The Use of Digital Interventions for Children and Adolescents with Autism Spectrum Disorder--A Meta-Analysis
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| Title: | The Use of Digital Interventions for Children and Adolescents with Autism Spectrum Disorder--A Meta-Analysis |
|---|---|
| Language: | English |
| Authors: | Fang Xu (ORCID |
| Source: | Journal of Autism and Developmental Disorders. 2026 56(2):499-515. |
| Availability: | Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ |
| Peer Reviewed: | Y |
| Page Count: | 17 |
| Publication Date: | 2026 |
| Document Type: | Journal Articles Information Analyses |
| Descriptors: | Intervention, Skill Development, Children, Adolescents, Autism Spectrum Disorders, Social Emotional Learning, Technology Uses in Education, Educational Technology, Language Skills, Communication Skills, Cognitive Development, Daily Living Skills, Physical Development, Child Development, Adolescent Development |
| DOI: | 10.1007/s10803-024-06563-4 |
| ISSN: | 0162-3257 1573-3432 |
| Abstract: | This comprehensive meta-analysis aimed to assess the effectiveness of digital interventions in improving developmental skills for children and adolescents with autism spectrum disorder (ASD). We conducted a systematic literature search based on three databases. A pre-test adjusted between-group standardized effect size was computed for effect size synthesis. We utilized a robust variance estimation model to analyze overall treatment effect. Moderator analyses and publication bias were also addressed. Twenty-eight studies (150 effect sizes) using randomized control trials (RCT; n = 22) or quasi-experimental designs (QED; n = 6) were included. Most studies (n = 22) included social-emotional skills as primary outcomes. The meta-analysis revealed a medium to large overall effect size, with Hedges' g = 0.62, 95% CI [0.36, 0.88], p < 0.001. We found that digital interventions have a statistically significantly large effect on enhancing social-emotional skills compared with language and communication skills, cognitive skills, daily living skills, and physical skills. The results of moderator analyses indicated that computer-based interventions have larger effect sizes in comparison to tablet/smartphone-based interventions. No statistically significant differences were observed between studies utilizing RCT and those using QED. We recommended the integration of digital interventions as supplemental resources in behavioral and educational interventions. Further research needs to focus on more females, young children, and adolescents with ASD in digital intervention research. |
| Abstractor: | As Provided |
| Entry Date: | 2026 |
| Accession Number: | EJ1504756 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEgELqBfzAX1bENULNNVdKWAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDIRP7rMdPbpwS4NaRgIBEICBmxFLavtoin6i1jXxgWK4ngnPv5DYtj6kfe60pfVB-UomYWmuyqCliEXNIG7PHo8auhqnETvcNtDRd2cEbrXMfzjmjBll1vh08DoSOhUYz0ZaG_9YB5OY6jLQ9wtRjjdwHXI9-g8D27waYQI55WgIM21cpV64zaqLzN9ASc6xfTBytnxdVV0BWOnSnhaD4BxddumzKdeyzt6-MRJz Text: Availability: 1 Value: <anid>AN0191290376;aut01feb.26;2026Feb04.02:38;v2.2.500</anid> <title id="AN0191290376-1">The Use of Digital Interventions for Children and Adolescents with Autism Spectrum Disorder—A Meta-Analysis </title> <p>This comprehensive meta-analysis aimed to assess the effectiveness of digital interventions in improving developmental skills for children and adolescents with autism spectrum disorder (ASD). We conducted a systematic literature search based on three databases. A pre-test adjusted between-group standardized effect size was computed for effect size synthesis. We utilized a robust variance estimation model to analyze overall treatment effect. Moderator analyses and publication bias were also addressed. Twenty-eight studies (150 effect sizes) using randomized control trials (RCT; n = 22) or quasi-experimental designs (QED; n = 6) were included. Most studies (n = 22) included social-emotional skills as primary outcomes. The meta-analysis revealed a medium to large overall effect size, with Hedges' g = 0.62, 95% CI [0.36, 0.88], p &lt; 0.001. We found that digital interventions have a statistically significantly large effect on enhancing social-emotional skills compared with language and communication skills, cognitive skills, daily living skills, and physical skills. The results of moderator analyses indicated that computer-based interventions have larger effect sizes in comparison to tablet/smartphone-based interventions. No statistically significant differences were observed between studies utilizing RCT and those using QED. We recommended the integration of digital interventions as supplemental resources in behavioral and educational interventions. Further research needs to focus on more females, young children, and adolescents with ASD in digital intervention research.</p> <p>Keywords: Autism spectrum disorder; Digital intervention; Technology-based intervention; Meta-analysis; Psychology and Cognitive Sciences Psychology</p> <p>Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10803-024-06563-4.</p> <hd id="AN0191290376-2">Digital Interventions and Autism</hd> <p>Recent research from the Centers for Disease Control and Prevention ([<reflink idref="bib13" id="ref1">13</reflink>]) has revealed an alarming increase in the prevalence of autism spectrum disorder (ASD), affecting 1 in 36 children across 11 sites. As a complex neurological and developmental disorder, children with ASD demonstrate persistent deficits in social communication and interaction with peers and adults, along with restricted and repetitive patterns of behavior, interests, or activities (American Psychiatric Association [<reflink idref="bib3" id="ref2">3</reflink>]).</p> <p>The bulk of research has illustrated the effectiveness of behavioral and educational interventions (e.g. early intensive behavioral intervention, functional communication training, pivotal response training) for children with ASD (e.g. Makrygianni et al., [<reflink idref="bib54" id="ref3">54</reflink>]; Reichow et al., [<reflink idref="bib75" id="ref4">75</reflink>]; Steinbrenner et al., [<reflink idref="bib81" id="ref5">81</reflink>]). In addition to traditional treatment, digital interventions have shown the potential for a positive impact on enhancing various skills and abilities of children with ASD (Bölte et al., [<reflink idref="bib8" id="ref6">8</reflink>]; Karami et al., [<reflink idref="bib43" id="ref7">43</reflink>]). The concepts of digital interventions or technology-based interventions addressing social communication and interaction issues emerged a few decades ago as an innovative strategy under the umbrella term of "innovative technologies" (Bölte et al., [<reflink idref="bib9" id="ref8">9</reflink>]; Goodwin, [<reflink idref="bib31" id="ref9">31</reflink>]; McConnell, [<reflink idref="bib57" id="ref10">57</reflink>]). Digital interventions have been receiving increasing attention from a growing number of researchers supporting children and young adults with ASD from theoretical and empirical perspectives (e.g. Grynszpan et al., [<reflink idref="bib32" id="ref11">32</reflink>]; Odom et al., [<reflink idref="bib62" id="ref12">62</reflink>]).</p> <p>Researchers use various terms to illustrate digital interventions, such as computer-based or -assisted intervention (e.g. Pennington, [<reflink idref="bib66" id="ref13">66</reflink>]; Ramdoss et al., [<reflink idref="bib72" id="ref14">72</reflink>]), technology-aided intervention (Odom et al., [<reflink idref="bib62" id="ref15">62</reflink>]), digital intervention or health (Hollis et al., [<reflink idref="bib36" id="ref16">36</reflink>]; Sandgreen et al., [<reflink idref="bib78" id="ref17">78</reflink>]), and innovative technology-based interventions (Grynszpan et al., [<reflink idref="bib32" id="ref18">32</reflink>]). In addition to desktop computers, digital interventions utilize a wide array of devices, including interactive videos or DVDs (Golan et al., [<reflink idref="bib30" id="ref19">30</reflink>]; McCoy &amp; Hermansen, [<reflink idref="bib58" id="ref20">58</reflink>]), smartphones, and tablets (e.g. Kagohara et al., [<reflink idref="bib42" id="ref21">42</reflink>]; Mechling, [<reflink idref="bib59" id="ref22">59</reflink>]), robotics (Dautenhahn, [<reflink idref="bib21" id="ref23">21</reflink>]; Diehl et al., [<reflink idref="bib23" id="ref24">23</reflink>]), wearable training systems (Koumpouros &amp; Kafazis, [<reflink idref="bib48" id="ref25">48</reflink>]), and virtual or augmented reality (VR/AR; Glaser et al., [<reflink idref="bib29" id="ref26">29</reflink>]; Lorenzo et al., [<reflink idref="bib52" id="ref27">52</reflink>]).</p> <hd id="AN0191290376-3">Digital Intervention Studies</hd> <p>Digital interventions not only create personalized learning environments with visual support and interactive interfaces, but also provide repeated and structured training sessions that individuals with ASD can practice (Goodwin, [<reflink idref="bib31" id="ref28">31</reflink>]). Researchers have observed that individuals with ASD have special interests in computerized programs and exhibit a preference for learning through these digital platforms (e.g. Mineo et al., [<reflink idref="bib60" id="ref29">60</reflink>]). The visual presentation of information, controlled and predictable environment, and the interactive multi-media provided by technology-based interventions can engage children and youth with ASD, enhancing their social skills, problem solving skills, and communication skills (e.g. Herrero &amp; Lorenzo, [<reflink idref="bib35" id="ref30">35</reflink>]; Syriopoulou-Delli &amp; Gkiolnta, [<reflink idref="bib82" id="ref31">82</reflink>]). Moreover, the repetition of interactions and feedback without degradation of fidelity via digital platforms, integrated with pre-written intervention systems on smartphones, tablets, or computers, is accessible for remote learners and can be used on a large scale with low-cost (Bölte et al., [<reflink idref="bib9" id="ref32">9</reflink>]; Kumm et al., [<reflink idref="bib49" id="ref33">49</reflink>]). Adapted from Odom et al. ([<reflink idref="bib62" id="ref34">62</reflink>]), digital interventions in this review include any digital treatment assisted by technological devices, software applications, or digital platforms aimed at improving skills and abilities for children and adolescents with ASD. The technological devices involved in the review consist of computers, smartphones, tablets, DVDs, and wearable systems (i.e. VR/AR).