Interventions to improve language skills in people diagnosed with autism: a systematic review and network meta-analysis

Research question What is the best intervention to improve language skills in autistic people?

Background Autism Spectrum Disorder (henceforth, autism) is characterised by difficulties in social communication and interaction, alongside restricted and repetitive patterns of behaviour, interests, or activities. At least 1% of people in UK have autism. Approximately one in four autistic people speak few or no words.

Even autistic people with fluent language often find it difficult to adapt their communication to different environments.

The impact of language difficulties on autistic people is significant (e.g., regarding employment, social disadvantage, mental health) and the lifetime cost for supporting autistic people is between £0.9-1.5 million.

Identifying interventions that improve the language skills of autistic people is a top research priority (Autistica, 2015).

Yet there is currently no network meta-analysis of interventions to determine which are best at improving the language skills of autistic people.

Objectives Primary objective To compare the relative benefits and harms of different interventions designed to improve language skills in autistic people using a systematic review and network meta-analysis.

Secondary objective To determine alignment of the evidence with the priorities of the autism community; and to identify evidence gaps.

Methods We will perform a systematic literature review of MEDLINE, EMBASE, Cochrane library, PsycINFO, CINAHL Plus, Science Citation Index as well as trial registers.

Two autistic researchers will independently screen the search results, identify relevant randomised controlled trials (RCTs), and extract data.

We will perform separate network meta-analyses based on age and speech impairment, because some interventions may be given to all groups of autistic people, but others are specifically given to certain groups (e.g., AAC is largely for those with impaired speech).

We will perform a network meta-analysis if similar types of participants were included in trials comparing different interventions.

We will present the results of the systematic review to members of the autism community (autistic people, parents and professionals who support them) through an online survey and/or in face-to-face or virtual focus groups, to develop recommendations for future research in the area of language interventions amongst autistic people.

Research timetable (all timelines from start of grant) 1.Ready to perform systematic review (pre-award) 2.Protocol finalised, study screening: 3 months 3.Data collection and data analysis completed: 15 months 4.Survey completed: 21 months 5.Interpretation (including advisory group meetings), and final report (Study complete): 24 months Anticipated impact and dissemination The identification of priority areas for research, to address evidence gaps, will be the major impact from this project.

As language is one of the strongest predictors of long-term outcomes for autistic people, such research has the potential to impact significantly on the lives of autistic people (e.g., reducing mental health difficulties and promoting employment prospects).

We will disseminate the findings to policymakers, healthcare and education networks, NICE, the NHS, relevant Royal colleges (e.g., Royal College of Speech and Language Therapists), commissioners, and other relevant stakeholders by working with the UK autism research charity Autistica and via journal publications, conferences and social media.