Caregiver skills training for caregivers of individuals with neurodevelopmental disorders: A systematic review and meta-analysis.

AIM: To systematically review the effectiveness of caregiver and parent skills training programs, including caregiver-mediated interventions, for caregivers of individuals with neurodevelopmental disorders. METHOD: We conducted a systematic review with a random-effects meta-analysis. We searched 11 electronic databases through July 2021 and used a snowball methodology to locate relevant articles of randomized controlled trials. Effect size estimates were pooled using Hedges' g from data extracted from study reports and through author requests using random-effects meta-analyses for three child outcome categories (child development, adaptive behavior, and problem behavior) and three caregiver outcome categories (parenting skills and knowledge, psychological well-being, and interpersonal family relations). RESULTS: We located 44 910 records, from which 75 randomized controlled trials involving 4746 individuals with neurodevelopmental disorders and their caregivers were included. Random-effects meta-analyses showed improvements in child development (g = 0.30; 99% confidence interval [CI] = 0.07-0.53) and reduction in reported problem behaviors (g = 0.41; 99% CI = 0.24-0.59), but not a statistically significant improvement in adaptive behavior (g = 0.28; 99% CI = -0.42 to 0.98). Caregivers showed improvements in parenting skills and knowledge (g = 0.72; 99% CI = 0.53-0.90), psychological well-being (g = 0.52; 99% CI = 0.34-0.71), and interpersonal family relations (g = 0.76; 99% CI = 0.32-1.20). INTERPRETATION: Caregiver skills training programs benefit both caregivers and children with neurodevelopmental disorders. Skills training programs improve child development and behavior, improve parenting skills, reduce caregiver mental health issues, and improve family functioning. Programs using culturally appropriate training material to improve the development, functioning, and participation of children within families and communities should be considered when caring for children with neurodevelopmental disorders.

Beginning reading interventions for children and adolescents with intellectual disability.

BACKGROUND: Historically, students with intellectual disability were not expected to learn to read, and thus were excluded from reading instruction. Over the past decades, societal expectations for this group of learners have changed in that children and adolescents with intellectual disability are now expected to be provided with, and benefit from, literacy instruction. This shift in societal expectations has also led to an increase in research examining effective interventions for increasing beginning reading skills for students with intellectual disability. OBJECTIVES: To assess the effectiveness of interventions for teaching beginning reading skills to children and adolescents with intellectual disability. SEARCH METHODS: We searched the following electronic databases up to October 2019: CENTRAL; MEDLINE, including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase, 13 other databases, and two trials registers. We contacted authors of included studies, examined reference lists, and used Google Scholar to search for additional studies. SELECTION CRITERIA: We included randomized controlled trials (including trials that use quasi-random methods of allocation such as date of birth), involving children and adolescents with intellectual disability (defined as an intelligence quotient (IQ) two standard deviations or more below the population mean) between the ages of 4 and 21 years, that evaluated the efficacy of a beginning reading intervention compared to a control intervention, including no treatment control, wait-list control, treatment as usual, attention control, or alternate non-reading instruction control. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts yielded by the search against the inclusion criteria, and extracted data from each trial using a piloted data extraction form to collect information about the population, intervention, randomization methods, blinding, sample size, outcome measures, follow-up duration, attrition and handling of missing data, and methods of analysis. When data were missing, one review author contacted the study authors to request additional information. Two review authors assessed the risk of bias of each included study and rated the quality of the evidence using the GRADE approach (a systematic method for rating the certainty of evidence in meta-analyses). We conducted random-effect meta-analyses, with inverse-variance weighting to combine effect sizes for each of our primary and secondary outcomes. We presented effect sizes as standardized mean differences (SMD) with 95% confidence intervals (CI). MAIN RESULTS: We identified seven studies involving 352 children and adolescents with intellectual disabilities that met the inclusion criteria. All studies provided the intervention in school settings. Four studies were conducted in the USA, one in Canada, and two in the UK. Three studies were funded by grants from the US Department of Education, Institute of Education Sciences; one study by the Canadian Language and Literacy Research Network and the Nova Scotia Health Research Foundation; and three studies did not indicate a funding source. We identified some concerns with risk of bias, mainly due to the difficulty of blinding of participants and personnel, and the lack of blinding of outcome assessors. Meta-analyses of the data demonstrated small-to-moderate effects of beginning reading interventions delivered to children and adolescents with intellectual disability across four dependent variables. We found medium effect sizes in favor of the beginning reading interventions for the primary outcomes of phonologic awareness (SMD 0.55, 95% CI 0.23 to 0.86; 4 studies, 178 participants; moderate-quality evidence), word reading (SMD 0.54, 95% CI 0.05 to 1.03; 5 studies, 220 participants; moderate-quality evidence), and decoding (SMD 0.40, 95% CI 0.12 to 0.67; 5 studies, 230 participants; low-quality evidence). The studies reported no adverse events. We also found a moderate effect for the secondary outcomes of oral reading fluency (SMD 0.65, 95% CI -0.12 to 1.42; 2 studies, 84 participants; low-quality evidence) and language skills (SMD 0.28, 95% CI 0.03 to 0.54; 3 studies, 222 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS: Results from this review provide evidence that beginning reading interventions that include elements of phonologic awareness, letter sound instruction, and decoding, delivered to children and adolescents with intellectual disability, are associated with small-to-moderate improvements in phonologic awareness, word reading, decoding, expressive and receptive language, and oral reading fluency. These findings are aligned with previously conducted studies that examined the effects of reading interventions for people without intellectual disability.

Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).

BACKGROUND: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorders. Early intensive behavioral intervention (EIBI) is a treatment based on the principles of applied behavior analysis. Delivered for multiple years at an intensity of 20 to 40 hours per week, it is one of the more well-established treatments for ASD. This is an update of a Cochrane review last published in 2012. OBJECTIVES: To systematically review the evidence for the effectiveness of EIBI in increasing functional behaviors and skills, decreasing autism severity, and improving intelligence and communication skills for young children with ASD. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 12 additional electronic databases and two trials registers in August 2017. We also checked references and contacted study authors to identify additional studies. SELECTION CRITERIA: Randomized control trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.We synthesized the results of the five studies using a random-effects model of meta-analysis, with a mean difference (MD) effect size for outcomes assessed on identical scales, and a standardized mean difference (SMD) effect size (Hedges' g) with small sample correction for outcomes measured on different scales. We rated the quality of the evidence using the GRADE approach. MAIN RESULTS: We included five studies (one RCT and four CCTs) with a total of 219 children: 116 children in the EIBI groups and 103 children in the generic, special education services groups. The age of the children ranged between 30.2 months and 42.5 months. Three of the five studies were conducted in the USA and two in the UK, with a treatment duration of 24 months to 36 months. All studies used a treatment-as-usual comparison group.Primary outcomesThere is low quality-evidence at post-treatment that EIBI improves adaptive behaviour (MD 9.58 (assessed using Vineland Adaptive Behavior Scale (VABS) Composite; normative mean = 100, normative SD = 15), 95% confidence interval (CI) 5.57 to 13.60, P < 0.0001; 5 studies, 202 participants), and reduces autism symptom severity (SMD -0.34, 95% CI -0.79 to 0.11, P = 0.14; 2 studies, 81 participants; lower values indicate positive effects) compared to treatment as usual.No adverse effects were reported across studies.Secondary outcomesThere is low-quality evidence at post-treatment that EIBI improves IQ (MD 15.44 (assessed using standardized IQ tests; scale 0 to 100, normative SD = 15), 95% CI 9.29 to 21.59, P < 0.001; 5 studies, 202 participants); expressive (SMD 0.51, 95% CI 0.12 to 0.90, P = 0.01; 4 studies, 165 participants) and receptive (SMD 0.55, 95% CI 0.23 to 0.87, P = 0.001; 4 studies, 164 participants) language skills; and problem behaviour (SMD -0.58, 95% CI -1.24 to 0.07, P = 0.08; 2 studies, 67 participants) compared to treatment as usual. AUTHORS' CONCLUSIONS: There is weak evidence that EIBI may be an effective behavioral treatment for some children with ASD; the strength of the evidence in this review is limited because it mostly comes from small studies that are not of the optimum design. Due to the inclusion of non-randomized studies, there is a high risk of bias and we rated the overall quality of evidence as 'low' or 'very low' using the GRADE system, meaning further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.It is important that providers of EIBI are aware of the current evidence and use clinical decision-making guidelines, such as seeking the family's input and drawing upon prior clinical experience, when making recommendations to clients on the use EIBI. Additional studies using rigorous research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.