</p> <p>The effectiveness of using various technology-based devices to enhance a variety of social, cognitive, and adaptive skills for individuals with ASD has been demonstrated in various experimental studies and review literature (e.g. Karami et al., [<reflink idref="bib43" id="ref35">43</reflink>]; Pi et al., [<reflink idref="bib68" id="ref36">68</reflink>]). The outcomes digital interventions have addressed for children with ASD involve social skills (e.g. Yuan &amp; Ip, [<reflink idref="bib97" id="ref37">97</reflink>]), emotion recognition (e.g. Bölte et al., [<reflink idref="bib10" id="ref38">10</reflink>]), communication skills (e.g. Ramdoss et al., [<reflink idref="bib72" id="ref39">72</reflink>]), social convention (Parsons et al., [<reflink idref="bib65" id="ref40">65</reflink>]), vocabulary (Massaro &amp; Bosseler, [<reflink idref="bib56" id="ref41">56</reflink>]), academic skills (Knight et al., [<reflink idref="bib46" id="ref42">46</reflink>]), and daily living skills (e.g. Josman et al., [<reflink idref="bib39" id="ref43">39</reflink>]). All of these are essential skills for the long-term success of individuals with ASD (Bal et al., [<reflink idref="bib5" id="ref44">5</reflink>]).</p> <hd id="AN0191290376-4">Review of Digital Intervention Studies for Individuals with ASD</hd> <p>Even though digital interventions have been used to improve a wide range of social, cognitive, and adaptive skills for children with ASD, research is needed on treatment efficacy and heterogeneity due to the diverse array of interactive technology platforms and multiple intervention strategies they encompass (Grynszpan et al., [<reflink idref="bib32" id="ref45">32</reflink>]). As innovative and interdisciplinary intervention approaches, digital interventions have been applied in experimental group design and case studies to assess the effectiveness of various devices or application systems by professionals from diverse fields, including computer science, special education, occupational therapy, rehabilitation engineering, and speech-language therapy (Porayska-Pomsta et al., [<reflink idref="bib69" id="ref46">69</reflink>]). Recently published literature reviews have contributed to our understanding of the effectiveness of different types of digital interventions for individuals with ASD (e.g. Chen et al., [<reflink idref="bib16" id="ref47">16</reflink>]; Lorenzo et al., [<reflink idref="bib51" id="ref48">51</reflink>]; Wu et al., [<reflink idref="bib94" id="ref49">94</reflink>]; Zhang et al., [<reflink idref="bib98" id="ref50">98</reflink>]). For instance, Odom et al. ([<reflink idref="bib62" id="ref51">62</reflink>]) provided a theoretical and conceptual framework for investigating the use of digital interventions in improving communication, social competence, vocational skills, challenging and adaptive behavior, and independence for adolescents with ASD. Three meta-analyses reviewed digital interventions in the treatment of children and adults with ASD and obtained varied results. Grynszpan et al. ([<reflink idref="bib32" id="ref52">32</reflink>]) focused on 21 digital intervention studies using pre-post designs for children and adults with ASD. The results showed a medium magnitude overall effect size (Cohen's <emph>d</emph> = 0.47) of digital interventions for individuals with ASD. Sandgreen et al. ([<reflink idref="bib78" id="ref53">78</reflink>]) examined 19 studies using randomized controlled trials (RCTs). They found a small overall effect (Cohen's <emph>d</emph> = 0.32) of digital interventions (e.g. computer programs, tablet apps, a robot, and interactive DVDs) for children and adults with ASD. Pi et al. ([<reflink idref="bib68" id="ref54">68</reflink>]) examined technology-assisted parent-mediated interventions for children with ASD using 16 RCT studies. They found that the interventions were effective in improving children's emotional recognition (z = 3.44, <emph>p</emph> &lt; 0.05) for three studies but had no significant effect on promoting social communication (z = 1.60, <emph>p</emph> = 0.11) or language skills.</p> <p>In addition, four reviews evaluated the effect of extended reality (XR; e.g. VR/AR) on individuals with ASD (e.g. Chen et al., [<reflink idref="bib16" id="ref55">16</reflink>]; Lorenzo et al., [<reflink idref="bib51" id="ref56">51</reflink>]; Zhang et al., [<reflink idref="bib98" id="ref57">98</reflink>]). One meta-analysis study (Karami et al., [<reflink idref="bib43" id="ref58">43</reflink>]) reported a large overall effect size (Hedges' <emph>g</emph> = 0.74) of VR or AR training on daily living skills, social communication skills, and emotion regulation and recognition skills. However, only nine of the included studies (27%) with controlled trials (e.g. RCTs or quasi-experimental designs) were involved in the review. Further, the age of participants in the study ranged from preschoolers to adults (mean age 4.6–29.8) rather than solely focusing on students under 18. The other three systematic reviews summarized evidence-based VR applications for children and adolescents with ASD in both qualitative and quantitative studies. Lorenzo et al. ([<reflink idref="bib51" id="ref59">51</reflink>]) found 12 VR application studies without a control group (i.e. non-VR for students with ASD). Most of these studies (<emph>n</emph> = 6) focused on social skills analysis. Similar results, indicating that VR application studies mostly focused on social communication skills, were found by Zhang et al. ([<reflink idref="bib98" id="ref60">98</reflink>]). Despite providing evidence of the application of VR in training students' social and communication skills, these reviews did not examine the effectiveness of VR training on student other outcomes.</p> <p>Chen et al. ([<reflink idref="bib16" id="ref61">16</reflink>]) conducted a comprehensive examination of 112 studies using VR, AR, and mixed reality (MR). They observed positive improvements in a broad range of social, cognitive, communication, and adaptive skills for children and adolescents with ASD. In addition to social-emotional and communication skills, Chen and colleagues found that XR improved daily living skills, speech, and attention, reduced anxiety symptoms and problem behaviors, and enhanced insomnia control. Yet, similar to Karami et al. ([<reflink idref="bib43" id="ref62">43</reflink>]), only a small percentage (36%) of the included studies conducted controlled trial designs (e.g. RCT or quasi-experimental design). Most of the studies (64%) in the review were within-group studies or qualitative studies.</p> <p>Previous reviews have conducted moderator analysis according to age groups, outcome types, and digital intervention types (e.g. Karami et al., [<reflink idref="bib43" id="ref63">43</reflink>]; Sandgreen et al., [<reflink idref="bib78" id="ref64">78</reflink>]). The categorization of each moderator varied according to the study's purpose. Some studies categorized ages into four groups (e.g. Sandgreen et al., [<reflink idref="bib78" id="ref65">78</reflink>]), while others focused on one (e.g. adolescents; Odom et al., [<reflink idref="bib62" id="ref66">62</reflink>]) or two groups (e.g. preschoolers and elementary age under 12; Pi et al., [<reflink idref="bib68" id="ref67">68</reflink>]). Researchers have reported varied results in the age group moderator analysis. For example, Sandgreen et al. ([<reflink idref="bib78" id="ref68">78</reflink>]) found there is no significant association between effect size and four age groups. However, another study (Karami et al., [<reflink idref="bib43" id="ref69">43</reflink>]) stated that children older than 16 show more acquisition in social emotional and daily living skills and children ages 4–8 show more improvement in cognitive skills. Therefore, our study mainly examined the effectiveness of digital interventions for four groups, including prek-K (i.e. less than 6 years old), elementary students (age 6–10), middle school students (age 11–13) and high school students (age 14–18). In terms of target skills, some studies (e.g. Pi et al., [<reflink idref="bib68" id="ref70">68</reflink>]) only focused on social and communication-related outcomes, while others (e.g. Karami et al., [<reflink idref="bib43" id="ref71">43</reflink>]; Sandgreen et al., [<reflink idref="bib78" id="ref72">78</reflink>]; Zhang et al., [<reflink idref="bib98" id="ref73">98</reflink>]) categorized outcomes into various domains with definitions and examples. Our study aimed to include all primary outcomes outlined in each study and analyze the effect size of each outcome. In addition, most of previous reviews categorized intervention types such as computer-based, Tablet app, Robot, and interactive DVD, while some exclusively examined the effectiveness of XR on children with ASD. Our study incorporated the intervention types mentioned in original studies and investigated the use of intervention types on child outcomes.</p> <hd id="AN0191290376-5">Current Study</hd> <p>Even though several studies have explored the efficacy and validity of digital interventions for individuals with ASD, the results regarding their effectiveness have shown variance across different types of reviews and outcomes. Moreover, many reviews included study designs, such as pre-post designs without control groups, that lack the rigor needed to draw confident conclusions about outcomes observed in children and adolescents with ASD. Compared with other research methods (e.g. pre-post design), the use of high-quality research methods (e.g. RCT and QEDs) can control for threats to internal validity and rule out alternative explanations for results and conclusions (Odom et al., [<reflink idref="bib62" id="ref74">62</reflink>]). These concerns limit the understanding of the effectiveness of digital interventions among children and adolescents with ASD.