Moderators of School Intervention Outcomes for Children with Autism Spectrum Disorder

A Systematic Review of Implicit Versus Explicit Social Skills Group Programs in Different Settings for School-Aged Autistic Children and Adolescents

This systematic review and meta-analysis aimed to identify and evaluate the quality of randomised controlled trials (RCTs), assessing the efficacy of Social Skills Group Programs (SSGPs) for primary and secondary school aged autistic children and adolescents exploring the influence of informant, setting characteristics and teaching strategies as moderating factors for social outcomes. A search of the electronic databases of Medline, ProQuest, CINAHL, Scopus, and Web of Sciences electronic databases was conducted for the period January 1, 2013 until December 31, 2023 for peer-reviewed RCT studies published in English, evaluating the efficacy of SSGPs for school-aged autistic children and adolescents (6-18 years). Included studies were assessed for methodological quality and efficacy using random effect meta-analysis. Informant analysis and moderator analyses were also conducted investigating the influence of informant, setting characteristics and teaching strategy utilised in the SSGPs on the participants social outcomes. Sixty-five studies were included in the systematic review with 49 studies included in the meta-analysis. Although most studies had strong or good methodological quality, a high possibility of publication bias was detected in the meta-analysis. After statistical adjustments for publication bias were made, findings revealed that SSGPs had no effect on the overall outcomes assessed by included studies on school-aged autistic children and adolescents. However, informant analysis revealed small effects reported by self-report, parent-proxy and researchers. Teaching strategies and setting characteristics were not significant moderators for the efficacy of SSGPs on the social outcomes of autistic children and adolescents. This review highlights the need for improvements in measurement frameworks for assessing social skills in autistic children and adolescents.

Beyond group differences: Exploring the preliminary signals of target engagement of an executive function training for autistic children

Understanding both for whom and how interventions work is a crucial next step in providing personalized care to children with autism spectrum disorder (ASD). Autistic children present with heterogeneity both within core ASD criteria and with respect to co‐occurring mental health challenges, which may affect their ability to benefit from intervention. In a secondary data analysis of a randomized control trial evaluating an executive function (EF) training with 70 7‐ to 11‐year‐old autistic children, we explored: (1) whether co‐occurring attention‐deficit/hyperactivity disorder (ADHD) features or anxiety features at baseline moderated the extent to which children benefited from the EF training. In other words, we asked, “For whom is training effective?” We also explored: (2) the extent to which changes in a brain‐based measure of target engagement predicted the clinical outcomes of the EF training. This is a step towards asking, “How is training effective?” We found that EF training improved behavioral inhibition only for children with clinically significant co‐occurring ADHD features. Anxiety features, while prevalent, did not moderate EF training efficacy. Finally, for the EF training group only, there was a significant correlation between pre‐to‐post change in an EEG‐based measure of target engagement, N2 incongruent amplitude during a flanker task, and change in repetitive behaviors, a behavioral outcome that was reported in the parent RCT to have improved with training compared to waitlist control. This study provides preliminary evidence that EF training may differentially affect subgroups of autistic children and that changes at the neural level may precede changes in behavior.