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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.
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.
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.
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;
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.
PROSPERO International Prospective Register of Systematic Reviews: CRD42018108824; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108824
Web-based interventions for children and young people (CYP) with physical and psychological problems are relatively new phenomena, with the first trials of internet-delivered therapies being conducted in the late 1990s [
Psychological therapeutic interventions exist for a range of NDDs. These include therapies to manage NDD symptoms, such as habit reversal therapy for TDs, behavioral therapy to alleviate commonly associated symptoms, such as cognitive behavioral therapy (CBT) for anxiety symptoms, and psychoeducation to facilitate the management of NDDs. Owing to their complexity and chronic nature, pharmacotherapy may often be used as part of a treatment plan [
Web-based interventions are self-guided or therapist-assisted programs with the aim of improving knowledge, providing support, care, or treatment to a diverse population with a range of health problems. In the field of psychological and neurodevelopmental health, Web-based therapeutic interventions have been designed for CYP with a range of problems including ADHD [
A preliminary search conducted in PROSPERO, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports indicated that there are no systematic reviews in progress or already published on CYP with NDDs.
The objective of this review was to evaluate the effectiveness of Web-based interventions for CYP with NDDs and conduct a meta-analysis of the most effective intervention characteristics (eg, therapist-supported vs stand-alone) with the aim of informing the future development of technologies. The findings will also be useful to health care providers, commissioners, and clinicians in informing future clinical developments in the delivery of care.
The systematic review was registered on PROSPERO (registration number: CRD42018108824) and conducted in accordance with the JBI methodology for systematic reviews of effectiveness evidence.
An initial limited scoping search of Medical Literature Analysis and Retrieval System Online (MEDLINE) was undertaken to identify relevant articles. The text words contained in the titles and abstracts of relevant articles and the index and Medical Subject Headings terms describing the articles were used to develop a full search strategy, which was then tailored for each included information source (see
A total of 6 electronic databases—including PsycINFO, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and MEDLINE—were searched in August and September 2018. One trial register (ClinicalTrials.gov) was also searched. The reference list of all studies selected for critical appraisal was screened for additional studies, and several specialized journals, publisher websites, and published reviews were hand-searched. As Web-based interventions are a recent development and older interventions will now be obsolete, the year of publication was limited from 2000 to September 5, 2018. There were no restrictions on the language of publication.
Studies were included if they met the following criteria:
The intervention aimed to improve the diagnostic symptomology of the targeted NDD as measured by a valid and reliable outcome measure.
The intervention was delivered on the Web via a website, a mobile app, social media, an email, or a personal digital assistant. The intervention could include human support in its delivery.
The study was an RCT design and published in a peer-reviewed journal. Trial arms needed to consist of an experimental group compared with no treatment and/or another active intervention or treatment as usual (TAU) or waitlist control.
The intervention was targeted at a youth population (aged ≤18 years or reported a mean age of ≤18 years) with a diagnosis or suspected diagnosis of the following NDDs: communication disorders (eg, language disorder and stuttering); ASD; ADHD; specific learning disorder (eg, dyslexia and dyscalculia); motor disorders; TD; other NDDs (eg, NDD associated with prenatal alcohol exposure).
These disorders were selected based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria [
Secondary outcomes of interest were comorbid or associated psychological symptomology and any adverse events. Papers had to report on either primary or secondary outcomes of interest to be included in this review. Studies were excluded if the intervention was not delivered on the Web or was primarily aimed at the parent or caregiver. Furthermore, we excluded studies where the participants were diagnosed with IDs as intervention characteristics that meet the needs of children with significant IDs would be difficult to generalize to a youth population as a whole. Moreover, studies on NDDs frequently exclude CYP with any form of learning difficulty because of their unique complexity [
Once duplicates were removed (n=2142), a total of 5140 titles and abstracts were retrieved. Titles were initially screened against the eligibility criteria by 1 assessor (screening phase, n=4985 ineligible). Subsequently, 155 titles and abstracts were then screened against the eligibility criteria by 2 independent assessors. Any conflicts concerning eligibility were resolved by group discussion. There was agreement on 7 papers to be included, 121 to be excluded, and 27 papers requiring further discussion. Following a discussion between the assessors, the full text of 19 papers was obtained for further analysis and coding. A consensus was reached among the assessors on 9 papers to be excluded, as they did not meet the eligibility criteria, leaving 10 papers for analysis.
Preferred reporting items for systematic reviews and meta-analyses flowchart outlining the process for systematic review and meta-analysis. NDD: neurodevelopmental disorder; RCT: randomized controlled trial.
The first assessor extracted the following data from all included studies: specific details about the study (authors, year, number of study arms, location, and Web-based program name), population demographics (sample size, age, and gender), study methods, interventions and comparisons, length of treatment or dosage, condition treated (eg, ASD and ADHD), outcome measures, type of analysis (eg, intention-to-treat [ITT]), and primary and secondary outcomes of significance to the review. These data were extracted and inputted into JBI System for the Unified Management, Assessment and Review of Information (SUMARI) software [
A total of 2 independent assessors examined the methodological quality of included studies using the JBI RCT appraisal tool in JBI SUMARI [
Continuous variables were examined using standardized mean differences (SMD) with 95% confidence intervals. Extracted continuous data were tested for normality using skew plots. Random effects meta-analyses were performed to compute overall estimates of treatment outcomes. The effect sizes of the primary studies were presented in a forest plot. Heterogeneity was examined with the I2 statistic [
In the protocol, subgroup analyses were planned to be conducted according to the main intervention characteristics that were shown to be the most effective, for example, therapist support versus no support and parent component versus no parent component. However, because of the low number of included studies in the review, this was deemed unsuitable and is therefore a deviation from the protocol. All data for the meta-analysis were conducted using JBI SUMARI [
The search generated 10 studies. A total of 5 interventions targeted ASD [
In 5 studies, NDD diagnosis was confirmed by DSM-IV or DSM-5 criteria [
Characteristics of included studies.
Study | Design, number of arms (N per arm), sample size and study location | Sample demographics and condition treated | Control or comparator group | Outcome measures | Summary of main findings or effect of intervention |
Conaughton et al, 2017 [ |
Randomized controlled trial (RCT) 2 arms: Intervention=21, control group=21, N=42, Australia | Children (8-12 years; mean 9.74; 85.7% male) with high-functioning autism spectrum disorder and an anxiety disorder | Waitlist control (WLC) | Anxiety Disorders Interview Schedule: parent and child, Children’s Global Assessment Scale, Child Behaviour Checklist, Spence Children’s Anxiety Scale–child, satisfaction with treatment | 9.5% of the intervention group versus 0% of the WLC group had lost all anxiety diagnoses at postassessment, with 14.3% of the intervention group being free of all anxiety diagnoses at 3-month follow-up; the intervention had a positive effect |
Esposito et al, 2017 [ |
RCT 2 arms: Intervention=15, control group=15, N=30, Europe | Children (2-5 years; mean 3.92; 90% male) with Autism Spectrum Disorder (ASD) who followed face-to-face (F2F) applied behavior analysis (ABA) treatment | Treatment as usual (TAU) | Measured attention, imitation of actions with objects, receptive identification of objects | Intervention group, who had daily practice of attention and identification of objects on tablet apps, showed greater progress within standard ABA therapy than the TAU group for all 3 programs investigated; however, this did not exceed the significance level (all |
Fletcher-Watson et al, 2016 [ |
RCT 2 arms: Intervention=27, control group=27, N=54, Europe | Children (<6 years; mean 4.13; 79.6% male) with ASD | WLC | The Autism Diagnostic Observation Schedule, Brief observation of social communication change, MacArthur Communicative Development Inventory (MCDI), Communication and Symbolic Behaviour Scales–Developmental Profile, parent impressions of the app | Change scores on all outcome measures revealed no significant differences between intervention and WLC groups (all |
Fridenson-Hayo et al, 2017 [ |
RCT 2 arms: Intervention=43, control group=40, N=83, Europe | Children (6-9 years; mean 7.29; 79.5% male) with ASD | WLC | Emotion recognition (ER) tasks, Wechsler Intelligence Scale for Children or Wechsler Primary and Preschool Scale of Intelligence, Social Responsiveness Scale, Vineland Adaptive Behaviour Scales (VABS-II) | Pairwise comparisons for the time by group interaction revealed that significant improvement over time was found on all ER tasks for the intervention group but not for the WLC group; the intervention had a positive effect |