</p> <p>Therefore, to address these critical gaps in the literature, we (a) conducted a comprehensive literature review to examine the implementation of digital interventions for children under the age of 18 with ASD and (b) examined the effectiveness of digital interventions for children with ASD by calculating the effect size between those in the treatment group and those in control or waitlist group. Additionally, we conducted moderator analyses to begin to explore the efficacy of digital interventions by age groups, designs, validated or non-validated measurement tools, pre-test control or no pre-test control effects, outcomes, and types of digital interventions targeting the improvement of treatment outcomes for children and adolescents with ASD. Finally, we explored publication bias using a funnel plot and File-Safe N. Three research questions guided our review and are listed below.</p> <p></p> <ulist> <item> What are the characteristics of digital interventions used for children and adolescents with ASD to improve their social-emotional skills, communication and language skills, physical skills and other skills?</item> <p></p> <item> What is the overall between-group effect size on digital interventions for children and adolescents with ASD compared to the control group?</item> <p></p> <item> How do potential moderators, including age, technology types, designs, and measures, impact between-group effect sizes?</item> </ulist> <hd id="AN0191290376-6">Methods</hd> <p></p> <hd id="AN0191290376-7">Study Searching and Selection</hd> <p>The systematic literature review was conducted using three online databases: Education Resources Information Center (ERIC), PsycINFO, and PubMed for Medical Science in September 2022. Key search terms and headings (e.g. ASD*, autism*, digital interventions, technology-based tr*, digital game-based tr*, computer game-based intervention*, and virtual reality tr*) were used and combined to locate articles. Detailed information on search terms and strategies is presented in <uline>supplemental material</uline>.</p> <p>All records identified were uploaded to Covidence, an internet-based systematic review management website. The initial screening involved examining each record's title and abstract and deciding whether to include, exclude, or maybe. Then, a full-text screening was conducted for these articles marked as maybe. The inclusion criteria for this review included five parts: (a) the studies needed to be published in English in peer-reviewed journals; (b) participants were less than 18 years old, and those in the experimental groups required to have Autism Spectrum Disorder (ASD) as the primary disability; (c) the design needed to be experimental design (i.e. RCT or QED) with two groups, a digital intervention group and control group; (d) the treatment group needed to be digital interventions (e.g. VR, computer-based intervention); (e) the outcomes primarily focused on reporting student improvement; (f) the outcomes needed to be reported for both intervention group and control group with quantitative measures; (g) the studies must include enough data for calculating effect sizes. Coders made decisions on whether to include or exclude articles during the full-text screening process based on the inclusion criteria. A snowball search was conducted as an additional strategy to find more studies that were missing from the databases. Coders used Google Scholar to search reference lists of each included article and repeated the scanning and selection procedures mentioned above.</p> <p>Two doctoral students majored in special education were trained by the first author before screening. To ensure the consistency of screening, the first author randomly selected 20% of articles for testing interobserver agreement (IOA). There were 18% disagreement between coders, mainly focused on the categorization of digital interventions. Coders modified the codings and reached consensus agreement after the first author restated definitions. Three students with background knowledge in digital interventions and ASD were trained by the first author for two-round coding processes. The total length of training lasted 4 h. In the first round of coding, each student coded eight or more articles. During the second-round coding check, two students re-checked ten randomly selected articles (35%) that were coded by other coders, and the first author checked the remaining articles. Disagreement in the second round coding occurs in two items (i.e. target skills). After the discussion, the coders reached mutual agreement and revised the codings. After a student extracted all the data for effect size calculation, the first author randomly reviewed data from 32% of included articles (<emph>n</emph> = 9) and confirmed that all data had been accurately recorded.</p> <hd id="AN0191290376-8">Data Coding</hd> <p>Several terms were categorized and operationally defined for coding based on previous studies (e.g. Karami et al., [<reflink idref="bib43" id="ref75">43</reflink>]). We categorized different types of digital interventions, including computer-based intervention, tablet or smartphone-based apps, DVDs, virtual reality, augmented reality, and mixed reality. We coded each study based on the categorization and definition of the variables (see Table 1). Studies using digital interventions (e.g. DVDs) that only involved the target children's or interventionists' faces were excluded because these interventions may not generalize to other individuals. Studies that delivered training via telehealth platforms (e.g. zoom) were not counted as digital interventions, since the technology was the medium to deliver a human-implemented intervention.</p> <p>Table 1 Types of digital interventions, their definitions, and examples</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Type of DI&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Definition&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Examples&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Computer-based intervention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Using computer software applications, online games, or websites to improve developmental skills for children with ASD (Ramdoss et al., &lt;xref ref-type="bibr" rid="bibr73"&gt;2012&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SAS social training computer program (Beaumont et al., &lt;xref ref-type="bibr" rid="bibr7"&gt;2021&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Tablet- or smartphone-based intervention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Using applications, online games, or tools designed for mobile devices such as tablet or smartphone devices to provide support and interventions for children with ASD (Aspiranti et al., &lt;xref ref-type="bibr" rid="bibr4"&gt;2020&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;iPad-supported TOBY intervention (Parsons et al., &lt;xref ref-type="bibr" rid="bibr63"&gt;2019&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;DVD-based intervention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Using DVDs as a resource to facilitate interventions for children with ASD (Pi et al., &lt;xref ref-type="bibr" rid="bibr68"&gt;2021&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Transporters DVD intervention (Williams et al., &lt;xref ref-type="bibr" rid="bibr92"&gt;2012&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Virtual reality -based intervention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Participants entirely immerse themselves in a computer-generated simulation or multidimensional digital environment, interacting with objects in an artificial world (Karami et al., &lt;xref ref-type="bibr" rid="bibr43"&gt;2021&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4-side immersive VR environment training (half-CAVE; Ip et al., &lt;xref ref-type="bibr" rid="bibr38"&gt;2018&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Augmented reality-based intervention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Using cameras and sensors embedded in devices to overlay images, text, graphics, or sound onto the real-world environment to support children with ASD (Karami et al., &lt;xref ref-type="bibr" rid="bibr43"&gt;2021&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ARSFM system (Chen et al., &lt;xref ref-type="bibr" rid="bibr14"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Mixed reality-based intervention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Using both AR- and VR- based interventions to support children with ASD (Chen et al., &lt;xref ref-type="bibr" rid="bibr16"&gt;2022&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR Fruits and AR Rackets games (Crowell et al., &lt;xref ref-type="bibr" rid="bibr19"&gt;2020&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>DI</emph> Digital interventions, <emph>ASD</emph> Autism spectrum disorder, <emph>SAS</emph> Secret agent society, <emph>TOBY</emph> Therapy outcome by you, <emph>DVDs</emph> Digital versatile discs, <emph>VR</emph> Virtual reality, <emph>CAVE</emph> Cave automatic virtual environment, <emph>ARSFM</emph> Augmented reality-based self-facial modeling, <emph>AR</emph> Augmented reality</p> <p>Based on the previous literature reviews and study purpose, we categorized student target behaviors or skills into five dimensions and provide corresponding definitions. Social-emotional skills refer to social interaction, adaptation, emotional identification, facial recognition, stress and anxiety management (e.g. phobia reduction), and reducing problem behaviors during social interactions (e.g. challenging or maladaptive behaviors). Language and communication skills include communication skills and language learning (e.g. vocabulary acquisition, mandarin articulation, receptive and expressive language). Daily living skills include learning safety skills (e.g. street crossing, fire safety skills) and self-help skills (e.g. asking for help). Cognitive skills include enhanced attention span, cognitive control, reasoning and problem-solving, executive function, self-regulation, and metacognition. Physical skills consist of visual and motor coordination, fine motor, and gross motor skills.