JMIR Publications

ABSTRACT

Background:

The prevalence of certain neurodevelopmental disorders (NDDs), specifically autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), has been increasing over the last four decades. Non-pharmacological interventions are available which can improve outcomes and reduce associated symptoms such as anxiety but these are often difficult to access. Children and young people (CYP) are using the internet and digital technology at higher rates than any other demographic, but although online interventions have potential to improve health outcomes in CYP with long-term conditions, no previous reviews have investigated the effectiveness of online intervention delivered to CYP with NDDs.

Objective:

To review the effectiveness of randomized controlled trials (RCTs) of online interventions delivered to CYP with NDDs.

Methods:

Six databases and one trial register were searched in August-September 2018. RCTs were included if they were published in a peer-reviewed journal and consisted of an experimental group compared to a control group. Interventions were included if they (1) aimed to improve the diagnostic symptomology of the targeted NDD as measured by a valid and reliable outcome measure, (2) delivered online via a website, mobile application (“app”), social media, email, or personal digital assistant (PDA), (3) targeted at a youth population (age ≤18 years old or studies that reported a mean age of ≤18 years old) with a diagnosis or suspected diagnosis of a NDD. Secondary outcomes of interest were comorbid psychological symptomology and any adverse events. Methodological quality was rated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for RCTs.

Results:

Of 5140 studies retrieved, 10 fulfilled inclusion criteria. Half of the interventions were delivered to CYP with autism spectrum disorders (ASD) with the other five targeting attention-deficit/hyperactivity disorder (ADHD), tic disorders (TD), dyscalculia, and specific learning disorder. Six of the ten trials found that the online intervention was effective in improving condition specific outcomes or reducing comorbid psychological symptoms in CYP. The four trials that failed to find an effect were all delivered by apps. The meta-analysis was conducted on five of the trials and did not show a significant effect, with a high level of heterogeneity detected (n=182, 5 RCTs, pooled standardized mean difference (SMD) -0.39, CI -0.98 to 0.20, Z=-1.29, P=.19 (I2 = 72%, P=.006).

Conclusions:

Online interventions can be effective in reducing symptoms in CYP with NDDs; however, caution should be taken when interpreting these findings due to methodological limitations and small samples of included studies. Overall, the number of studies was small and mainly limited to ASD, thus restricting the generalizability of the findings. Clinical Trial: PROSPERO International Prospective Register of Systematic Reviews: CRD42018108824: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108824 (Archived by WebCite at http://www.webcitation.org/75QCXb6Qx)