{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T01:27:52Z","timestamp":1786498072766,"version":"build-2736575974"},"posted":{"date-parts":[[2026,8,10]]},"group-title":"Psychiatry and Clinical Psychology","reference-count":203,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,8,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the positive and adverse effects of parent-mediated interventions (PMIs) versus care as usual for children with autism.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Systematic review and meta-analysis and Trial Sequential Analyses (TSA), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched for randomised clinical trials of PMIs for children with autism in the databases CENTRAL, EMBASE, LILACS, PsycINFO, MEDLINE, and SCI-EXPANDED (up to 13 August, 2025), complemented with manual searches. 12,359 articles were screened. Data were synthesised using meta-analyses and Trial Sequential Analyses (TSA), and risks of bias and certainty of the evidence were evaluated.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>The primary outcome was autism characteristics. Secondary outcomes were adverse effects, child adaptive functioning, child language, child and parent quality of life, and parental stress. Ten exploratory outcomes were included.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    32 trials (N=1,625) comparing PMIs to usual care, waiting list, or no intervention were included. All trials had a high risk of bias. The multiplicity-adjusted threshold for statistical significance was\n                    <jats:italic>p<\/jats:italic>\n                    = 0.013 due to the number of outcomes. Meta-analyses and TSAs showed it could be rejected that PMIs reduced autism characteristics (MD = \u22120.88; 95% confidence interval \u22122.92 to 1.15;\n                    <jats:italic>p<\/jats:italic>\n                    = 0.05, 4 trials,\n                    <jats:italic>N<\/jats:italic>\n                    =353, low certainty), child adaptive functioning (7 trials,\n                    <jats:italic>N<\/jats:italic>\n                    =408), child language (4 trials,\n                    <jats:italic>N<\/jats:italic>\n                    =308), or parental stress (7 trials,\n                    <jats:italic>N<\/jats:italic>\n                    =385). Due to insufficient data, the remaining secondary meta-analyses could not be conducted. Meta-analyses of exploratory outcomes showed beneficial effects concerning child behaviour problems and parent sensitivity\/synchronicity.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This meta-analysis found no benefits of PMIs on child autism characteristics, child adaptive functioning, child language, or parental stress. Benefits were found in reduction of child behaviour problems and improved parent sensitivity\/synchronicity. The evidence remains uncertain, and more trials including outcomes of adverse effects and quality of life are needed.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Trial registration<\/jats:title>\n                  <jats:p>\n                    CRD42022385188\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42022385188\">PROSPERO<\/jats:ext-link>\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.08.06.26357818","type":"posted-content","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:00:19Z","timestamp":1786374019000},"source":"Crossref","is-referenced-by-count":0,"title":["Parent-mediated interventions versus usual care in children with autism: A systematic review with meta-analysis and Trial Sequential Analysis"],"prefix":"10.64898","author":[{"given":"Charlotte Engberg","family":"Conrad","sequence":"first","affiliation":[{"name":"Psychiatry, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2113-2080","authenticated-orcid":false,"given":"Sonja Martha Teresa","family":"Ziegler","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Southern Denmark, Odense University Hospital, Region of Southern Denmark"},{"name":"Research Unit of Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Bilenberg","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Southern Denmark, Odense University Hospital, Region of Southern Denmark"},{"name":"Research Unit of Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Master International A\/S, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirstine Agnete","family":"Davidsen","sequence":"additional","affiliation":[{"name":"Research Unit of Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Psychology, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitte","family":"Fagerlund","sequence":"additional","affiliation":[{"name":"Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark"},{"name":"Department of Psychology, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"F\u00e6rk","sequence":"additional","affiliation":[{"name":"Psychiatry, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Psychiatry, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikke Hermann","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Jeppesen","sequence":"additional","affiliation":[{"name":"Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark"},{"name":"Research Unit, Department of Child and Adolescent Psychiatry, Copenhagen University 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Hove","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon","family":"Varenne","sequence":"additional","affiliation":[{"name":"Research Unit, Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Copenhagen, Copenhagen, Denmark"},{"name":"Research Unit, Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region 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