Parent-Mediated Interventions in Infants at Risk of Autism Specturm Disorder: A Neuropsychiatric Systematic Review and Meta-Analysis
L. Kade, H. B. NeedhamIntroduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterised by social communication deficits. The diagnosis, treatment and ASD research focuses on children >24 months, though risk is detectable in infancy. Parent-mediated interventions (PMIs) promote early social and cognitive development, but the impact during infancy remains unexplored. This systematic review and meta-analysis found PMIs delivered to high-risk infants (<15 months) can improve early social communication and modestly reduce symptom severity, potentially influencing developmental trajectories.
Objectives
Analyse PMI effectiveness in high-risk infants ≤15 months.
Examine PMI as an early neuropsychiatric intervention, exploring the neurobiological mechanisms behind its effects and limitations.
Evaluate the feasibility of PMI within local healthcare settings, and pre-existing 12-15 month national paediatric health visitor pathways.
Methods
The review followed PRISMA guidelines. Databases searched included Medline, COCHRANE, Scopus, APA PsycINFO, and PubMed (last search February 2025). Risk of bias was assessed using RoB 2.0 and the Newcastle-Ottawa Scale. Studies evaluating PMI efficacy in high-risk infants ≤15 months were included, exclusion criteria were participants >15 months or no consideration of PMI efficacy. A random-effects meta-analysis was conducted.
Results
Of 259 studies screened, nine randomised-controlled trials and longitudinal studies (n = 247 infants) met inclusion criteria. PMIs produced moderate-to-large improvements in social communication and parent–child engagement, pooled effect size (Hedges’ g = 0.58, 95% CI 0.53–0.63, p = 0.001). Significant improvements occurred in social engagement (g = 0.44, p = 0.002) and joint attention (g = 0.66, p = 0.001). PMI modestly reduced ASD symptom severity (g = –0.12, p = 0.011), with effects peaking at 16–20 weeks of intervention. Therapist-supported models (iBASIS-VIPP) showed the greatest impact (SMD = 0.51), followed by hybrid (0.42) and self-directed (0.32) formats; adherence was highest with therapist-led delivery (78%). Remote models demonstrated sustained but smaller benefits. Overall, findings highlight promising, early improvements in social communication and engagement, an area where meaningful shifts in diagnostic outcomes remain rare.
Conclusions
Despite small samples, lack of RCTs, and limited long-term data, this review suggests PMIs are a promising neuropsychiatric intervention for high-risk ASD infants (≤15 months). Evidence indicates PMIs can improve early social development, communication, and quality of life while reducing later psychiatric risk and ASD symptom severity. PMIs mark a shift in autism care; early intervention uses proactive and personalised neuropsychiatric care rooted in neuroscience. Future studies should assess long-term outcomes, optimal duration, cost-effectiveness, and feasibility.
Disclosure of Interest
None Declared