Parent-mediated early intervention for young children with
autism spectrum disorder (Cochrane Review).
Diggle T, McConachie HR, Randle VR.
Department of Child Health, The University of Newcastle, University of
Newcastle, Newcastle upon Tyne, UK, NE2 4AE. T.J.Diggle@newcastle.ac.uk
BACKGROUND: Recent estimates concerning the prevalence of autistic spectrum
disorder are much higher than those reported 30 years ago, with at least 1 in
400 children affected. This group of children and families have important
service needs. The involvement of parents in implementing intervention
strategies designed to help their autistic children has long been accepted as
helpful. The potential benefits are increased skills and reduced stress for
parents as well as children. OBJECTIVES: The objective of this review was to
determine the extent to which parent-mediated early intervention has been
shown to be effective in the treatment of children aged 1 year to 6 years 11
months with autistic spectrum disorder. In particular, it aimed to assess the
effectiveness of such interventions in terms of the benefits for both children
and their parents. SEARCH STRATEGY: A range of psychological, educational and
biomedical databases were searched. Bibliographies and reference lists of key
articles were searched, field experts were contacted and key journals were
hand searched. SELECTION CRITERIA: Only randomised or quasi-randomised studies
were included. Study interventions had a significant focus on
parent-implemented early intervention, compared to a group of children who
received no treatment, a waiting list group or a different form of
intervention. There was at least one objective, child related outcome measure.
DATA COLLECTION AND ANALYSIS: Appraisal of the methodological quality of
included studies was carried out independently by two reviewers. Differences
between the included studies in terms of the type of intervention, the
comparison groups used and the outcome measures were too great to allow for
direct comparison. MAIN RESULTS: The results of this review are based on data
from two studies. Two significant results were found to favour parent training
in one study: child language and maternal knowledge of autism. In the other,
intensive intervention (involving parents, but primarily delivered by
professionals) was associated with better child outcomes on direct measurement
than were found for parent-mediated early intervention, but no differences
were found in relation to measures of parent and teacher perceptions of skills
and behaviours. REVIEWER'S CONCLUSIONS: This review has little to offer in the
way of implications for practice: there were only two studies, the numbers of
participants included were small, and the two studies could not be compared
directly to one another. In terms of research, randomised controlled trials
involving large samples need to be carried out, involving both short and
long-term outcome information and full economic evaluations. Research in this
area is hampered by barriers to randomisation, such as availability of
equivalent services.
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