A comprehensive survey of current and former college students with autism spectrum disorders.

BACKGROUND: There is a paucity of research concerning individuals with autism spectrum disorders (ASD) pursuing higher education. METHOD: This study sought to augment this gap in the literature by surveying individuals with ASD who are currently college students or who have previously attended college. RESULTS: Thirty-five individuals completed an online survey. These individuals reported receiving extensive academic supports that enabled their academic success. Their reported difficulties in the social and emotional domains received less support. In addition, not all areas of campus life were supportive, as study abroad and career service offices were reported to not understand individuals with ASD. CONCLUSIONS: Overall, the results of this survey indicate the importance of self-advocacy and the need for institutions of higher education to provide comprehensive supports for individuals with ASD in the academic, social, and emotional domains in order to effectively integrate this group into the campus environment.

Overview of Meta-Analyses on Naturalistic Developmental Behavioral Interventions for Children with Autism Spectrum Disorder.

We conducted an overview of reviews to determine the effects of naturalistic developmental behavioral interventions (NDBIs; Schreibman et al. (2015) J Autism Dev Disorders 45:2411-2428) on children with autism spectrum disorder under 8 years old. We conducted an electronic database search of Academic Search Premier, CINHAL, ERIC, Medline, and APA PsycINFO in October 2022 and August 2023 and utilized snowball methods to locate relevant reviews of NDBI. We included reviews meeting the following inclusion criteria: (1) review included a meta-analytic synthesis for at least one child outcome; (2) primary studies examined a NDBI; (3) primary studies included children with ASD with a mean pre-treatment age under eight years; (4) primary studies were conducted using a two-group comparison design; and (5) review was published in English. We extracted data on characteristics of the review, participant characteristics from the primary studies, intervention characteristics, and assessed the risk of bias of the included reviews. We conducted a narrative synthesis across outcomes reported in the included reviews. We included five reviews from six reports in this overview. Two reviews included studies that examined the Early Start Denver Model, two reviews included studies that examined the Pivotal Response Treatment, and one review included studies examining NDBIs collectively. We found positive effects of NDBIs on child's communication/language, cognition, and adaptive behavior. We found mixed effects for NDBIs on autism symptomatology and restricted and repetitive behaviors. Examination of moderator analyses reported in the included reviews suggested variables influencing the effects of NDBIs included proximity of outcome to intervention, boundedness of outcome to intervention, and study location. As shown in this overview, positive effects of NDBI for young children with ASD are supported by meta-analytic evidence. While the overall findings for NDBI across reviews are positive, the findings on specific outcomes and influential variables moderating the effects of NDBI are inconsistent. Additional evidence from randomized controlled trials and future meta-analyses are needed to strengthen our knowledge of the effects of NDBI for young children with ASD.Protocol Registration: PROSPERO CRD42022353045.

A systematic review of the measurement properties of the Family Empowerment Scale.

PURPOSE: To systematically review and evaluate existing psychometric evidence for the Family Empowerment Scale (FES), which has been widely used to measure empowerment across the world. METHODS: Three databases were searched up until December 2021. Eligible studies were identified by an interdisciplinary team using the PRISMA procedure. The methodological quality of psychometrics (Risk of Bias standards) and sufficiency of each psychometric property (e.g., reliability, content validity, construct validity, responsiveness) were independently evaluated by three members, following COnsesus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS: Twelve studies involving 3278 caregivers were included in the review. Studies reported limited information about content validity and study sample characteristics. There is sufficient evidence with moderate methodological quality to support structural validity for a four and three-bifactor structure. Sufficient evidence with good methodological quality was found for internal consistency. No studies examined responsiveness. CONCLUSIONS: Future psychometric studies of the FES should include diverse families and establish content validity following current COSMIN standards. Structural validity evidence does not support the original three-factor structure, which suggests the need to refine the theoretical measurement constructs. Responsiveness is needed prior to using FES as an instrument of change in applied research studies.Implications for RehabilitationThe evidence for the use of the Family Empowerment Scale (FES) is primarily with families of children with disabilities who identify as white, non-Hispanic, and live in the US.Across studies, evidence suggests the FES items work well together to measure family empowerment.Caution should be used when using the FES to measure changes in empowerment over time.

Non-specialist psychosocial interventions for children and adolescents with intellectual disability or lower-functioning autism spectrum disorders: a systematic review.

