The Intensity and Duration of Autism Interventions Do Not Predict Efficacy

Increased amounts of autism interventions do not translate to increased intervention efficacy, according to meta-analysis study findings published in JAMA Pediatrics. Accordingly, existing evidence does not support the provision of intensive autism interventions.

Currently, health care professionals and clinicians regularly recommend intensive interventions for the treatment of autism spectrum disorder (ASD). These interventions often consist of treatment sessions provided for 20 to 40 hours per week and are recommended for at least 2 to 3 years. However, the evidence supporting the presumption that increased interventions yield increased treatment effects is sparse and lack robust methodology. Therefore, investigators conducted a meta-analysis to determine if the amount of intervention provided to children with ASD is associated with improved developmental outcomes.

The investigators used data from a previous meta-analysis which included randomized clinical trials or quasi-experimental trials published before November 2021 that evaluated autism interventions among children who were 8 years of age or younger. The primary predictor of interest was intervention amount, quantified according to daily intensity, duration, and cumulative intensity. The primary outcomes of interest were gains in any developmental domain, measured via Hedges g effect sizes. Outcomes related to sleep, sensory, brain imaging, and academic outcome domains were excluded.

A total of 144 were included in the present analysis, with a pooled sample of 9038 children. The participants had a mean (SD) age of 49.3 (17.2) months and 82.6% were boys. The investigators were able to determine intervention duration in 97% of the included studies, but daily intensity and cumulative intensity were derived for less than two-thirds of the studies.

After controlling for study design, risk for detection bias, age of participants, outcome proximity, and outcome domain, the investigators observed no significant association between any measure of intervention amount and intervention effect size.

The largest positive association between the daily intensity of autism interventions and developmental outcomes was observed for technology-based interventions (β=0.10; 95% CI, -0.09 to 0.29), but the association did not reach significance (P =.27). In contrast, intervention duration was negatively associated with intervention effects for technology-based interventions (β= -0.12;95% CI, -0.22 to -0.02; P =.03).

“There is not robust evidence that the benefits of early childhood interventions to young autistic children increase when those interventions are intensified,” the investigators concluded. “Health professionals recommending interventions should be advised that there is little robust evidence supporting the provision of intensive intervention.”

Study limitations include the heterogeneity across studies, the lack of data for some measures, and the lack of differentiation between caregiver-mediated intervention hours and clinician-delivered intervention hours.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor