Recently, studies on behavioral interventions for autism have gained popularity. Naturalistic Developmental Behavior Interventions (NDBIs) are among the most effective, evidence-based, and widely used behavior interventions for autism. However, no research has been conducted on which of the several NDBI methods is most effective for parents and children with autism spectrum disorders. Therefore, we conducted a network meta-analysis to compare the specific effects of each type of parental-mediated NDBI on children's developmental skills and parent fidelity.
PubMed, Embase, Cochrane Library, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), CINAHL, and Wanfang databases were searched from inception to August 30, 2023. A total of 32 randomized controlled trial studies that examined the efficacy of different NDBIs were included.
Parents of children with ASD who received Pivotal Response Treatment (PRT) reported significant improvements in their children's social skills (SUCRA, 74.1%), language skills (SUCRA, 88.3%), and parenting fidelity (SUCRA, 99.5%). Moreover, parents who received Early Start Denver Model (ESDM) reported significant improvements in their children's language (SMD = 0.41, 95% CI: 0.04, 0.79) and motor skills (SMD = 0.44, 95% CI: 0.09, 0.79). In terms of the efficacy of improving parent fidelity, the results showed that the Improving Parents as Communication Teachers (ImPACT) intervention significantly improved parent fidelity when compared with the treatment-as-usual group (TAU) (SMD = 0.90, 95% CI: 0.39, 1.42) and the parental education intervention (PEI) (SMD = 1.10, 95% CI:0.28, 1.91).There was a difference in parent fidelity among parents who received PRT(SMD = 3.53, 95% CI: 2.26, 4.79) or ESDM(SMD = 1.42, 95% CI: 0.76, 2.09) training compared with PEI.
In conclusion, this study revealed that parents can achieve high fidelity with the ImPACT intervention, and it can serve as an early first step for children newly diagnosed with ASD. It also showed that parent-mediated ESDM is effective in improving language and motor skills for children with ASD and can be used as part of the second stage of parent training. Parent-mediated PRT can also be used as a third stage of parent training with sufficient training intensity to further improve language, social, and motor skills.

Comparison of the efficacy of parent-mediated NDBIs on developmental skills in children with ASD and fidelity in parents: a systematic review and network meta-analysis.

The crucial constraint in the broiler production sector is feed efficiency; many feed additives have been widely employed to increase broiler growth. Nonetheless, some of these substances exacerbate health and animal-based food product safety concerns. This meta-analysis examines the effect of clay minerals on alkaline phosphatase (ALP), broiler health, and performance. Metadata was constructed from 369 data items that were harvested from 86 studies. The addition of clay minerals was set as a fixed effect and the difference between experiments was established as a random effect. The metadata were fitted using a linear mixed model. Due to the presence of clay minerals, growth performance as assessed by body weight (BW), average daily gain (ADG), and performance efficiency index (PEI) increased significantly (P < 0.01). In the total period, the increases of BW, ADG, and PEI were 4.12 g, 0.0714 g/d, and 0.648, respectively, per unit of clay minerals added. Clay minerals did not affect blood serum parameters (e.g., ALP and calcium). The IgA and IgM concentrations in the jejunum and ileum were significantly greater (P < 0.01) in the starter phase. Among clay minerals, broilers fed diets with aluminosilicate, halloysite, kaolin, and zeolite consistently exhibited higher (P < 0.05) BW, ADG, PEI, and lower feed conversion ratio (P < 0.05) in the finisher phase. Aluminosilicate was the only clay that increased (P < 0.05) secretory IgA concentration in both jejunum and ileum. In conclusion, clay minerals could be used as a growth promoter, especially during the finisher phase, without adversely affecting feed intake, liver function, and mineral metabolism in broiler chickens. Aluminosilicate was superior in improving the mucosal immunity status of broiler chickens.

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