</p> <p>The assessment tools used to measure student target skills were categorized into two types: research-validated and non-validated measures. Research-validated measures indicate the instrument is standardized or validated in previous studies. A non-validated instrument indicates an assessment tool designed and developed by the researchers based on the study's purpose without prior standardization or validation. Additional variables collected during the review include (a) study characteristics (e.g. authors, year of publication, design), (b) participant (i.e. students and tutors/interventionists) demographic information, (c) the target behaviors or skills of students, (d) intervention characteristics (e.g. type of digital interventions, dosage, and intervention fidelity), and (e) results of the studies (e.g. student pre-post data of the intervention and control groups). If a study had multiple groups involving both children with ASD and children not diagnosed with ASD, the coder recorded the data from the intervention and the comparison group consisting of children with ASD in accordance with the review's purpose.</p> <hd id="AN0191290376-9">Statistical Analysis</hd> <p></p> <hd id="AN0191290376-10">Effect Size Synthesis</hd> <p>We conducted pre-test adjusted between-group standardized effect size calculation for the studies that reported pre- and post-test data (e.g. mean and standard deviation) for both intervention and control groups using a web-based effect size calculator (Wilson, n.d.). Specifically, we used Hedges' <emph>g</emph> due to the small sample sizes (<emph>n</emph> &lt; 50) in some studies (Borenstein et al., [<reflink idref="bib11" id="ref76">11</reflink>]). The calculation for Hedges' <emph>g</emph> was performed as follows.</p> <p> <ephtml> &lt;math display="block" xmlns="http://www.w3.org/1998/Math/MathML"&gt;&lt;mrow&gt;&lt;mi&gt;H&lt;/mi&gt;&lt;mi&gt;e&lt;/mi&gt;&lt;mi&gt;d&lt;/mi&gt;&lt;mi&gt;g&lt;/mi&gt;&lt;mi&gt;e&lt;/mi&gt;&lt;mi&gt;s&lt;/mi&gt;&lt;mo&gt;&amp;#8242;&lt;/mo&gt;&lt;mi&gt;g&lt;/mi&gt;&lt;mo&gt;=&lt;/mo&gt;&lt;mfrac&gt;&lt;mrow&gt;&lt;mo stretchy="false"&gt;(&lt;/mo&gt;&lt;mi&gt;M&lt;/mi&gt;&lt;mi&gt;i&lt;/mi&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;o&lt;/mi&gt;&lt;mi&gt;s&lt;/mi&gt;&lt;mi&gt;t&lt;/mi&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mi&gt;M&lt;/mi&gt;&lt;mi&gt;i&lt;/mi&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;r&lt;/mi&gt;&lt;mi&gt;e&lt;/mi&gt;&lt;mo stretchy="false"&gt;)&lt;/mo&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mo stretchy="false"&gt;(&lt;/mo&gt;&lt;mi&gt;M&lt;/mi&gt;&lt;mi&gt;c&lt;/mi&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;o&lt;/mi&gt;&lt;mi&gt;s&lt;/mi&gt;&lt;mi&gt;t&lt;/mi&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mi&gt;M&lt;/mi&gt;&lt;mi&gt;c&lt;/mi&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;r&lt;/mi&gt;&lt;mi&gt;e&lt;/mi&gt;&lt;mo stretchy="false"&gt;)&lt;/mo&gt;&lt;/mrow&gt;&lt;mrow&gt;&lt;msup&gt;&lt;mrow&gt;&lt;mi mathvariant="italic"&gt;SD&lt;/mi&gt;&lt;/mrow&gt;&lt;mn&gt;2&lt;/mn&gt;&lt;/msup&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;r&lt;/mi&gt;&lt;mi&gt;e&lt;/mi&gt;&lt;mfenced close=")" open="("&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;o&lt;/mi&gt;&lt;mi&gt;o&lt;/mi&gt;&lt;mi&gt;l&lt;/mi&gt;&lt;/mfenced&gt;&lt;/mrow&gt;&lt;/mfrac&gt;&lt;mrow /&gt;&lt;mo&gt;&amp;#8727;&lt;/mo&gt;&lt;mrow&gt;&lt;mo stretchy="false"&gt;(&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mfrac&gt;&lt;mn&gt;3&lt;/mn&gt;&lt;mrow&gt;&lt;mn&gt;4&lt;/mn&gt;&lt;mi&gt;d&lt;/mi&gt;&lt;mi&gt;f&lt;/mi&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;/mrow&gt;&lt;/mfrac&gt;&lt;mo stretchy="false"&gt;)&lt;/mo&gt;&lt;/mrow&gt;&lt;/mrow&gt;&lt;/math&gt; </ephtml> </p> <p> <ephtml> &lt;math display="block" xmlns="http://www.w3.org/1998/Math/MathML"&gt;&lt;mrow&gt;&lt;msup&gt;&lt;mrow&gt;&lt;mi mathvariant="italic"&gt;SD&lt;/mi&gt;&lt;/mrow&gt;&lt;mn&gt;2&lt;/mn&gt;&lt;/msup&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;r&lt;/mi&gt;&lt;mi&gt;e&lt;/mi&gt;&lt;mfenced close=")" open="("&gt;&lt;mi&gt;p&lt;/mi&gt;&lt;mi&gt;o&lt;/mi&gt;&lt;mi&gt;o&lt;/mi&gt;&lt;mi&gt;l&lt;/mi&gt;&lt;/mfenced&gt;&lt;mo&gt;=&lt;/mo&gt;&lt;msqrt&gt;&lt;mfrac&gt;&lt;mrow&gt;&lt;mfenced close=")" open="("&gt;&lt;mi&gt;N&lt;/mi&gt;&lt;mi&gt;i&lt;/mi&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;/mfenced&gt;&lt;mi&gt;S&lt;/mi&gt;&lt;mi&gt;D&lt;/mi&gt;&lt;mi&gt;i&lt;/mi&gt;&lt;mo&gt;+&lt;/mo&gt;&lt;mfenced close=")" open="("&gt;&lt;mi&gt;N&lt;/mi&gt;&lt;mi&gt;c&lt;/mi&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mn&gt;1&lt;/mn&gt;&lt;/mfenced&gt;&lt;mi&gt;S&lt;/mi&gt;&lt;mi&gt;D&lt;/mi&gt;&lt;mi&gt;c&lt;/mi&gt;&lt;/mrow&gt;&lt;mrow&gt;&lt;mi&gt;N&lt;/mi&gt;&lt;mi&gt;i&lt;/mi&gt;&lt;mo&gt;+&lt;/mo&gt;&lt;mi&gt;N&lt;/mi&gt;&lt;mi&gt;c&lt;/mi&gt;&lt;mo&gt;-&lt;/mo&gt;&lt;mn&gt;2&lt;/mn&gt;&lt;/mrow&gt;&lt;/mfrac&gt;&lt;/msqrt&gt;&lt;/mrow&gt;&lt;/math&gt; </ephtml> </p> <p>In the equitation above, <emph>Mipost</emph> is the mean of the intervention group on the outcome at post-test, <emph>Mipre</emph> is the mean of the intervention group on the outcome at pre-test, <emph>Mcpost</emph> is the mean of the comparison group on the outcome at post-test, <emph>Mcpre</emph> is the mean of the comparison group on the outcome at pre-test, and SD<sups>2</sups><emph>pre</emph> is the standard deviation (SD) of the outcome for the treatment and comparison group at pre-test.</p> <p>Two studies (Voss et al., [<reflink idref="bib88" id="ref77">88</reflink>]; Whitehouse et al., [<reflink idref="bib91" id="ref78">91</reflink>]) only reported regression results. Therefore, we used an unstandardized regression coefficient and baseline SD to calculate the effect size (Borenstein et al., [<reflink idref="bib11" id="ref79">11</reflink>]). In one study (Kouhbanani et al., [<reflink idref="bib47" id="ref80">47</reflink>]), only the mean deviation was reported rather than the mean and standard deviation. Consequently, we could not calculate the effect size based on the available information. For the study (Jung et al., [<reflink idref="bib41" id="ref81">41</reflink>]) that only reported post-test data for intervention and control groups (i.e. no pre-test data), we used only the post-test data to calculate the effect size. A few studies (i.e. Moore &amp; Calvert, [<reflink idref="bib61" id="ref82">61</reflink>]; Silver &amp; Oakes, [<reflink idref="bib79" id="ref83">79</reflink>]; Tanaka et al., [<reflink idref="bib83" id="ref84">83</reflink>]; Whalen et al., [<reflink idref="bib90" id="ref85">90</reflink>]; Yuan &amp; Ip, [<reflink idref="bib97" id="ref86">97</reflink>]) reported repeated measures ANOVA with <emph>F</emph>-values for group and time interactions. We used these <emph>F</emph> results to calculate the effect size with a web-based effect calculator (Wilson and (n.d.). , [<reflink idref="bib93" id="ref87">93</reflink>]). For all effect sizes, we recorded <emph>g</emph> and the variance of <emph>g</emph> for subsequent meta-analyses.</p> <hd id="AN0191290376-11">Overall Treatment Effect Analysis</hd> <p>The overall effect size was calculated using a robust variance estimation (RVE; Fisher &amp; Tipton, [<reflink idref="bib26" id="ref88">26</reflink>]; Hedges et al., [<reflink idref="bib34" id="ref89">34</reflink>]; Tipton, [<reflink idref="bib85" id="ref90">85</reflink>]; Tipton &amp; Pustejovsky, [<reflink idref="bib86" id="ref91">86</reflink>]) model to address the fact that there were multiple dependent effect sizes from the same studies, as various assessment tools were used to measure target skills. RVE is a random effects meta-analysis model that can provide an overall effect size and be extended to meta-regression modeling for moderator analyses. We estimated the RVE model in Robumeta (Fisher et al., [<reflink idref="bib27" id="ref92">27</reflink>]) in R (R Core Team, [<reflink idref="bib70" id="ref93">70</reflink>]). All models were controlled for the correlation between within-study effect sizes and were adjusted for using a small sample correction (Hedges et al., [<reflink idref="bib34" id="ref94">34</reflink>]). This approach allows for the inclusion of dependent effect sizes and provides valid point estimates, standard errors, and hypothesis tests (Fisher &amp; Tipton, [<reflink idref="bib26" id="ref95">26</reflink>]). According to the guidelines provided by Cohen ([<reflink idref="bib17" id="ref96">17</reflink>], [<reflink idref="bib18" id="ref97">18</reflink>]), effect sizes with values of 0.20, 0.50, and 0.80 are considered small, medium, and large effects, respectively. We used <emph>I</emph><sups><emph>2</emph></sups> and <emph>τ</emph><sups><emph>2</emph></sups> (Tau square) to assess heterogeneity across studies. A smaller <emph>I</emph><sups><emph>2</emph></sups> indicates a higher level of consistency of effect sizes from study to study. The value of <emph>τ</emph><sups><emph>2</emph></sups> suggests the degree of consistency or diversity of the intervention effects across studies (Borenstein et al., [<reflink idref="bib11" id="ref98">11</reflink>]).</p> <hd id="AN0191290376-12">Moderator Analyses</hd> <p>Moderator analyses were conducted to investigate whether effect sizes varied by different subgroups. Several moderator analyses were conducted, exploring differential effects by student age (i.e. less than age 6, 6–10 years, 11–13 years, and 14–18 years), research designs (i.e. RCTs or QEDs), digital intervention types (e.g. computer-based, tablet- or phone-based, DVDs, AR, VR, and MR), outcome types (e.g. social and emotional skills, language and communication skills, daily living skills, cognitive skills, physical skills, and other outcomes), measures (i.e. research-validated or non-validated), and effect size calculation (effect size calculation included pre-test data adjustment or did not include pre-test data adjustment).