Whitehouse et al, 2017 [ |
RCT 2 arms: Intervention=41), control group=39, N=80, Australia | Children (<4 years; mean 3.32; 78.7% male) with ASD | TAU | The Autism Treatment Evaluation Checklist (ATEC), The Mullen Scales of Early Learning, VABS-II, MCDI, Communication and Symbolic Behaviour Scales, Repetitive Behaviour Scale-Revised , Behaviour Flexibility Rating Scale | No significant differences were observed between groups for any of the 4 ATEC subscales at either the 3- or 6-month assessments, although the 3-month communication subscale showed a trend toward greater improvement in the intervention group, 2.1 units (95% CI 4.5 to 0.3; |
Himle et al, 2012 [ |
RCT 2 arms: Intervention=10, comparator group=10, N=20, North America | Children (8-17 years, mean 11.6, 94% male) with tic disorders (TD) or chronic tic disorders (CTD) | F2F Comprehensive Behavioural Intervention for Tics | Yale Global Tic Severity Scale (YGTSS), Clinical Global Impression-Improvement Scale (CGI-I), Parent Tic Questionnaire (PTQ), Treatment Acceptability Questionnaire (TAQ) | The videoconferencing group showed a mean YGTSS reduction of 6.4 points versus 4.2 points for the F2F group at follow-up; both interventions were effective in reducing tics however, there was a slightly better effect on the intervention group at both post-treatment and follow-up compared with the F2F group |
Ricketts et al, 2016 [ |
RCT 2 arms: Intervention=12, control group=8, N=20, North America | Children (8-16 years; mean 12.16; 64.9% male) with TD or CTD | WLC | YGTSS, CGI-I, PTQ, Children’s Perception of Therapeutic Relationship, Client Satisfaction Questionnaire, TAQ, Videoconferencing Satisfaction Questionnaire | In the intervention group, there was a statistically significant decrease of 7.25 points in YGTSS total scores from baseline to postassessment. In the WLC group, the 1.75-point decrease on the YGTSS total scores from baseline to postassessment was not significant; the intervention had a positive effect |
Bul et al, 2016 [ |
Crossover RCT 2 arms: Intervention=88, comparator group=82, N=170, Europe | Children (8-12 years; mean 9.85; 80.6% male) with attention deficit hyperactivity disorder | TAU crossover group | Time management questionnaire, Behaviour Rating Inventory of Executive Function (subscale plan or organize), Social Skills Rating System (subscale cooperation), It’s About Time Questionnaire, self-efficacy, satisfaction | Intervention group achieved significantly greater improvements on the primary outcome of time management skills compared with TAU crossover group (parent-reported; |
Coutinho et al, 2017 [ |
RCT 2 arms: Intervention=10, comparator group=10, N=20, North America | School-aged children (4-7 years; mean 6.18; 12 males) with a specific learning disorder such as dyspraxia or speech delay with poor visual-motor integration (VMI) skills | Traditional occupational therapy sessions | Beery VMI, Miller function and participation scales, intervention appreciation scale | There were some improvements in VMI skills in both groups; however, the finding was not statistically significant; the intervention had no effect |
De Castro et al, 2014 [ |
RCT 2 arms: Intervention=13, control group=13, N=26, South America | Primary school children (7-10 years; mean 8.11; 16 male) with dyscalculia | Traditional teaching techniques | Scholastic Performance Test | The intervention using the virtual environment yielded a significant score improvement ( |
A total of 4 interventions were delivered via apps [
A summary of the characteristics of each intervention is shown in
Characteristics of interventions
Study | Intervention, modality, and aim of the intervention | Length or dosage, follow-ups | Therapist supported | Parent component |
Conaughton et al [ |
Internet trans diagnostic CBTa intervention aimed at improving comorbid anxiety symptoms | 10 weeks, 10 sessions—one 60-min session per week | Yes | Yes |
Esposito et al [ |
Tablet apps aimed at improving attention and identification of objects | 4 weeks, 3 app components—30 min daily | Yes | Yes |
Fletcher-Watson [ |
