Do increased interventions benefit children with autism? | Image Credit: Contemporary Pediatrics

According to a recent study, the answer to this question is no. Investigators analyzed data from 144 studies of early childhood autism interventions related to more than 9038 children and found no significant association between intervention amounts and intervention effects. The mean age of participants was 49.3 months, and 82.6% were boys.

The analysis addressed whether increased amounts of common interventions for autism were associated with gains in any developmental domain as indicated by any of 3 measures. These measures were daily intensity (amount of intervention in hours provided within a given time frame), duration (total number of days the intervention is provided), and cumulative intensity (the total number of hours of intervention provided). The analysis focused on 4 broad intervention approaches: naturalistic developmental behavioral interventions (NDBIs), which are widely accepted for treating language-related symptoms in autism; behavioral interventions; technology-based interventions; and developmental interventions.

Compared with other intervention types, behavioral interventions tended to be studied at higher levels of daily intensity, and behavioral and developmental interventions for longer durations and higher cumulative intensity. Daily intervention intensity was not associated with significant effect sizes for any of the 4 intervention types, though technology-based interventions showed the largest positive association. Cumulative intensity, too, was not significantly associated with effectiveness for any intervention type. Not only was intervention duration not significantly associated with effects for NDBIs, behavioral interventions, and developmental interventions, but it was associated with reductions in effectiveness for technology-based interventions. This was the only statistically significant association investigators found among the 3 measures and 4 intervention approaches.

Investigators concluded that their findings do not support assertions that intervention effects increase with increased amounts of intervention in autism. They therefore advise practitioners to consider how much intervention is developmentally appropriate when they recommend interventions for autism.

Thoughts From Dr Farber

Traditionally, treatment such as applied behavior analysis was done for 40 hours per week. This study does not say that such therapies are ineffective but that such intensive courses are unnecessary. All children, including those with autism, need unstructured time in their lives for maximal benefit.

Reference:

Sandbank M, Pustejovsky JE, Bottema-Beutel K, et al. Determining associations between intervention amount and outcomes for young autistic children: a meta-analysis. JAMA Pediatr. 2024;178(8):763-773. doi:10.1001/jamapediatrics.2024.1832