</p> <hd id="AN0191290376-13">Publication Bias</hd> <p>To visualize possible publication bias, we created a funnel plot to display effect size estimates and standard errors for each study. A funnel plot could not be created using the RVE model results. Therefore, we aggregated effect sizes within each study (Klingbeil et al., [<reflink idref="bib45" id="ref99">45</reflink>]) and estimated a random-effects meta-analysis model. It's important to note that the aggregated effect size random effects model was only used to assess the publication bias. A symmetric plot in the graph indicates low concern of publication bias, while an asymmetrical plot suggests possible publication bias. In addition, we used the Fail-Safe N based on the Rosenthal approach to calculate the number of studies needed to reject significant meta-analysis results (Rosenthal, [<reflink idref="bib77" id="ref100">77</reflink>]).</p> <hd id="AN0191290376-14">Results</hd> <p>The PRISM flowchart in Fig. 1 illustrates the search process. Our Boolean search procedures used across three databases yielded 1287 records. Following deduplication, 1157 records remained for initial screening. After conducting a full-text screening, 22 articles met the inclusion criterion. From 1117 snowball-searching articles, 15 additional articles met the inclusion criteria. However, nine studies (e.g. Dickinson &amp; Place, [<reflink idref="bib22" id="ref101">22</reflink>]; Hanrahan et al., [<reflink idref="bib33" id="ref102">33</reflink>]; Kirst et al., [<reflink idref="bib44" id="ref103">44</reflink>]) were excluded due to incomplete data, which prevented the calculation of effect size estimates. Overall, 28 studies were included in the review.</p> <p>Graph: Fig. 1 Study inclusion decision tree (Adopted PRISMA Flow Diagram)</p> <hd id="AN0191290376-15">Description of Studies</hd> <p>As Table 2 shows, 28 studies included 1360 participants, of which 1222 were students diagnosed with ASD as the primary disorder. Except for one study (Young &amp; Posselt, [<reflink idref="bib96" id="ref104">96</reflink>]) that only reported the participants' age range as including preschool to elementary school-aged students, the majority of the studies (<emph>n</emph> = 14; 50%) included participants in elementary school (age 6–10), followed by preschool- and kindergarten-age children (<emph>n</emph> = 9; 32%). The average age of students across all studies was approximately 8.18 years. Most of the studies (<emph>n</emph> = 23; 82%) reported the gender of their participants. In these studies, females represented only about 13.15% of the total participants. In terms of students with disabilities, the majority of studies (<emph>n</emph> = 22; 79%) exclusively involved participants with ASD. The remaining studies included participants with ASD combined with other disorders such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), obsessive–compulsive disorder (OCD), and Dyslexia.</p> <p>Table 2 Characteristics of included studies</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Study&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Design&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;N (age)&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;Disabilities&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="3"&gt;&lt;p&gt;Intervention&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;ASD (female%)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Co-Occurring Disorders&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Length /session (mins)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Total session&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Intv. fidelity&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Beaumont &amp; Sofronof, 2008&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49 (M = 9.6&amp;#8211;9.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49 (10%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M = 67&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Beaumont et al., &lt;xref ref-type="bibr" rid="bibr7"&gt;2021&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;70 (M = 9.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;70 (14%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADHD, ODD, OCD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M = 41&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;74.2%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Chen et al., &lt;xref ref-type="bibr" rid="bibr15"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;QED&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22 (M = 4.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22 (9%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M = 60&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Eden &amp; Oren, &lt;xref ref-type="bibr" rid="bibr24"&gt;2021&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;58 (M = 5.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28 (5.2%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Frolli et al., &lt;xref ref-type="bibr" rid="bibr28"&gt;2022&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;60 (M = 9.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;60 (8.6%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;36&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Golan et al., &lt;xref ref-type="bibr" rid="bibr30"&gt;2010&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;QED&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;56 (M = 5.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;38 (4.3%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;60&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Hopkins et al., &lt;xref ref-type="bibr" rid="bibr37"&gt;2011&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49 (M = 10.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49 (10%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&amp;#8211;15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Ip et al., &lt;xref ref-type="bibr" rid="bibr38"&gt;2018&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;94 (M = 8.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;94 (12.5%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30&amp;#8211;40&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Jouen et al., &lt;xref ref-type="bibr" rid="bibr40"&gt;2017&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;QED&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24 (6&amp;#8211;8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 (0%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Jung et al., &lt;xref ref-type="bibr" rid="bibr41"&gt;2006&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;QED&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32 (5&amp;#8211;6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12 (18%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Maskey et al., &lt;xref ref-type="bibr" rid="bibr55"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32 (M = 10.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32 (22%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADHD, Dyslexia&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M = 25&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;94.5%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Moore &amp; Calvert, &lt;xref ref-type="bibr" rid="bibr61"&gt;2000&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 (3&amp;#8211;6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 (14%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Parsons et al., &lt;xref ref-type="bibr" rid="bibr63"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;59 (M = 5.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;59 (18.7%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADHD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11.3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;90&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;57%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Petrovska &amp; Trajkovski, &lt;xref ref-type="bibr" rid="bibr67"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32 (M = 10.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32 (31%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ID&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15&amp;#8211;30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24&amp;#8211;48&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Rice et al., &lt;xref ref-type="bibr" rid="bibr76"&gt;2015&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31(M = 7.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31 (NR)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Silver &amp; Oakes, &lt;xref ref-type="bibr" rid="bibr79"&gt;2001&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22(M = 14.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22 (NR)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sosnowski et al., &lt;xref ref-type="bibr" rid="bibr80"&gt;2022&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;54 (M = 8.6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;54 (13%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt; &amp;#62; 15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18&amp;#8211;30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Tanaka et al., &lt;xref ref-type="bibr" rid="bibr83"&gt;2010&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;79 (M = 11)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;79 (21%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100/wk&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Thomeer et al., &lt;xref ref-type="bibr" rid="bibr84"&gt;2015&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43 (M = 8.