development such as intellectual, cognitive and social behavior for the children from 0-6 years with ASD.

Methods: A systematic review of RCTs is conducted. Studies were searched in PubMed, MEDLINE and EMBASE by using MeSH. Inclusion and exclusion criteria were applied to the selection process. RCTs that target on the effect of early interventions for the toddlers/preschoolers other than EIBI based on a non-clinical setting delivered by non-professionals were included in this review. Studies mainly focused on the screening or diagnose of early onset ASD were excluded.

Results: Out of 319 RCTs were retrieved from the database with 16 of them were included and analyzed in this review. 12 kinds of early interventions are identified with 11 them carried out under a home or preschool setting, 1 of them carried out under a clinical setting by using acupuncture. Large effect size was found in Qi-gong (ES=0.59, 0.80, 0.85; p<0.05), Joint attention (JA) (ES=0.44, 0.67; p<0.05 and ES=1.09, 0.74, 0.88; p<0.05), Preschool Autism Communication Trial (PACT) (ES=1.22, 0.41, 0.33; p<0.05), Autism 1-2-3 (χ2=-2.85, -2.65, -2.81, -2.69; p<0.01), and Communication focused Interpersonal Synchrony (IS) (ES=0.86; p<0.05) interventions, which all intervened with high intensity. Children with ASD showed large improvement in the development outcomes from these studies. Conclusions: Early interventions based on a home or preschool setting delivered by parents and teachers are identified in this systematic review and can be used for children diagnosed with ASD who are on a waitlist and not be able to go to a therapy center. Intervention with higher intensity such as JA, PACT, Qi-gong and Communication focused intervention are highly recommended to do pilot study in Hong Kong as none of them have been applied in Hong Kong before. Since Autism 1-2-3 study were done in Hong Kong with a good compliance and the effective result, it is a recommended for the Department of Health and Non-governmental organizations to consider providing these interventions for the children diagnose as ASD.