A Systematic Literature Review and Meta-Analysis on the Effectiveness of Parent-Mediated Intervention in Child with Autism Spectrum Disorder
Article Sidebar
Main Article Content
Abstract
Objective: This study aimed to investigate the characteristics and effectiveness of parent-mediated intervention programs for children with Autism Spectrum Disorder (ASD).
Methods: A comprehensive search was conducted across major databases, including PubMed, Embase, CENTRAL, and Thai Journals Online (ThaiJO), as well as thesis collection databases such as ProQuest, EBSCO, and ThaiLIS. The search covered the period from January 1946 to December 2024. The PICO framework (Population: ASD children; Intervention: parent-mediated; Comparison: randomized controlled trial; Outcome: in children OR in parents) guided the systematic literature review. Inclusion criteria were English or Thai randomized controlled trials (RCTs) evaluating the effects of programs for autistic children with parental involvement (comprising therapists, parents, and children) in children under 18 years old diagnosed with ASD. The quality of the included studies was assessed by two independent researchers using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2); disagreements were resolved by a third researcher. Data were analyzed using descriptive statistics (percentage, frequency, mean) to characterize the programs. Meta-analysis was performed for outcomes within the same groups, with results displayed using forest plots and effect sizes calculated as standardized mean differences (SMD).
Results: Out of 1,866 initial studies, 18 met the inclusion criteria. Of these, 11 had a high risk of bias, 4 had a medium risk of bias, and 3 had a low risk of bias. A total of 12 distinct program characteristics were identified. Most programs involved 12 sessions, with each session lasting 90 minutes. For children, parent-mediated interventions showed effectiveness in improving behavior (SMD 1.33; 95% CI [0.84, 1.83]) and social skills (SMD 0.68; 95% CI [0.50, 0.87]). However, these interventions were not effective for general development (SMD 0.19; 95% CI [-0.16, 0.55]) or language and communication (SMD 0.09; 95% CI [-0.10, 0.27]). For parents, effectiveness was observed in terms of knowledge and ability (SMD 0.54; 95% CI [0.02, 1.06]; p=0.04), but not for mental health (SMD 0.21; 95% CI [-0.10, 0.52]) or parent-child interaction (SMD -0.09; 95% CI [-0.59, 0.42]).
Conclusion: This study indicates that parent-mediated programs for children with ASD are effective in improving children’s behavior and social skills. Furthermore, these programs enhance parents’ knowledge and abilities.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles submitted for consideration must not have been previously published or accepted for publication in any other journal, and must not be under review by any other journal.
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Washington DC: American Psychiatric Association; 2013.
Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, et al. Global prevalence of autism: A systematic review update. Autism Res 2022;15(5):778-90.
Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry 2011;68(11):1095-102.
Taylor MJ, Rosenqvist MA, Larsson H, Gillberg C, D'Onofrio BM, Lichtenstein P, et al. Etiology of autism spectrum disorders and autistic traits over time. JAMA Psychiatry 2020;77(9):936-43.
Iadarola S, Levato L, Harrison B, Smith T, Lecavalier L, Johnson C, et al. Teaching parents behavioral strategies for autism spectrum disorder (ASD): Effects on stress, strain, and competence. J Autism Dev Disord 2018;48(4):1031-40.
Rao PA, Beidel DC. The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning. Behav Modif 2009;33(4):437-51.
Mackler JS, Kelleher RT, Shanahan L, Calkins SD, Keane SP, O'Brien M. Parenting stress, parental reactions, and externalizing behavior from ages 4 to 10. J Marriage Fam 2015;77(2):388-406.
Maneerat T, Jenjaivit P, Ruechurak P, Kabklang P, Srisuruk P, Hanhak P. Promoting family quality of life of family who have individual with autism in Khon Kaen province through social skill training program. JKKPHO 2020;2(1):107-24.
Phoasavasdi C. Autistic spectrum disorder [Internet]. Rajanukul Institute [cited 2025 Mar 27]. Available from: https://th.rajanukul.go.th/academic/academics-data/mdg/1/381.
Hickey EJ, Hartley SL, Papp L. Psychological well-being and parent-child relationship quality in relation to child autism: An actor-partner modeling approach. Fam Process 2020;59(2):636-50.
Raina P, O'Donnell M, Rosenbaum P, Brehaut J, Walter SD, Russell D, et al. The health and well-being of caregivers of children with cerebral palsy. Pediatric. 2005;115(6):e626-36.
Hayes SA, Watson SL. The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. J Autism Dev Disord 2013;43(3):629-42.
Barroso NE, Mendez L, Graziano PA, Bagner DM. Parenting stress through the lens of different clinical groups: a systematic review & meta-analysis. J Abnorm Child Psycho 2018;46(3):449-61.
Sirirutraykha T. Autism Spectrum Disorder [Internet]. HAPPY HOME ACADEMY. [cited 2022]. Available from: https://www.happyhomeclinic.com/au02-autism.htm.
National Professional Development Center on ASD. Parent-Implemented Intervention Module. [cited 2009 May 29]. Available from: https://autisminternetmodules.org/storage/ocali-ims-sites/ocali-ims-aim/documents/ParentImplementedInterventionOverview.pdf.
Glenn E, Taiwo A, Arbuckle S, Riehl H, McIntyre L. Self-directed web-based parent-mediated interventions for autistic children: A systematic review. Review Journal of Autism and Developmental Disorders 2022;10.
Ogourtsova T, O'Donnell M, De Souza Silva W, Majnemer A. Health coaching for parents of children with developmental disabilities: a systematic review. Dev Med Child Neurol 2019;61(11):1259-65.