BACKGROUND: The development of effective treatments for use by non-specialists is listed among the top research priorities for improving the lives of people with mental illness worldwide. The purpose of this review is to appraise which interventions for children with intellectual disabilities or lower-functioning autism spectrum disorders delivered by non-specialist care providers in community settings produce benefits when compared to either a no-treatment control group or treatment-as-usual comparator. METHODS AND FINDINGS: We systematically searched electronic databases through 24 June 2013 to locate prospective controlled studies of psychosocial interventions delivered by non-specialist providers to children with intellectual disabilities or lower-functioning autism spectrum disorders. We screened 234 full papers, of which 34 articles describing 29 studies involving 1,305 participants were included. A majority of the studies included children exclusively with a diagnosis of lower-functioning autism spectrum disorders (15 of 29, 52%). Fifteen of twenty-nine studies (52%) were randomized controlled trials and just under half of all effect sizes (29 of 59, 49%) were greater than 0.50, of which 18 (62%) were statistically significant. For behavior analytic interventions, the best outcomes were shown for development and daily skills; cognitive rehabilitation, training, and support interventions were found to be most effective for improving developmental outcomes, and parent training interventions to be most effective for improving developmental, behavioral, and family outcomes. We also conducted additional subgroup analyses using harvest plots. Limitations include the studies' potential for performance bias and that few were conducted in lower- and middle-income countries. CONCLUSIONS: The findings of this review support the delivery of psychosocial interventions by non-specialist providers to children who have intellectual disabilities or lower-functioning autism spectrum disorders. Given the scarcity of specialists in many low-resource settings, including many lower- and middle-income countries, these findings may provide guidance for scale-up efforts for improving outcomes for children with developmental disorders or lower-functioning autism spectrum disorders. PROTOCOL REGISTRATION: PROSPERO CRD42012002641

Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD).

BACKGROUND: Since autism was first described, major difficulties in social interaction have been a defining feature of individuals with autism spectrum disorders (ASD). Social skills groups are a common intervention for individuals with ASD. Although a frequently recommended practice, the few studies that have addressed the efficacy of social skills groups have shown mixed results. OBJECTIVES: To determine the effectiveness of social skills groups for improving social competence, social communication, and quality of life for people with ASD who are six to 21 years of age. SEARCH METHODS: We searched the following databases in December 2011: CENTRAL (2011 Issue 4), MEDLINE (1948 to November Week 3, 2011), EMBASE (1980 to Week 50, 2011), PsycINFO (1887 to December Week 2, 2011), CINAHL (1937 to current), ERIC (1966 to current), Sociological Abstracts (1952 to current), OCLC WorldCat (12 December 2011), Social Science Citation Index (1970 to 16 December 2011), and the metaRegister of Controlled Trials (20 December 2011). We also searched the reference lists of published papers. SELECTION CRITERIA: Randomized control trials (RCTs) comparing treatment (social skills groups) with a control group who were not receiving the treatment for participants aged six to 21 years with ASD. The control group could be no intervention, wait list, or treatment as usual. Outcomes sought were standardized measures of social competence, social communication, quality of life, emotion recognition, and any other specific behaviors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected and appraised studies for inclusion and assessed the risk of bias in each included study. All outcome data were continuous and standardized mean difference effect sizes (ES) with small sample correction were calculated. We conducted random-effects meta-analysis where possible. MAIN RESULTS: We included five RCTs evaluating the effects of social skills groups in 196 participants with ASD aged 6 to 21 years old. The results show there is some evidence that social skills groups improve overall social competence (ES = 0.47, 95% confidence interval (CI) 0.16 to 0.78, P = 0.003) and friendship quality (ES = 0.41, 95% CI 0.02 to 0.81, P = 0.04) for this population. No differences were found between treatment and control groups in relation to emotional recognition (ES = 0.34, 95% CI -0.20 to 0.88, P = 0.21) assessed in two studies or social communication as related to the understanding of idioms (ES = 0.05, 95% CI -0.63 to 0.72, P = 0.89), which was assessed in only one study. Two additional quality of life outcomes were evaluated, with results of single studies suggesting decreases in loneliness (ES = -0.66, 95% CI -1.15 to -0.17) but no effect on child or parental depression. No adverse events were reported.Given the nature of the intervention and the selected outcome measures, the risk of performance and detection bias are high. There is limited generalizability from the studies as they were all conducted in the US; they focused mainly on children aged 7 to 12, and the participants were all of average or above average intelligence. AUTHORS' CONCLUSIONS: There is some evidence that social skills groups can improve social competence for some children and adolescents with ASD. More research is needed to draw more robust conclusions, especially with respect to improvements in quality of life.

Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).

BACKGROUND: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorder. Early intensive behavioral intervention (EIBI), a treatment based on the principles of applied behavior analysis delivered for multiple years at an intensity of 20 to 40 hours per week, is one of the more well-established treatments for ASD. OBJECTIVES: To systematically review the evidence for the effectiveness of EIBI in increasing the functional behaviors and skills of young children with ASD. SEARCH METHODS: We searched the following databases on 22 November 2011: CENTRAL (2011 Issue 4), MEDLINE (1948 to November Week 2, 2011), EMBASE (1980 to Week 46, 2011), PsycINFO (1806 to November Week 3, 2011), CINAHL (1937 to current), ERIC (1966 to current), Sociological Abstracts (1952 to current), Social Science Citation Index (1970 to current), WorldCat, metaRegister of Controlled Trials, and Networked Digital Library of Theses and Dissertations. We also searched the reference lists of published papers. SELECTION CRITERIA: Randomized control trials (RCTs), quasi-randomized control trials, or clinical control trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. DATA COLLECTION AND ANALYSIS: Two authors independently selected and appraised studies for inclusion and assessed the risk of bias in each included study. All outcome data were continuous, from which standardized mean difference effect sizes with small sample correction were calculated. We conducted random-effects meta-analysis where possible, which means we assumed individual studies would provide different estimates of treatment effects. MAIN RESULTS: One RCT and four CCTs with a total of 203 participants were included. Reliance on synthesis from four CCTs limits the evidential base and this should be borne in mind when interpreting the results. All studies used a treatment-as-usual comparison group. We synthesized the results of the four CCTs using a random-effects model of meta-analysis of the standardized mean differences. Positive effects in favor of the EIBI treatment group were found for all outcomes. The mean effect size for adaptive behavior was g = 0.69 (95% CI 0.38 to 1.01; P < 0.0001). The mean effect size for IQ was g = 0.76 (95% CI 0.40 to 1.11; P < 0.0001). Three measures of communication and language skills all showed results in favor of EIBI: expressive language g = 0.50 (95% CI 0.05 to 0.95; P = 0.03), receptive language g = 0.57 (95% CI 0.20 to 0.94; P = .03), and daily communication skills g = 0.74 (95% CI 0.30 to 1.18; P = 0.0009). The mean effect size for socialization was g = 0.42 (95% CI 0.11 to 0.73; P = 0.0008), and for daily living skills was g = 0.55 (95% CI 0.24 to 0.87; P = 0.0005). Additional descriptive analyses of other aspects related to quality of life and psychopathology are presented. However, due to the inclusion of non-randomized studies, there is a high risk of bias and the overall quality of evidence was rated as 'low' using the GRADE system, which rates the quality of evidence from meta-analyses to determine recommendations for practice. AUTHORS' CONCLUSIONS: There is some evidence that EIBI is an effective behavioral treatment for some children with ASD. However, the current state of the evidence is limited because of the reliance on data from non-randomized studies (CCTs) due to the lack of RCTs. Additional studies using RCT research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.

A Meta-Analytic Review of Randomized Controlled Trials of the Good Behavior Game.

The Good Behavior Game (GBG) is widely recognized as an evidence-based intervention that reinforces prosocial behaviors and discourages disruptive behaviors among students in the classroom setting. The current meta-analysis synthesized randomized controlled trials of the GBG to examine its impact on proximal student outcomes across seven studies representing 4,700 children. Although recent reviews focusing on single-case studies of the GBG have reported moderate to large treatment effects, our results were quite modest in comparison (hedges' g = 0.09-0.32). Treatment effect sizes also varied according to outcome and sex. The GBG significantly outperformed the comparison conditions for peer-rated conduct problems and shy/withdrawn behavior as well as teacher-rated conduct problems for which a greater effect was found for girls relative to boys. Moreover, the treatment effect in favor of the GBG for reading comprehension was specific to boys and not girls. No significant differences were found between the GBG and comparison conditions for inattention and teacher-rated shy/withdrawn behavior. These results suggest that the GBG may not be as impactful as originally reported and the intended population and treatment targets should be considered before its implementation in the classroom.

