Efficacy of interventions based on applied behavior analysis for autism spectrum disorder: A meta-analysis

Objective To systematically evaluate evidence for the use of interventions based on appied behavior analysis (ABA) to manage various symptoms of children with autism spectrum disorder (ASD). Methods Sensitivity analyses were conducted by removing any outlying studies and subgroup analyses were performed to compare the effectiveness of ABA and early start denver model (ESDM), picture exchange communication systems (PECS) and discrete trial training (DTT). Results 14 randomized control trials of 555 participants were included in this meta-analysis. The overall standardized mean difference was d=-0.36 (95% CI-1.31, 0.58; Z=0.75, p=0.45) for autism general symptoms, d=0.11 (95% CI-0.31, 0.54; Z=0.52, p=0.60) for social-ization, d=0.30 (95% CI-0.02, 0.61; Z=1.84, p=0.07) for communication and d=-3.52 (95% CI-6.31,-0.72; Z=2.47, p=0.01) for expressive language, d=-0.04 (95% CI-0.44, 0.36; Z=0.20, p=0.84) for receptive language. Those results suggested outcomes of socialization, communication and expressive language may be promising targets for ABA-based interventions involving children with ASD. However, significant effects for the outcomes of autism general symptoms, receptive language, adaptive behavior, daily living skills, IQ, verbal IQ, nenverbal IQ, restricted and repetitive behavior, motor and cognition were not observed. Conclusion The small number of studies included in the present study limited the ability to make inferences when comparing ABA, ESDM, PECS and DTT interventions for children with ASD. Psychiatry Investig 2020;17(5):432-443. Copyright © 2020 Korean Neuropsychiatric Association.