title: Non-specialist psychosocial interventions for children and adolescents with intellectual disability or lower-functioning autism spectrum disorders: a systematic review.
abstract: BACKGROUND
  The development of effective treatments for use by non-specialists is listed among the top research priorities for improving the lives of people with mental illness worldwide. The purpose of this review is to appraise which interventions for children with intellectual disabilities or lower-functioning autism spectrum disorders delivered by non-specialist care providers in community settings produce benefits when compared to either a no-treatment control group or treatment-as-usual comparator.
  
  
  RESULTS
  We systematically searched electronic databases through 24 June 2013 to locate prospective controlled studies of psychosocial interventions delivered by non-specialist providers to children with intellectual disabilities or lower-functioning autism spectrum disorders. We screened 234 full papers, of which 34 articles describing 29 studies involving 1,305 participants were included. A majority of the studies included children exclusively with a diagnosis of lower-functioning autism spectrum disorders (15 of 29, 52%). Fifteen of twenty-nine studies (52%) were randomized controlled trials and just under half of all effect sizes (29 of 59, 49%) were greater than 0.50, of which 18 (62%) were statistically significant. For behavior analytic interventions, the best outcomes were shown for development and daily skills; cognitive rehabilitation, training, and support interventions were found to be most effective for improving developmental outcomes, and parent training interventions to be most effective for improving developmental, behavioral, and family outcomes. We also conducted additional subgroup analyses using harvest plots. Limitations include the studies' potential for performance bias and that few were conducted in lower- and middle-income countries.
  
  
  CONCLUSIONS
  The findings of this review support the delivery of psychosocial interventions by non-specialist providers to children who have intellectual disabilities or lower-functioning autism spectrum disorders. Given the scarcity of specialists in many low-resource settings, including many lower- and middle-income countries, these findings may provide guidance for scale-up efforts for improving outcomes for children with developmental disorders or lower-functioning autism spectrum disorders.
  
  
  BACKGROUND
  PROSPERO CRD42012002641
authors.affiliation: Yale Child Study Center, New Haven, Connecticut, United States of America ; University of Connecticut Health Center, Farmington, Connecticut, United States of America.
authors.forename: Brian
authors.initials: B
authors.lastname: Reichow
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Chiara
authors.initials: C
authors.lastname: Servili
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: M Taghi
authors.initials: MT
authors.lastname: Yasamy
authors.affiliation: WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Barbui
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000628:therapy*; D006801:Humans; D008607:Intellectual Disability / Q000628:therapy*