A Systematic Review of Caregiver-Implemented Functional Analyses.

The purpose of this systematic review was to systematically locate and analyze the research on caregiver-implemented functional analyses and subsequent function-based interventions. We included 36 studies and examined multiple features of the studies, including participant demographics, functional analysis characteristics, intervention characteristics, procedural fidelity, risks of bias, and social validity. Overall, the studies showed that caregivers were able to implement functional analyses that yielded differential responding, although few studies reported procedural fidelity data. Caregivers were also able to implement function-based interventions that led to socially significant changes in challenging behavior. Implications for practice and future research are discussed.

Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model.

A 3-part comprehensive synthesis of the early intensive behavioral intervention (EIBI) for young children with autism based on the University of California at Los Angeles Young Autism Project method (Lovaas in Journal of Consulting and Clinical Psychology, 55, 3-9, 1987) is presented. The three components of the synthesis were: (a) descriptive analyses, (b) effect size analyses, and (c) a meta-analysis. The findings suggest EIBI is an effective treatment, on average, for children with autism. The conditions under which this finding applies and the limitations and cautions that must be taken when interpreting the results are discussed within the contextual findings of the moderator analyses conducted in the meta-analysis.

Development of the WHO Caregiver Skills Training Program for Developmental Disorders or Delays.

Globally, 52.9 million children under the age of 5 experience a developmental disability, such as sensory impairment, intellectual disability, and autism spectrum disorders. Of these 95% live in low-and-middle-income countries. Most of these children lack access to care. In light of the growing evidence that caregivers can learn skills to support their children's social communication and adaptive behavior and to reduce their challenging behavior, the World Health Organization developed a novel Caregiver Skills Training Program (CST) for families of children with developmental disorders or delay to address such treatment gap. This report outlines the development process, content, and global field-testing strategy of the WHO CST program. The CST program is designed to be feasible, scalable, and adaptable and appropriate for implementation in low-resource settings by nonspecialists. The program was informed by an evidence review utilizing a common elements approach and was developed through extensive stakeholder consultation and an iterative revision process. The program is intended for a global audience and was designed to be adapted to the cultural, socioeconomic, geographic, and resource context in which it is used to ensure that it is comprehensible, acceptable, feasible, and relevant to target users. It is currently undergoing field-testing in more than 30 countries across all world regions.

Development of the evaluative method for evaluating and determining evidence-based practices in autism.

Although research in autism has grown more sophisticated, the gap between research knowledge and applicability of research in real world settings has grown. There have been a number of different reviews of evidence-based practices of treatments for young children with autism. Reviews which have critically evaluated the empirical evidence have not found any treatments that can be considered evidence-based. Reasons for this shortcoming are explored, and a new method for the evaluation of empirical evidence is provided. Future uses of this evaluative method are provided as well as a discussion of how this tool might aid in narrowing the research to practice gap.

Development and applications of the single-case design risk of bias tool for evaluating single-case design research study reports.

Systematic reviews and meta-analyses can be a useful method for synthesizing evidence across multiple studies to draw conclusions about a research base. An important aspect of rigorous systematic reviews is an assessment of the study methods and potential biases impacting results or interpretations and conclusions of the primary studies. Single-case design (SCD) research has been a primary mechanism for identifying evidence-based practices across disciplines, but primarily in behavioral fields and special education. While the Cochrane Risk of Bias tool has been adapted for use in reviews of non-randomized studies, there is currently no guidance for evaluating SCD research. Hence, we developed a single case design risk of bias tool (SCD RoB) based on current conceptualizations of biases that might affect the validity of claims from single-case design research. We used the Cochrane risk of bias criteria and contemporary single-case design quality indicators and design standards to guide development. We describe the SCD RoB tool and two early applications of its use to demonstrate its application and provide initial validation. We also provide an overview of future areas of research using the SCD RoB tool in an effort to advance the science of single-case design research methods.

Between-case standardized effect size analysis of single case designs: Examination of the two methods.

An increasing movement in single case research is to employ statistical analyses as one form of data analysis. Researchers have proposed different statistical approaches. The purpose of this paper is to examine the utility and discriminant validity of two novel types of between-case standardized effect size analyses with two existing systematic reviews. The between-case analyses found greater effect sizes for the studies in the object play review and smaller effect sizes for studies of sensory intervention, which were consistent with the overall conclusions reached in the original systematic reviews. These findings provide evidence of discriminant validity, although concerns remain around the methods' utility across different single case research designs. Future directions for research and development also are provided.