iPad app aimed to improve social communication skills | 2-months, 2 parts–5 min per day, or 10 min every other day | No | No |
Fridenson-Hayo et al [ |
An internet-based serious game aimed at improving emotion recognition | 8-12 weeks, 4 components—2 hours per week | No | Yes |
Whitehouse et al [ |
iPad app aimed at improving developmental skills relevant to autism | 6 months, 4 components–20 min per day | No | Yes |
Himle et al [ |
Internet-accessed videoconference aimed at improving tic severity | 10 weeks—6 weekly sessions followed by 2 biweekly sessions | Yes | Yes |
Ricketts et al [ |
Internet-accessed videoconference (Skype) aimed at improving tic severity | 10 weeks—2 1.5-hour sessions followed by 6 1-hour sessions | Yes | Yes |
Bul et al [ |
An internet-based serious game aimed at improving time management and planning skills | 10 weeks, 2 game components—65 min approximately 3 times per week | No | No |
Coutinho et al [ |
Multiple iPad apps aimed at improving visual motor skills | 10 weeks, minimum of 8 and maximum of 12 sessions—2 40-min sessions per week | No | No |
De Castro et al [ |
Internet-accessed virtual environment aimed at improving mathematical skills | 5 weeks, 10 sessions—60 min twice a week | No | No |
aCBT: cognitive behavioral therapy.
In total, 4 interventions were therapist assisted [
One of the major factors that developers need to consider when creating Web-based intervention is the ease with which nontechnologically advanced individuals can access and use the program. Thus, it is crucial to provide technical support as and when needed. In total, 7 of the 10 included studies reported the use of technical support. In 2 trials [
A total of 545 participants consented and were randomized to a trial arm. Sample sizes ranged from 20 [
In the 10 trials, participants ranged in age from 2 to 17 years, with a mean age ranging from 3.32 to 12.16 years. Males were the majority in all studies, with gender balance varying from 62.5% [
Most of the trials recruited participants from clinics [
Only 1 study [
It was estimated that the outcome measurement battery ranged from 16 [
The JBI Critical Appraisal Checklist for RCTs provided a framework for scoring the quality of the included studies by addressing different aspects of the research such as randomization, allocation concealment, blinding, and follow-up data. The methodological quality of included studies was felt to be moderate, mostly because of trials providing insufficient details or being unclear in their reporting (see
Critical appraisal of included studies.
Study | Q1a | Q2b | Q3c | Q4d | Q5e | Q6f | Q7g | Q8h | Q9i | Q10j | Q11k | Q12l | Q13m |
Conaughton et al [ |
Yes | Yes | Yes | Unclear | No | Yes | No | Yes | Yes | No | Yes | Yes | Yes |
Esposito et al [ |
Unclear | Unclear | Yes | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Fletcher-Watson et al [ |
Yes | Yes | Yes | No | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Fridenson-Hayo et al [ |
Unclear | Unclear | Yes | No | No | Unclear | Yes | Yes | Unclear | Yes | Yes | Yes | Yes |
Whitehouse et al [ |
Unclear | Unclear | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Himle et al [ |
Unclear | Unclear | Yes | No | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes |
Ricketts et al [ |
Yes | Unclear | Yes | No | No | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Bul et al [ |
Yes | No | Yes | No | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Coutinho et al [ |
Yes | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
De Castro et al [ |
Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Unclear | Yes | Yes | Yes | Yes |
Number that met the criteria (%) | 50 | 20 | 100 | 0 | 10 | 50 | 90 | 100 | 70 | 90 | 100 | 100 | 100 |
aQ1: True randomization.
bQ2: Allocation concealed.
cQ3: Treatment groups similar at the baseline.
dQ4: Participants blind to treatment.
eQ5: Those delivering intervention blind to treatment.
fQ6: Outcome assessors blind to treatment.
gQ7: Treatment groups treated identically.
hQ8: Follow-up complete and if not, differences between groups adequately described and analyzed.
iQ9: Participants analyzed in the groups to which they were randomized.
jQ10: Outcomes measured in the same way for groups.
kQ11: Outcomes measured reliably.
lQ12: Appropriate statistical analysis.
mQ13: Appropriateness of trial design and any deviations from RCT design accounted for.
