An evidence-based framework for determining the optimal amount of intervention for autistic children

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

About the autistic author marker

Metadata sources used for this reference

OpenAlex Crossref PubMed OpenCitations
Learn more about the sources used

Trembath, D., Waddington, H., Sulek, R., Varcin, K., Bent, C., Ashburner, J., Eapen, V., Goodall, E., Hudry, K., Silove, N., & Whitehouse, A. (2021). An evidence-based framework for determining the optimal amount of intervention for autistic children. The Lancet Child & Adolescent Health, 5(12), 896-904. https://doi.org/10.1016/s2352-4642(21)00285-6

Publication date: 20 Oct 2021 Added to AutiHub: 25 Sep 2026 Type: Article Article language: English
Publisher source (DOI) OpenAlex source

This publication is integrated into AutiHub through:

Authors

Publication authors
11
Publication authors identified as autistic
1 / 11 (9.1%)
  1. David Trembath
  2. Hannah Waddington
  3. Rhylee Sulek
  4. Kandice Varcin
  1. Catherine Bent
  2. Jill Ashburner
  3. Valsamma Eapen
  4. Emma Goodall *
  1. Kristelle Hudry
  2. Natalie Silove
  3. Andrew Whitehouse

Abstract

The provision of timely, effective, and socially valid non-pharmacological intervention is at the core of efforts to support the development of young autistic children. These efforts are intended to support children to develop skills, empower their caregivers, and lay the foundation for optimal choice, independence, and quality of life into adulthood. But what is the optimal amount of intervention? In this Viewpoint, we review current guidelines and consider evidence from an umbrella review of non-pharmacological interventions for autistic children aged up to 12 years. We show the lack of consensus on the issue, identify factors that might be relevant to consider, and present an evidence-based framework for determining the optimal amount of intervention for each child, along with recommendations for future research.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 2 Oct 2026 01:35.

