RESUMO
Culturally responsive interventions for autistic children and their families have been developed and implemented to address issues related to limited representation, inequities, and disparities in access to care of minoritized families in research. Currently available reviews are relatively limited in scope or do not synthesize interventions specifically. Therefore, we conducted a meta-analysis to synthesize autism intervention literature that specifically targeted autistic individuals and their family members from minoritized backgrounds, such as immigrant families. We used four databases to identify studies that used culturally responsive interventions with minoritized autistic children and their families. An article was included if it included empirical intervention data using an experimental design. A total of 354 studies were initially screened, and 24 studies were included. Effect sizes of these studies were extracted across two levels (i.e., child and family levels). Data from group design studies were extracted manually, and data from single-case design studies were extracted using a web-based tool. We used design-comparable standardized effect sizes to compare across both designs. The analysis revealed a large, positive, and significant overall effect size across culturally responsive interventions. Specifically, social-communication and mental health outcomes yielded significant effects at the child level. Additionally, parents' mental health and fidelity of strategy implementation also yielded significant results. Our results suggest that culturally responsive interventions yield comparable outcomes to unadapted, original interventions. Future research should examine the distinction between the effect of cultural adaptation and the efficacy of the intervention itself.
RESUMO
BACKGROUND: Identification of ASD biomarkers is a key priority for understanding etiology, facilitating early diagnosis, monitoring developmental trajectories, and targeting treatment efforts. Efforts have included exploration of resting state encephalography (EEG), which has a variety of relevant neurodevelopmental correlates and can be collected with minimal burden. However, EEG biomarkers may not be equally valid across the autism spectrum, as ASD is strikingly heterogeneous and individual differences may moderate EEG-behavior associations. Biological sex is a particularly important potential moderator, as females with ASD appear to differ from males with ASD in important ways that may influence biomarker accuracy. METHODS: We examined effects of biological sex, age, and ASD diagnosis on resting state EEG among a large, sex-balanced sample of youth with (N = 142, 43% female) and without (N = 138, 49% female) ASD collected across four research sites. Absolute power was extracted across five frequency bands and nine brain regions, and effects of sex, age, and diagnosis were analyzed using mixed-effects linear regression models. Exploratory partial correlations were computed to examine EEG-behavior associations in ASD, with emphasis on possible sex differences in associations. RESULTS: Decreased EEG power across multiple frequencies was associated with female sex and older age. Youth with ASD displayed decreased alpha power relative to peers without ASD, suggesting increased neural activation during rest. Associations between EEG and behavior varied by sex. Whereas power across various frequencies correlated with social skills, nonverbal IQ, and repetitive behavior for males with ASD, no such associations were observed for females with ASD. CONCLUSIONS: Research using EEG as a possible ASD biomarker must consider individual differences among participants, as these features influence baseline EEG measures and moderate associations between EEG and important behavioral outcomes. Failure to consider factors such as biological sex in such research risks defining biomarkers that misrepresent females with ASD, hindering understanding of the neurobiology, development, and intervention response of this important population.