Meta-analysis of organizational skills interventions for children and adolescents with Attention-Deficit/Hyperactivity Disorder.

BACKGROUND: In addition to problems with attention and hyperactivity, children with ADHD present with poor organizational skills required for managing time and materials in academic projects. Organizational skills training (OST) has been increasingly used to address these deficits. We conducted a systematic review and meta-analysis of OST in children with ADHD. OBJECTIVES: The objective of this study was to systematically review the evidence of the effects of OST for children with ADHD for organizational skills, attention, and academic performance. METHODS: We searched 3 electronic databases to locate randomized controlled trials published in English in peer-reviewed journals comparing OST with parent education, treatment-as-usual, or waitlist control conditions. Standardized mean difference effect sizes from the studies were statistically combined using a random-effects meta-analyses across six outcomes: teacher- and parent-rated organizational skills, teacher- and parent-rated inattention, teacher-rated academic performance, and Grade Point Average (GPA). Risk of bias was assessed for randomization, allocation concealment, blinding of participants and treatment personnel, blinding of outcome assessors, incomplete outcome data, and selective outcome reporting. RESULTS: Twelve studies involving 1054 children (576 treatment, 478 control) were included in the meta-analyses. Weighted mean effect sizes for teacher- and parent-rated outcome measures of organizational skills were g=0.54 (95% CI 0.17 to 0.91) and g=0.83 (95% CI 0.32 to 1.34), respectively. Weighted mean effect sizes of teacher- and parent-rated symptoms of inattention were g=0.26 (95% CI 0.01 to 0.52) and g=0.56 (95% CI 0.38 to 0.74), respectively. Weighted standardized mean effect size for teacher-rated academic performance and GPA were g=0.33 (95% CI 0.14 to 0.51) and g=0.29 (95% CI 0.07 to 0.51), respectively. CONCLUSIONS: OST leads to moderate improvements in organizational skills of children with ADHD as rated by teachers and large improvements as rated by parents. More modest improvements were observed on the ratings of symptoms of inattention and academic performance. PROTOCOL REGISTRATION: PROSPERO (CRD42015019261).

The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review.

A growing body of research has raised concerns about the number of individuals diagnosed with autism spectrum disorder (ASD) according to DSM-IV-TR who may no longer qualify for diagnoses under the new DSM-5 criteria, published in May 2013. The current study systematically reviews 25 articles evaluating samples according to both DSM-IV-TR and DSM-5 ASD criteria. Consistent with previous reviews, the majority of included studies indicated between 50 and 75% of individuals will maintain diagnoses. We conducted visual analyses of subgroups using harvest plots and found the greatest decreases among high-functioning populations with IQs over 70 and/or previous diagnoses of PDD-NOS or Asperger's disorder. We discuss the potential research and clinical implications of reduced numbers of individuals diagnosed with ASD.

A systematic review of sensory-based treatments for children with disabilities.

Sensory-based therapies are designed to address sensory processing difficulties by helping to organize and control the regulation of environmental sensory inputs. These treatments are increasingly popular, particularly with children with behavioral and developmental disabilities. However, empirical support for sensory-based treatments is limited. The purpose of this review was to conduct a comprehensive and methodologically sound evaluation of the efficacy of sensory-based treatments for children with disabilities. Methods for this review were registered with PROSPERO (CRD42012003243). Thirty studies involving 856 participants met our inclusion criteria and were included in this review. Considerable heterogeneity was noted across studies in implementation, measurement, and study rigor. The research on sensory-based treatments is limited due to insubstantial treatment outcomes, weak experimental designs, or high risk of bias. Although many people use and advocate for the use of sensory-based treatments and there is a substantial empirical literature on sensory-based treatments for children with disabilities, insufficient evidence exists to support their use.

Brief report: systematic review of Rett syndrome in males.

Rett syndrome (RTT) is a neurogenetic disorder in which a period of typical development is followed by loss of previously acquired skills. Once thought to occur exclusively in females, increasing numbers of male cases of RTT have been reported. This systematic review included 36 articles describing 57 cases of RTT in males. Mutations of the MECP2 gene were present in 56 % of cases, and 68 % of cases reported other genetic abnormalities. This is the first review of published reports of RTT in male patients.