Background: The development of effective treatments for use by non-specialists is listed among the top research prioritiesfor improving the lives of people with mental illness worldwide. The purpose of this review is to appraise whichinterventions for children with intellectual disabilities or lower-functioning autism spectrum disorders delivered by nonspecialistcare providers in community settings produce benefits when compared to either a no-treatment control group ortreatment-as-usual comparator.Methods and Findings: We systematically searched electronic databases through 24 June 2013 to locate prospectivecontrolled studies of psychosocial interventions delivered by non-specialist providers to children with intellectual disabilitiesor lower-functioning autism spectrum disorders. We screened 234 full papers, of which 34 articles describing 29 studiesinvolving 1,305 participants were included. A majority of the studies included children exclusively with a diagnosis of lowerfunctioningautism spectrum disorders (15 of 29, 52%). Fifteen of twenty-nine studies (52%) were randomized controlledtrials and just under half of all effect sizes (29 of 59, 49%) were greater than 0.50, of which 18 (62%) were statisticallysignificant. For behavior analytic interventions, the best outcomes were shown for development and daily skills; cognitiverehabilitation, 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. Wealso conducted additional subgroup analyses using harvest plots. Limitations include the studies’ potential for performancebias 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 tochildren who have intellectual disabilities or lower-functioning autism spectrum disorders. Given the scarcity of specialists inmany low-resource settings, including many lower- and middle-income countries, these findings may provide guidance forscale-up efforts for improving outcomes for children with developmental disorders or lower-functioning autism spectrumdisorders.
Non-Specialist Psychosocial Interventions for Children and Adolescents with Intellectual Disability or Lower-Functioning Autism Spectrum Disorders: A Systematic Review
BARBUI, Corrado;
2013-01-01
Abstract
Background: The development of effective treatments for use by non-specialists is listed among the top research prioritiesfor improving the lives of people with mental illness worldwide. The purpose of this review is to appraise whichinterventions for children with intellectual disabilities or lower-functioning autism spectrum disorders delivered by nonspecialistcare providers in community settings produce benefits when compared to either a no-treatment control group ortreatment-as-usual comparator.Methods and Findings: We systematically searched electronic databases through 24 June 2013 to locate prospectivecontrolled studies of psychosocial interventions delivered by non-specialist providers to children with intellectual disabilitiesor lower-functioning autism spectrum disorders. We screened 234 full papers, of which 34 articles describing 29 studiesinvolving 1,305 participants were included. A majority of the studies included children exclusively with a diagnosis of lowerfunctioningautism spectrum disorders (15 of 29, 52%). Fifteen of twenty-nine studies (52%) were randomized controlledtrials and just under half of all effect sizes (29 of 59, 49%) were greater than 0.50, of which 18 (62%) were statisticallysignificant. For behavior analytic interventions, the best outcomes were shown for development and daily skills; cognitiverehabilitation, 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. Wealso conducted additional subgroup analyses using harvest plots. Limitations include the studies’ potential for performancebias 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 tochildren who have intellectual disabilities or lower-functioning autism spectrum disorders. Given the scarcity of specialists inmany low-resource settings, including many lower- and middle-income countries, these findings may provide guidance forscale-up efforts for improving outcomes for children with developmental disorders or lower-functioning autism spectrumdisorders.
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