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43 (11%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;90&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;98%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;V&amp;#233;lez-Coto et al., &lt;xref ref-type="bibr" rid="bibr87"&gt;2017&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;QED&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;125 (M = 13.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;65 (28%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CLF ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&amp;#8211;15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Voss et al., &lt;xref ref-type="bibr" rid="bibr88"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;52 (M = 8.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;52 (11%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Vuki&amp;#263;evi&amp;#263; et al., &lt;xref ref-type="bibr" rid="bibr89"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10 (M = 10.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10 (0%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&amp;#8211;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Whalen et al., &lt;xref ref-type="bibr" rid="bibr90"&gt;2010&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;47 (3&amp;#8211;6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;47 (NR)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;90&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Whitehouse et al., &lt;xref ref-type="bibr" rid="bibr91"&gt;2017&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75 (M = 3.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75 (20%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;180&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Williams et al., &lt;xref ref-type="bibr" rid="bibr92"&gt;2012&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;55 (M = 5.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;55 (NR)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Yerys et al., &lt;xref ref-type="bibr" rid="bibr95"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19 (M = 11)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19 (10%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADHD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Young &amp; Posselt, &lt;xref ref-type="bibr" rid="bibr96"&gt;2012&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 (4&amp;#8211;8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 (NR)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&amp;#8211;10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Yuan &amp; Ip, &lt;xref ref-type="bibr" rid="bibr97"&gt;2018&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;QED&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;72 (M = 8.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;72 (11%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>RCT</emph> Randomized control trial, <emph>QED</emph> Quasi-experimental design, <emph>ASD</emph> Autism spectrum disorder, <emph>ADHD</emph> Attention-deficit/hyperactivity disorder, <emph>ODD</emph> Oppositional defiant disorder, <emph>OCD</emph> Obsessive–compulsive disorder, <emph>CLF</emph> Cognitively low-functioning, <emph>ID</emph> Intellectual disability, <emph>M</emph> Mean, <emph>wk</emph> Week, <emph>NR</emph> Not report, <emph>Intv.</emph> Intervention</p> <p>Most studies (<emph>n</emph> = 22; 79%) employed an RCT design for their interventions, while six studies (21%) used QEDs (i.e. participants not randomly assigned to groups). The outcomes measured varied across studies. Most studies (<emph>n</emph> = 22; 79%) included social-emotional skills (SES) as their primary focus during intervention (see Table 3). A variety of technology tools and platforms were utilized in the interventions. Half of the studies (<emph>n</emph> = 14; 50%) incorporated computer-based programs, such as the Junior Detective game (Beaumont &amp; Sofronoff, [<reflink idref="bib6" id="ref105">6</reflink>]), the Secret Agent Society social training computer program (Beaumont et al., [<reflink idref="bib7" id="ref106">7</reflink>]), and Let's Face it! computer-based intervention (Tanaka et al., [<reflink idref="bib83" id="ref107">83</reflink>]). Six studies (21%) conducted intervention using VR, while four studies (14%) utilized tablets (e.g. iPads) or smartphone applications. The least (<emph>n</emph> = 1; 4%) used digital intervention strategy is MR.</p> <p>Table 3 Effect size, variance, and other characteristics of included studies</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Study&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Target skills&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Intv. types&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Social validity&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;ES (agg.)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Var&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Weight&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Beaumont &amp; Sofronof, 2008&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1.04&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;14.56&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Beaumont et al., &lt;xref ref-type="bibr" rid="bibr7"&gt;2021&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.54&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.04&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;24.59&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Chen et al., &lt;xref ref-type="bibr" rid="bibr15"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;LCS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.39&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.14&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;7.20&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Eden &amp; Oren, &lt;xref ref-type="bibr" rid="bibr24"&gt;2021&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.37&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.09&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;11.75&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Frolli et al., &lt;xref ref-type="bibr" rid="bibr28"&gt;2022&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;4.03&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.16&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;6.44&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Golan et al., &lt;xref ref-type="bibr" rid="bibr30"&gt;2010&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, LCS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DVDs&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1.49&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;11.79&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Hopkins et al., &lt;xref ref-type="bibr" rid="bibr37"&gt;2011&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.54&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.09&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;10.55&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Ip et al., &lt;xref ref-type="bibr" rid="bibr38"&gt;2018&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.32&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.03&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;31.86&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Jouen et al., &lt;xref ref-type="bibr" rid="bibr40"&gt;2017&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, LCS, Cog., Living&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.04&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.10&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;10.05&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Jung et al., &lt;xref ref-type="bibr" rid="bibr41"&gt;2006&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cog., PS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.43&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.09&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;10.70&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Maskey et al., &lt;xref ref-type="bibr" rid="bibr55"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;12.23&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Moore &amp; Calvert, &lt;xref ref-type="bibr" rid="bibr61"&gt;2000&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;LCS, Cog&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1.65&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.27&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;3.72&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Parsons et al., &lt;xref ref-type="bibr" rid="bibr63"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, LCS, PS, Cog&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tablet/phone&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.07&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.04&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;26.68&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Petrovska &amp; Trajkovski, &lt;xref ref-type="bibr" rid="bibr67"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1.44&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.10&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;10.