The Effectiveness of Web-Based Interventions Delivered to Children and Young People With Neurodevelopmental Disorders: Systematic Review and Meta-Analysis

Background The prevalence of certain neurodevelopmental disorders, specifically autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), has been increasing over the last four decades. Nonpharmacological interventions are available that can improve outcomes and reduce associated symptoms such as anxiety, but these are often difficult to access. Children and young people are using the internet and digital technology at higher rates than any other demographic, but although Web-based interventions have the potential to improve health outcomes in those with long-term conditions, no previous reviews have investigated the effectiveness of Web-based interventions delivered to children and young people with neurodevelopmental disorders. Objective This study aimed to review the effectiveness of randomized controlled trials (RCTs) of Web-based interventions delivered to children and young people with neurodevelopmental disorders. Methods Six databases and one trial register were searched in August and September 2018. RCTs were included if they were published in a peer-reviewed journal. Interventions were included if they (1) aimed to improve the diagnostic symptomology of the targeted neurodevelopmental disorder or associated psychological symptoms as measured by a valid and reliable outcome measure; (2) were delivered on the Web; (3) targeted a youth population (aged ≤18 years or reported a mean age of ≤18 years) with a diagnosis or suspected diagnosis of a neurodevelopmental disorder. Methodological quality was rated using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Results Of 5140 studies retrieved, 10 fulfilled the inclusion criteria. Half of the interventions were delivered to children and young people with ASDs with the other five targeting ADHD, tic disorder, dyscalculia, and specific learning disorder. In total, 6 of the 10 trials found that a Web-based intervention was effective in improving condition-specific outcomes or reducing comorbid psychological symptoms in children and young people. The 4 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 [33.4%, 182/545], 5 RCTs; pooled standardized mean difference=–0.39; 95% CI –0.98 to 0.20; Z=–1.29; P=.19 [I2=72%; P=.006]). Conclusions Web-based interventions can be effective in reducing symptoms in children and young people with neurodevelopmental disorders; however, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, 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. Trial Registration PROSPERO International Prospective Register of Systematic Reviews: CRD42018108824; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108824


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("Specific Learning Disorder*" or "Specific reading disorder" or "Disorder of written expression" or "Mathematics disorder" or "specific spelling disorder" or "dyslexia" or "disorder of arithmetical skills" or "dyscalculia" or "Specific developmental disorder of motor function" or "dyspraxia" or "developmental co?ordination disorder").tw.

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1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 34 exp Mobile Applications/ or (Application or Applications or App or Apps or Intervention or Interventions).mp. or ((Smartphone or Smart-phone or Smart phone or Smartphones or Smart-phones or Smart phones or Mobile or iPhone or Android) adj2 (Application or Applications or App or Apps or Intervention or Interventions)).ti,ab.
[mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

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(Internet or computer or computer* or online or web or e-therapy or e-mental or e-health or telehealth or telecare or teletherapy or telemedicine or telemental or technolog* or virtual or cyber or cyberpsychology or cybertherapy or iCBT or cCBT or web-based or web-guided or web-supported or web-delivered or web-assisted or webaided or web-facilitated or computer-based or computer-guided or computer-supported or computer-delivered or computer-assisted or computer-aided or computer-facilitated or internet-based or internet-guided or internet-supported or internet-delivered or internet-assisted or internet-aided or internet-facilitated or online-based or online-guided or online-supported or online-delivered or online-assisted or online-aided or onlinefacilitated).ti,ab.

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34 or 35 37 (adolescence or adolescent or adolescent development or boy or child or childhood or elementary student or girl or high school student or high school or kindergarten or middle school student or middle school or preschool child or puberty or student or minors or adolescent psychiatry or adolescent psychology or adolescent psychotherapy or adolescent psychopathology or child psychotherapy or child psychiatry or child* or juvenile* or teen*).ti,ab. TS=(adolescence or adolescent or boy or child or childhood or elementary student or girl or high school student or high school or kindergarten or middle school student or middle school or preschool child or puberty or student or minors or child* or juvenile* or teen*) App or Apps or Intervention or Interventions or Internet or computer or computer* or online or web or e-therapy or e-mental or e-health or telehealth or telecare or teletherapy or telemedicine or telemental or technolog* or virtual or cyber or cyberpsychology or cybertherapy or iCBT or cCBT or web-based or web-guided or websupported or web-delivered or web-assisted or web-aided or web-facilitated or computer-based or computer-guided or computer-supported or computer-delivered or computer-assisted or computer-aided or computer-facilitated or internet-based or internet-guided or internet-supported or internet-delivered or internet-assisted or internet-aided or internet-facilitated or online-based or online-guided or onlinesupported or online-delivered or online-assisted or online-aided or online-facilitated or