1.31 IMPLEMENTATION AND EFFECTIVENESS OF NON-SPECIALIST MEDIATED INTERVENTIONS FOR CHILDREN WITH ASD: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives: The task shifting of ASD to nonspecialist-mediated interventions has been suggested as a cost-effective way to ensure accessible care for all populations. This meta-analysis rates the quality of evidence presented in a RCT assessing the effectiveness of nonspecialist-mediated interventions for ASD. Methods: Eight electronic databases were searched for the RCT of nonspecialized mediated interventions for youth with a clinical diagnosis of ASD and no restrictions on age, gender, language, socioeconomic status, or time period. The quality of studies was assessed using the Cochrane tool. The meta-analytical data were rated for quality using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. The outcomes included in the meta-analysis were those reported in ≥2 studies. Heterogeneity was defined at a cutoff value of ≥40 percent and was based on its extent; data were pooled together with fixed or random effects. For outcomes reported in ≥10 studies, a meta-regression analysis established potential moderators of intervention effects. Results: We selected 33 RCTs for our predetermined eligibility criteria. With various interventions used, there was a significant improvement in communication, motor and social skills, and the parent-child relationship. The Cochrane tool revealed a low risk of bias among the studies. According to GRADE criteria, the ratings varied from very low to high. There were notably high ratings for communication, language and motor skills, moderate ratings for adaptive behaviors, the severity of symptoms, receptive language, social skills, and improvement in the parent-child relationship. The analysis revealed no impact of varying density of dosages on the effectiveness of interventions. Methodological heterogeneity was found because of differences in diagnosis criteria, study strategies, and intervention mediators, which is considered an important limitation. Conclusions: The meta-analysis showed that the interventions given by nonspecialists were effective across varying outcomes, improved the parent-child relationship, and lowered stress for parents. This analysis favors the implementation of nonspecialist-mediated interventions for youth with ASD in a cost-effective manner