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Rice et al., &lt;xref ref-type="bibr" rid="bibr76"&gt;2015&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, Cog&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.45&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;12.08&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Silver &amp; Oakes, &lt;xref ref-type="bibr" rid="bibr79"&gt;2001&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1.02&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.14&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;7.30&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sosnowski et al., &lt;xref ref-type="bibr" rid="bibr80"&gt;2022&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.56&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;12.92&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Tanaka et al., &lt;xref ref-type="bibr" rid="bibr83"&gt;2010&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, Cog&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.20&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.03&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;34.08&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Thomeer et al., &lt;xref ref-type="bibr" rid="bibr84"&gt;2015&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.71&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.06&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;17.13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;V&amp;#233;lez-Coto et al., &lt;xref ref-type="bibr" rid="bibr87"&gt;2017&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, LCS, Cog&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.17&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.03&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;33.66&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Voss et al., &lt;xref ref-type="bibr" rid="bibr88"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tablet/phone&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.19&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.04&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;27.78&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Vuki&amp;#263;evi&amp;#263; et al., &lt;xref ref-type="bibr" rid="bibr89"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.63&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.42&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;2.38&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Whalen et al., &lt;xref ref-type="bibr" rid="bibr90"&gt;2010&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;LCS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.46&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.11&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;8.95&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Whitehouse et al., &lt;xref ref-type="bibr" rid="bibr91"&gt;2017&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;LCS, Cog., PS, other&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tablet/phone&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.20&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.03&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;31.89&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Williams et al., &lt;xref ref-type="bibr" rid="bibr92"&gt;2012&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES, Cog&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DVDs&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.15&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.05&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;19.13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Yerys et al., &lt;xref ref-type="bibr" rid="bibr95"&gt;2019&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cog., SES, other&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Tablet/phone&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Positive&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.55&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.14&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;7.23&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Young &amp; Posselt, &lt;xref ref-type="bibr" rid="bibr96"&gt;2012&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DVDs&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.50&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.10&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;9.60&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Yuan &amp; Ip, &lt;xref ref-type="bibr" rid="bibr97"&gt;2018&lt;/xref&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;NR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.60&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.04&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;22.95&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>SES</emph> Social and emotional skills, <emph>LCS</emph> Language and communication skills, <emph>Cog.</emph> Cognitive skills, <emph>Living</emph> Daily living skills, <emph>PS</emph> Physical skills, <emph>Intv </emph>Intervention, <emph>Cmp-based</emph> Computer-based, <emph>DVDs</emph> Digital versatile discs, <emph>VR</emph> Virtual reality, <emph>MR</emph> Mixed reality, <emph>NR</emph> Not report, <emph>ES</emph> Effect size, <emph>agg.</emph> Aggregated effect size for each study, <emph>Var.</emph> Variance</p> <p>Most studies (<emph>n</emph> = 27; 96%) provided intervention dosage information, including the length of each session and total number of sessions. There was considerable variation in intervention dosage. The average length of each training session ranged from 5 to 100 min. On average, the length of each session was approximately 32.78 min. Similarly, the number of intervention sessions varied across the studies, ranging from 6 to 90 sessions. The average number of total sessions across the studies was 28.59.</p> <p>Only five studies (18%) reported intervention fidelity, which indicates the degree to which the interventions were delivered as planned (see Table 2). Among the five studies, three studies (60%) followed the intervention protocol and achieved over 90% fidelity. Seven of the 28 studies (25%) reported social validity, indicating high levels of participant satisfaction with the intervention (see Table 3). Participants (e.g. parents, teachers, and children and adolescents) found the digital interventions were acceptable, favorable, and easy to understand and use.</p> <hd id="AN0191290376-16">Overall Digital Interventions Effect</hd> <p>Each included study examined the effect of digital interventions on a range of social, cognitive, and adaptive skills in students with ASD using a variety of measures. The overall effect size was calculated using an intercept-only RVE meta-regression model to determine the average treatment effect. The number of outcome measures in each study varied, ranging from 1 to 10. There are 150 total effect sizes included in the 28 studies. The overall treatment effect size was medium to large, with <emph>g</emph> = 0.62, 95% CI [0.36, 0.88], <emph>p</emph> &lt; 0.001. The estimate of <emph>Tau</emph> square indicates moderate (i.e. <emph>T</emph><sups><emph>2</emph></sups> = 0.42) heterogeneity of effect size across studies. Based on the <emph>I</emph><sups><emph>2</emph></sups>, about 80% of the variability can be explained by differences between studies rather than random error.</p> <hd id="AN0191290376-17">Moderator Analysis Results</hd> <p>Table 4 shows the results of the moderator analyses based on different subgroups (e.g. age, design, types of outcomes) and included all 150 effect sizes across 28 studies. Except for one study (Young &amp; Posselt, [<reflink idref="bib96" id="ref108">96</reflink>]) whose participants included two age groups, 23 articles (121 effect sizes) involved participants who were less than elementary school age and four studies (23 effect sizes) focused on middle or high school students. We found that preK-K children and high school students demonstrated higher overall improvement than elementary and middle school students.</p> <p>Table 4 Moderator analysis results</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2" colspan="2"&gt;&lt;p&gt;Subgroup&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Estimate&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;N/n&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;Confidence Interval&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;&lt;italic&gt;t&lt;/italic&gt;-value&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;&lt;italic&gt;dfs&lt;/italic&gt;&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Lower bound&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Upper bound&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Age&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Prek-K&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.53&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9/47&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.12&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.93&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.01&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7.58&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;Elementary&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.21&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14/74&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.39&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.82&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.74&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16.78&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;Middle&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.24&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3/20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.84&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.36&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.48&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;High&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.49&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1/3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.09&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.90&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.81&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7.85&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" rowspan="2"&gt;&lt;p&gt;Design&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Quasi&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.51&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6/23&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.04&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.05&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.40&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.95&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;RCT&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22/127&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.46&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.75&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.53&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8.00&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" rowspan="5"&gt;&lt;p&gt;Types