Singsawat N, Pulom N, Lopbumrung K, Phasooktoy K. The effects of parental involvement programs on promoting knowledge, parental attitudes, and the fine motor development in preschool children. J Health Sci BCNSP [internet]. 2023 Dec. 26 [cited 2025 Aug. 19];7(3):106-18. available from: https://he01.tci-thaijo.org/index.php/bcnsp/article/view/265911.
Higgins JPT TJ CJ, Cumpston M, Li T, Page MJ, Welch VA. Chapter 8: Assessing risk of bias in a randomized trial: Cochrane 2023. Available from: https://training.cochrane.org/handbook/current/chapter-08.
Solomon M, Ono M, Timmer S, Goodlin-Jones B. The effectiveness of parent-child interaction therapy for families of children on the autism spectrum. J Autism Dev Disord. 2008;38(9):1767-76.
Pajareya K, Nopmaneejumruslers K. A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism 2011;15(5):563-77.
Pajareya K, Nopmaneejumruslers K. A one-year prospective follow-up study of a DIR/Floortime parent training intervention for pre-school children with autistic spectrum disorders. J Med Assoc Thai 2012;95(9):1184-93.
Kosasena U, Yuniband J. Effects of play therapy with family involvement on social, intellectual, and language development of autistic children. The journal of Psychiatric Nursing and Mental Health 2013;27(3):125-37.
Reitzel J, Summers J, Lorv B, Szatmari P, Zwaigenbaum L, Georgiades S, et al. Pilot randomized controlled trial of a Functional Behavior Skills Training program for young children with Autism Spectrum Disorder who have significant early learning skill impairments and their families. Research in Autism Spectrum Disorders 2013;7(11):1418-32.
Siller M, Hutman T, Sigman M. A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: a randomized clinical trial. J Autism Dev Disord. 2013;43(3):540-55.
Siller M, Swanson M, Gerber A, Hutman T, Sigman M. A parent-mediated intervention that targets responsive parental behaviors increases attachment behaviors in children with ASD: results from a randomized clinical trial. J Autism Dev Disord 2014;44(7):1720-32.
Solomon R, Van Egeren LA, Mahoney G, Quon Huber MS, Zimmerman P. PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial. J Dev Behav Pediatr. 2014;35(8):475-85.
Kasari C, Siller M, Huynh LN, Shih W, Swanson M, Hellemann GS, et al. Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behav Dev 2014;37(4):711-21.
Stadnick NA, Stahmer A, Brookman-Frazee L. Preliminary Effectiveness of Project ImPACT: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program. J Autism Dev Disord. 2015;45(7):2092-104.
Kasari C, Gulsrud A, Paparella T, Hellemann G, Berry K. Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. J Consult Clin Psychol 2015;83(3):554-63.
Salisbury C, Woods J, Snyder P, Moddelmog K, Mawdsley H, Romano M, et al. Caregiver and provider experiences with coaching and embedded intervention. Topics in Early Childhood Special Education 2017;38:027112141770803.
Siller M, Hotez E, Swanson M, Delavenne A, Hutman T, Sigman M. Parent coaching increases the parents’ capacity for reflection and self-evaluation: results from a clinical trial in autism. Attachment & Human Development. 2018;20(3):287-308.
Beaudoin AJ, Sébire G, Couture M. Parent-mediated intervention tends to improve parent-child engagement, and behavioral outcomes of toddlers with ASD-positive screening: A randomized crossover trial. Research in Autism Spectrum Disorders 2019;66:101416.
Phaengphomma N, Yunibhand J, Upasen R. The effect of behavior therapy with family involvement on aggressive behavior of autistic children. The journal of Psychiatric Nursing and Mental Health. 2019;33(2):91-104.
Yoder PJ, Stone WL, Edmunds SR. Parent utilization of ImPACT intervention strategies is a mediator of proximal then distal social communication outcomes in younger siblings of children with ASD. Autism 2021;25(1):44-57.
Allen K, Harrington J, Quetsch LB, Masse J, Cooke C, Paulson JF. Parent-child interaction therapy for children with disruptive behaviors and autism: A randomized clinical trial. J Autism Dev Disord 2023;53(1):390-404.
Liu G, Chen Y, Ou P, Huang L, Qian Q, Wang Y, et al. Effects of Parent-Child Sandplay Therapy for preschool children with autism spectrum disorder and their mothers: A randomized controlled trial. J Pediatr Nurs 2023;71:6-13.
Oono IP, Honey EJ, McConachie H. Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2013(4):Cd009774.
McConachie H, Diggle T. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. J Eval Clin Pract 2007;13(1):120-9.
Liu Q, Hsieh WY, Chen G. A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan. Autism 2020;24(8):1960-79.
Cheng WM, Smith T, Butler M, Taylor T, Clayton D. Effects of parent-implemented interventions on outcomes of children with autism: A meta-analysis. Journal of Autism and Developmental Disorders 2022;53.
Ilias K, Cornish K, Kummar AS, Park MS, Golden KJ. Parenting stress and resilience in parents of children with autism spectrum disorder (ASD) in Southeast Asia: A systematic review. Front Psychol 2018;9:280.
Buchwald K, Shepherd D, Siegert RJ, Vignes M, Landon J. Factors predicting parenting stress in the autism spectrum disorder context: A network analysis approach. PLoS One 2025;20:e0319036
Koly KN, Martin-Herz SP, Islam MS, Sharmin N, Blencowe H, Naheed A. Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review. PLoS One 2021;16(3):e0247432.
