Title: Interventions to improve language skills in people diagnosed with autism: a systematic review and network meta-analysis
Funder: Department of Health and Social Care

Abstract: 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 &pound;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.

Lay abstract: At least 1% of people in UK have autism; a lifelong condition that affects how people experience the world and interact with others. Many autistic people struggle with language and about a quarter speak few or no words. Even autistic people who speak fluently often find it difficult to adapt the way they communicate to different situations. There are many different interventions that aim to improve the language skills of autistic people. However, there is uncertainty about which interventions yield long term improvements in language (speaking and understanding). Finding out which interventions are effective is important, as language skills in early childhood are a good predictor of how well people will fare later in life. The autism community (autistic people, their families, and the professionals who support them) jointly identified research on improving language skills in autism as an important research priority. In our research, we will review different interventions designed to improve language skills in autistic people. We will thoroughly search for published and unpublished randomised controlled trials (RCTs) on this issue (a systematic review ). RCTs provide the best information about how well an intervention works, when conducted well. Existing high-quality systematic reviews compare only two interventions at a time. We will use advanced methods that allow us to compare many different interventions at the same time (a network meta-analysis ). We will present the research findings to the autism community to find out how well the research evidence aligns with the views and priorities of these groups through surveys and focus group meetings. This is important, as there is often a mismatch between the research that is carried out, and the research that the autism community want to see carried out. We will use the information from our research and consultations to develop recommendations for future research. Central to this application is the involvement of the autism community: the application is co-led by an autistic researcher and parent of an autistic child; autism professionals (including a speech and language therapist, clinical psychologist, and charity director) were involved in this proposal (one of whom has an autism diagnosis); and members of the autism community (including two autistic research assistants) will be involved in collecting data, overseeing the project, and sharing the results of the research. We will publish written reports, present at conferences, and work with policymakers, clinics and schools to share the findings.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.7 PHYSICAL
Health categories: MENTAL HEALTH