Of 10 trials, 6 trials found that Web-based interventions were effective in reducing NDDs or associated symptoms in CYP [
Of 10 interventions, 4 interventions in the included studies were aimed at a youth population with ASD; however, just one [
Both studies evaluating the effectiveness of internet-delivered CBIT via videoconferencing for young people with TD/CTD showed it could be effective for reducing tic symptomology. Overall, the studies were of similar design but used different comparators with Himle et al [
There were 3 other studies that looked to improve primary symptoms in CYP, and these were targeted at CYP with NDDs other than ASD or TD. One study showed improvements in time management skills for children with ADHD [
A total of 4 trials included participant satisfaction measures [
In studies that used a valid and reliable outcome measurement of NDD and associated symptoms, a meta-analysis was undertaken. All outcomes were continuous and scale-based and were extracted as endpoint average scores with lower scores indicating less severe symptomology. The outcomes combined for the meta-analysis were anxiety [
Forest plot of postintervention neurodevelopmental disorder outcomes for intervention compared with controls.
A total of 5 trials investigated the effects of Web-based interventions on NDD symptoms using a valid, standardized outcome measure to explore symptom reduction. Within the 5 trials, neither intervention nor control was favored, with a high level of heterogeneity detected: 182/545 (33.4%), 5 RCTs, pooled SMD=–0.39; 95% CI –0.98 to 0.20; Z=–1.29;
We set out to evaluate whether RCT evidence showed Web-based interventions were effective for CYP with NDDs and/or associated symptoms. Our review retrieved 10 studies in total. A further meta-analysis was conducted on 5 of the 10 studies. Most of the interventions targeted ASD in CYP. Overall, the meta-analysis indicated no difference between the intervention and control groups; however, with 6 of the 10 retrieved papers showing a positive effect, the findings suggest that Web-based interventions can be effective in reducing NDD symptoms in CYP. However, the evidence is inconclusive owing to the limited number of retrieved studies and small sample sizes in included trials. The findings indicate the need for further research in the use of Web-based interventions aimed at CYP with NDDs.
Furthermore, one of our initial aims was to evaluate the main characteristics of effective Web-based interventions. A parent component as an adjunct to the main intervention was utilized in 4 of the 6 effective trials, indicating the potential importance of assisted interventions and in line with previous research [
All 4 of the included interventions delivered by apps were unsuccessful in yielding statistically significant outcomes. This suggests apps may not be a promising platform for delivering therapeutic interventions, at least to CYP with NDDs. Indeed, recent systematic reviews [
Half of the included interventions were delivered to CYP with ASD, and much of the research to date evaluating digital technologies administered to NDDs has focused on ASD [
The RCTs included in this review were assessed as being of acceptable quality for a review of effectiveness. However, the main methodological issues centered on the lack of blinding of participants and of those delivering treatment. All studies had a control group, which was either active or inactive, with half of the trials using valid, standardized outcome measures. Most trials had low attrition rates thus improving the overall quality of the included studies. Only 1 of the 10 trials explicitly recorded and reported adverse events [
Some limitations of the review and meta-analysis need to be considered. A major limitation is the minimal number of studies retrieved meaning that any conclusions drawn from this review must be met with caution. To provide an expansive overview of the effectiveness of Web-based interventions for CYP, we included trials targeting a myriad of NDDs, which may have equilibrated disorder-specific effects of Web-based interventions. As there were very few RCTs evaluating the effectiveness of Web-based interventions in CYP with NDDs, it would have been impractical to carry out a review focusing on 1 NDD only. We could have increased the number of NDDs by also including trials focusing on CYP with learning disabilities; however, this would have further increased the heterogeneity and added to the problems of generalizability owing to the complexity of this particular population. The search was conducted on multiple databases and updated through a repeated search, thus ensuring a comprehensive overview of the topic. A particular strength of this review is that we had 2 independent reviewers screening relevant papers, with discrepancies between the reviewers discussed. This ensured a structured, meticulous approach was undertaken in study selection, therefore, improving review quality.