Cited references
39
With a DOI
31
Without a DOI, from raw bibliography text
8
1 / 39 (2.6%) cited references include at least one author identified as autistic.
References with data to complete
4 / 39 (10.3%)
References with detected author names
35 / 39 (89.7%)
Without detected author names
4
Without a structured title
0
Without a stable identifier
8
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
163
From DOI or external metadata
163
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
64 / 163 (39.3%) names are linked to an author already present in AutiHub. 99 / 163 (60.7%) names are not yet linked.
Names linked to a person identified as autistic
2 / 163 (1.2%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 2 / 64 (3.1%). Distinct people identified as autistic: 2 / 135 (1.5%).
  1. Maria K. Makrygianni , Phil Reed (2010). A meta-analytic review of the effectiveness of behavioural early intervention programs for children with Autistic Spectrum Disorders . Research in Autism Spectrum Disorders, 4(4), 577-593. Elsevier BV.
    Type: Article DOI: 10.1016/j.rasd.2010.01.014 OpenAlex: https://openalex.org/W1974813978
    Crossref OpenAlex OpenCitations
  2. L. H. Hampton , A. P. Kaiser (2016). Intervention effects on spoken‐language outcomes for children with autism: a systematic review and meta‐analysis . Journal of Intellectual Disability Research, 60(5), 444-463. Wiley.
    Type: Article DOI: 10.1111/jir.12283 OpenAlex: https://openalex.org/W2344493661
    Crossref OpenAlex OpenCitations
  3. David L Sackett , William M C Rosenberg , J A Muir Gray , R Brian Haynes , W Scott Richardson (1996). Evidence based medicine: what it is and what it isn't . BMJ, 312(7023), 71-72. BMJ.
    Type: Article DOI: 10.1136/bmj.312.7023.71 OpenAlex: https://openalex.org/W2106952837
    Crossref OpenAlex OpenCitations
  5. Kristen Bottema-Beutel , Shannon Crowley LaPoint , Micheal Sandbank , Tiffany G. Woynaroski (2021). Research Review: Conflicts of Interest (COIs) in autism early intervention research – a meta‐analysis of COI influences on intervention effects . Journal of Child Psychology and Psychiatry, 62(1), 5-15. Wiley.
    Type: Article DOI: 10.1111/jcpp.13249 OpenAlex: https://openalex.org/W3021450028
    Crossref OpenAlex OpenCitations
  6. Nienke Peters-Scheffer , Robert Didden , Hubert Korzilius , Peter Sturmey (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with Autism Spectrum Disorders . Research in Autism Spectrum Disorders, 5(1), 60-69. Elsevier BV.
    Type: Article DOI: 10.1016/j.rasd.2010.03.011 OpenAlex: https://openalex.org/W2109128810
    Crossref OpenAlex OpenCitations
  7. Lorcan Kenny , Caroline Hattersley , Bonnie Molins , Carole Buckley , Carol Povey , Elizabeth Pellicano (2016). Which terms should be used to describe autism? Perspectives from the UK autism community . Autism, 20(4), 442-462. SAGE Publications.
    Type: Article DOI: 10.1177/1362361315588200 OpenAlex: https://openalex.org/W2227393071
    Crossref OpenAlex OpenCitations
  8. Sadiq Naveed , Ahmed Waqas , Afshan Naz Amray , Raheel Imtiaz Memon , Nisma Javed , Muhammad Annas Tahir et al. (2019). Implementation and effectiveness of non-specialist mediated interventions for children with Autism Spectrum Disorder: A systematic review and meta-analysis . PLOS ONE, 14(11), e0224362. Public Library of Science (PLoS).
    Type: Article DOI: 10.1371/journal.pone.0224362 OpenAlex: https://openalex.org/W2968065579
    Crossref OpenAlex OpenCitations
  9. Javier Virués-Ortega (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose–response meta-analysis of multiple outcomes . Clinical Psychology Review, 30(4), 387-399. Elsevier BV.
    Type: Article DOI: 10.1016/j.cpr.2010.01.008 OpenAlex: https://openalex.org/W2154650119
    Crossref OpenAlex OpenCitations
  10. Bury (2020). It defines Who I Am" or "It's Something I Have": what language do [Autistic] Australian adults [on the Autism Spectrum] prefer? J. Autism. Dev. Disord..
    Type: Other
    Crossref
  11. Layne Case , Joonkoo Yun (2019). The Effect of Different Intervention Approaches on Gross Motor Outcomes of Children With Autism Spectrum Disorder: A Meta-Analysis . Adapted Physical Activity Quarterly, 36(4), 501-526. Human Kinetics.
    Type: Article DOI: 10.1123/apaq.2018-0174 OpenAlex: https://openalex.org/W2972373461
    Crossref OpenAlex OpenCitations
  12. Micheal Sandbank , Kristen Bottema-Beutel , Shannon Crowley LaPoint , Margaret Cassidy , Kacie Dunham-Carr , Jacob I Feldman et al. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychol Bull, 146(1), 1. American Psychological Association (APA).
    Type: Article DOI: 10.1037/bul0000215 OpenAlex: https://openalex.org/W2990306783
    Crossref OpenAlex OpenCitations
  13. Brian Reichow , Erin E Barton , Brian A Boyd , Kara Hume (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD) . Cochrane Database of Systematic Reviews, 10, CD009260. Wiley.
    Type: Article DOI: 10.1002/14651858.cd009260.pub2 OpenAlex: https://openalex.org/W1624352668
    OpenCitations
  14. Hannah Waddington , Larah van der Meer , Jeff Sigafoos (2016). Effectiveness of the Early Start Denver Model: a Systematic Review . Review Journal of Autism and Developmental Disorders, 3(2), 93-106. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40489-015-0068-3 OpenAlex: https://openalex.org/W2235332310
    Crossref OpenAlex OpenCitations
  15. Whitehouse (2020). Interventions for children on the autism spectrum: a synthesis of research evidence .
    Type: Other
    Crossref
  16. Elizabeth A. Fuller , Kelsey Oliver , Sarah Vejnoska , Sally J. Rogers (2020). The Effects of the Early Start Denver Model for Children with Autism Spectrum Disorder: A Meta-Analysis . Brain Sciences, 10(6), 368. MDPI AG.
    Type: Article DOI: 10.3390/brainsci10060368 OpenAlex: https://openalex.org/W3034358705
    Crossref OpenAlex OpenCitations
  17. Elizabeth A. Fuller , Ann P. Kaiser (2020). The Effects of Early Intervention on Social Communication Outcomes for Children with Autism Spectrum Disorder: A Meta-analysis . Journal of Autism and Developmental Disorders, 50(5), 1683-1700. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-019-03927-z OpenAlex: https://openalex.org/W2916113381
    Crossref OpenAlex OpenCitations
  18. Edoardo Aromataris , Ritin Fernandez , Christina M. Godfrey , Cheryl Holly , Hanan Khalil , Patraporn Tungpunkom (2015). Summarizing systematic reviews . JBI Evidence Implementation, 13(3), 132. Ovid Technologies (Wolters Kluwer Health).
    Type: Article DOI: 10.1097/xeb.0000000000000055 OpenAlex: https://openalex.org/W2364450135
    Crossref OpenAlex OpenCitations
  19. (2001). Educating children with autism .
    Type: Other
    Crossref
  20. Simon Bury , Rachel Jellett , Jennifer R. Spoor , Darren Hedley (2023). “It Defines Who I Am” or “It’s Something I Have”: What Language Do [Autistic] Australian Adults [on the Autism Spectrum] Prefer? Journal of Autism and Developmental Disorders, 53(2), 677-687. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-020-04425-3 OpenAlex: https://openalex.org/W3007056653
    OpenCitations
  21. Katherine E. Pickard , Amanda N. Kilgore , Brooke R. Ingersoll (2016). Using Community Partnerships to Better Understand the Barriers to Using an Evidence-Based, Parent-Mediated Intervention for Autism Spectrum Disorder in a Medicaid System . American Journal of Community Psychology, 57(3-4), 391-403. Wiley.
    Type: Article DOI: 10.1002/ajcp.12050 OpenAlex: https://openalex.org/W2407932194
    Crossref OpenAlex OpenCitations
  22. (2014). Therapies for children with autism spectrum disorder: behavioral interventions update .
    Type: Other
    Crossref
  23. Rose E Nevill , Luc Lecavalier , Elizabeth A Stratis (2018). Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder . Autism, 22(2), 84-98. SAGE Publications.
    Type: Article DOI: 10.1177/1362361316677838 OpenAlex: https://openalex.org/W2550871595
    Crossref OpenAlex OpenCitations
  24. Roberts (2016). Autism Spectrum Disorder: evidence-based/evidence-informed good practice for supports provided to preschool children, their families and carers .
    Type: Other
    Crossref
  25. Gabrielle Tiede , Katherine Walton (2019). Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder . Autism, 23(8), 2080-2095. SAGE Publications.
    Type: Article DOI: 10.1177/1362361319836371 OpenAlex: https://openalex.org/W2940871774
    Crossref OpenAlex OpenCitations
  26. Joaquin Fuentes , Amaia Hervás , Patricia Howlin , (ESCAP ASD Working Party) (2021). ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment . European Child & Adolescent Psychiatry, 30(6), 961-984. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s00787-020-01587-4 OpenAlex: https://openalex.org/W3043444385
    Crossref OpenAlex OpenCitations
  27. (2016). New Zealand autism spectrum disorder guideline, 2nd edn .