For the meta-analysis, we could only include data from 5 of the 10 trials, meaning the pool of data from included interventions was small and limited the overall power. Moreover, there was a high level of heterogeneity detected in the meta-analysis, which may have been because of the types of comparison with the interventions or differences in baseline symptomology [
When interpreting the findings, some inherent methodological issues of the included studies must also be considered, as methodological flaws of the primary trials can have a considerable impact on the review results. One intrinsic methodological limitation of many therapeutic intervention trials is the lack of blinding of participants and those delivering treatment [
Gender balance was a potential issue of bias in included studies, as most of the trials had more male participants than female. However, this is not surprising given that NDDs are more common in males than females [
As some of the interventions found positive outcomes, health care professionals working with CYP may want to consider utilizing Web-based and digital resources to support their patients, especially those with tics. The National Health Service (NHS) has already developed improving access to psychological therapy services for young people with mental health problems and is aiming to incorporate this into practice nationwide within the coming years [
Future studies of Web-based interventions for CYP with NDDs must have larger sample sizes to generate a reasonable degree of statistical power and allow for an increase in generalizability. They must also consider including long-term follow-up assessments to evaluate whether effects are maintained over a prolonged period. A cost-effectiveness evaluation would also be appropriate and much needed in future research. Furthermore, qualitative feedback in the form of a process evaluation would be useful in addressing the intervention’s mechanisms of impact and usability.
Our review found multiple methodological issues with the included trials. Sources of high risk of bias in the RCTs included failure to blind participants and personnel to the Web-based intervention and inadequate reporting of allocation concealment. Failing to blind participants, which can be difficult in Web-based intervention studies, can lead to the
Technological advances and mobile device popularity have huge potential to improve outcomes in CYP with NDDs and comorbid psychological problems. Overall, this study suggests that Web-based interventions can be beneficial in improving symptoms in this population; however, because of the small number of RCTs yielded and several methodological limitations in the included studies, mean findings must be considered with caution. There need to be more studies with larger sample sizes assessing the effectiveness of Web-based interventions for CYP. Furthermore, a qualitative evaluation of the intervention is encouraged in future work to provide bespoke Web-based interventions for youth populations.
Full search strategy.
Further information.
Attention deficit hyperactivity disorder
Autism Spectrum Disorder
Comprehensive Behavioural Intervention for Tics
cognitive behavioral therapy
control group
Chronic Tic Disorder
children and young people
Diagnostic and Statistical Manual of Mental Disorder
emotion recognition
face-to-face
high-functioning autism spectrum disorder
intention-to-treat
Joanna Briggs Institute
learning disorder
Medical Literature Analysis and Retrieval System Online
neurodevelopmental disorder
National Health Service
National Institute for Health Research
occupational therapy
randomized controlled trial
standardized mean difference
System for the Unified Management, Assessment and Review of Information
treatment as usual
tic disorder
Therapy Outcomes By You
visual-motor integration
waitlist control
The PhD is funded by National Institute for Health Research (NIHR) MindTech MedTech Cooperative and NIHR Nottingham BRC Mental Health & Technology Theme. The PhD explores the process evaluation of the Online Remote Behavioral Intervention for Tics Trial, which is funded by the NIHR Health Technology Assessment (Ref 16/19/02).
The PhD studentship is funded by the NIHR MindTech MedTech Cooperative from whom EBD, CH, and CG received financial support. This study is funded by the National Institute for Health Research. The views represented are the views of the authors alone and do not necessarily represent the views of the Department of Health in England, NHS, or the National Institute for Health Research.
CLH acknowledges receiving financial support from NIHR Collaborations for Leadership in Applied Health Research and Care East Midlands.
KK conducted the literature searches and extracted, tabulated, and interpreted data, contributed to the conception and design of the review, and wrote the manuscript. CLH and EBD aided in the protocol development, performed the second review of the papers, and critically reviewed and revised the manuscript. CG contributed to the conception and design of the review, critically reviewed, and revised the manuscript. CH approved the final version of the manuscript.
None declared.