    Type: Other
    Crossref
  28. Meng-Chuan Lai , Evdokia Anagnostou , Max Wiznitzer , Carrie T. Allison , Simon Baron-Cohen (2020). Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person–environment fit . Lancet Neurol., 19(5), 434. Elsevier BV.
    Type: Article DOI: 10.1016/s1474-4422(20)30034-x OpenAlex: https://openalex.org/W3009489683
    Crossref OpenAlex OpenCitations
  29. Micheal Sandbank , Kristen Bottema-Beutel , Tiffany G. Woynaroski (2021). Intervention Recommendations for Children With Autism in Light of a Changing Evidence Base . JAMA Pediatr, 175(4), 341. American Medical Association (AMA).
    Type: Article DOI: 10.1001/jamapediatrics.2020.4730 OpenAlex: https://openalex.org/W3103964371
    Crossref OpenAlex OpenCitations
  30. Jenna E. Crank , Micheal Sandbank , Kacie Dunham-Carr , Shannon Crowley LaPoint , Kristen Bottema-Beutel , Jacob I Feldman et al. (2021). Understanding the Effects of Naturalistic Developmental Behavioral Interventions: A Project AIM Meta‐analysis . Autism Research, 14(4), 817-834. Wiley.
    Type: Article DOI: 10.1002/aur.2471 OpenAlex: https://openalex.org/W3123275178
    Crossref OpenAlex OpenCitations
  31. Álvaro Bejarano‐Martín , Ricardo Canal-Bedia , María Magán-Maganto , Clara Fernández-Álvarez , Sigrídur Lóa-Jónsdóttir , Evald Saemundsen et al. (2020). Efficacy of focused social and communication intervention practices for young children with autism spectrum disorder: A meta-analysis . Early Childhood Research Quarterly, 51, 430-445. Elsevier BV.
    Type: Article DOI: 10.1016/j.ecresq.2020.01.004 OpenAlex: https://openalex.org/W3004873775
    Crossref OpenAlex OpenCitations
  32. Paul Yoder , Sally J. Rogers , Annette M. Estes , Zachary Warren , Jeff Munson , Gerhard Hellemann et al. (2020). Interaction of Treatment Intensity and Autism Severity on Frequency and Maturity of Spontaneous Communication in Toddlers with A utism Spectrum Disorder . Autism Research, 13(11), 1902-1912. Wiley.
    Type: Article DOI: 10.1002/aur.2416 OpenAlex: https://openalex.org/W3093918165
    Crossref OpenAlex OpenCitations
  33. Kristelle Hudry , Elizabeth Pellicano , Mirko Uljarevic , Andrew Whitehouse (2020). Setting the research agenda to secure the wellbeing of autistic people . The Lancet Neurology, 19(5), 374-376. Elsevier BV.
    Type: Article DOI: 10.1016/s1474-4422(20)30031-4 OpenAlex: https://openalex.org/W3010021740
    Crossref OpenAlex OpenCitations
  34. Micheal Sandbank , Kristen Bottema-Beutel , Shannon Crowley LaPoint , Margaret Cassidy , Jacob I Feldman , Marcos Canihuante et al. (2020). Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis . Journal of Speech, Language, and Hearing Research, 63(5), 1537-1560. American Speech Language Hearing Association.
    Type: Article DOI: 10.1044/2020_jslhr-19-00167 OpenAlex: https://openalex.org/W3021862202
    Crossref OpenAlex OpenCitations
  35. Gauri Divan , Supriya Bhavnani , Kathy Leadbitter , Ceri Ellis , Jayashree Dasgupta , Amina Abubakar et al. (2021). Annual Research Review: Achieving universal health coverage for young children with autism spectrum disorder in low‐ and middle‐income countries: a review of reviews . Journal of Child Psychology and Psychiatry, 62(5), 514-535. Wiley.
    Type: Article DOI: 10.1111/jcpp.13404 OpenAlex: https://openalex.org/W3157918851
    Crossref OpenAlex OpenCitations
  36. Sally J. Rogers , Paul Yoder , Annette M. Estes , Zachary Warren , John McEachin , Jeff Munson et al. (2021). A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism . Journal of the American Academy of Child & Adolescent Psychiatry, 60(6), 710-722. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaac.2020.06.013 OpenAlex: https://openalex.org/W3080547514
    Crossref OpenAlex OpenCitations
  37. Kristen Bottema-Beutel , Shannon Crowley LaPoint , Micheal Sandbank , Tiffany G. Woynaroski (2021). Adverse event reporting in intervention research for young autistic children . Autism, 25(2), 322. SAGE Publications.
    Type: Article DOI: 10.1177/1362361320965331 OpenAlex: https://openalex.org/W3093300669
    Crossref OpenAlex OpenCitations
  38. Reichow (2018). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD) . Cochrane Database Syst Rev, 10, CD009260.
    Type: Other
    Crossref
  39. (2002). Towards a common language for functioning, disability and health: the International Classification of Functioning, Disability and Health (ICF) .
    Type: Other
    Crossref