of DI&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Cmp-based&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.62&amp;#42;&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14/73&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.36&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.87&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.23&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.81&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;DVDs&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.09&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3/18&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.48&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.21&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.92&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Tablet/phone&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.38&amp;#42;&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4/28&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.76&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.004&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 2.61&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.92&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;MR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.01&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1/1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.24&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.27&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.11&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.81&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;VR&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.26&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6/30&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.91&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.44&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.41&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" rowspan="2"&gt;&lt;p&gt;Valid measure&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Non-validate&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.88&amp;#42;&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18/55&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.27&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.48&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.14&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.8&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Validate&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.45&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19/95&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.04&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.55&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.1&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" rowspan="6"&gt;&lt;p&gt;Types of outcomes&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;SES&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.72&amp;#42;&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22/102&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.35&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.08&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.07&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.59&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Cog&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.29&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10/23&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.82&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.25&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.88&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;LCS&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.27&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8/16&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.76&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.22&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.31&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6.43&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Daily living&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.94&amp;#42;&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1/1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.31&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.57&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 5.33&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.59&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Other&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.29&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 4.41&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.29&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.80&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.05&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;PS&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&amp;#8722; 0.22&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4/5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 0.97&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.53&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8722; 1.15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.25&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" rowspan="2"&gt;&lt;p&gt;Control pre-adjusted&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Non-control&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.43&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1/3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Control&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.20&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27/147&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.077&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.47&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.47&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25.5&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>*<emph>p</emph> &lt;.10, **<emph>p</emph> &lt;.05, *** <emph>p</emph> &lt;.01. <emph>DI</emph> Digital interventions, <emph>N</emph> the total number of articles, <emph>n</emph> the total number of effect sizes in these articles, <emph>RCT</emph> Randomized control trial, <emph>Cmp-based</emph> Computer-based, <emph>DVDs</emph> Digital versatile discs, <emph>MR</emph> Mixed reality, <emph>VR</emph> Virtual reality, <emph>SES</emph> Social-emotional skills, <emph>Cog.</emph> Cognitive skills, <emph>LCS</emph> Language and communication skills, <emph>PS</emph> Physical skills</p> <p>Twenty-two studies (127 effect sizes) used an RCT design, while six studies (23 effect sizes) conducted QEDs. The results indicate no statistically significant differences between the design of the included studies. Regarding interventions, 14 studies (73 effect sizes) evaluated the effect of computer-based programs on students' outcomes, whereas four studies (28 effect sizes) utilized tablet or smartphone-based interventions. The results (see Table 4) revealed that studies using tablet or smartphone-based interventions had statistically significant smaller effect sizes than computer-based interventions.</p> <p>A study may use both validate and non-validate measures to assess students' outcomes. As Table 4 shows, 19 studies (95 effect sizes) utilized validate measurements, while 18 studies (55 effect sizes) utilized non-validate (researcher-developed) assessment tools. The results in Table 4 illustrate statistically significant differences between studies that used validated and non-validated measures. A larger effect size was demonstrated in studies using the non-validated measurements compared to those employing validated measurements. For student outcomes, we found a statistically significant larger effect on social-emotional skills (22 studies, 102 effect sizes) compared with cognitive skills (10 studies, 23 effect sizes), language and communication skills (8 studies, 16 effect sizes), daily living skills (1 study, 1 effect size), physical skills (4 studies, 5 effect sizes), and other skills (2 studies, 3 effect sizes). We found the smallest effect size on daily living skills when compared with social-emotional skills. Only one study did not report pre-test data, indicating it had an unadjusted effect size (Jung et al., [<reflink idref="bib41" id="ref109">41</reflink>]). We estimated a model to compare the pre-adjusted and non-pre-adjusted effect sizes. The results show no significant difference between the two effect size approaches.</p> <hd id="AN0191290376-18">Publication Bias Results</hd> <p>To assess publication bias, we estimated a random-effects model with aggregated effect sizes (i.e. all dependent effect sizes within a study were aggregated so that each study contributed only one effect size to the model). Table 3 depicts aggregated effect size for each study. We then used the random-effects model to create a funnel plot depicted in Fig. 2. The overall treatment effect from the aggregated effect size for each study is <emph>g</emph> = 0.64 (SE = 0.13), <emph>p</emph> &lt; 0.001, which was congruent with the RVE model. The funnel plot displays a small gap in the lower left-hand side and the upper right-hand side, suggesting a small level of asymmetry in the treatment effects. However, the results of the rank test for the funnel plow show no asymmetrical results or potential bias, with Kendall's tau = − 0.02, <emph>p</emph> &gt; 0.05. The results of the Rosenthal Fail-Safe N approach suggest that 1314 null effect studies are needed to confirm the null hypothesis. These results suggest little evidence of publication bias.</p> <p>Graph: Fig. 2 Funnel plot of aggregate effect sizes of included studies</p> <hd id="AN0191290376-19">Discussion</hd> <p>The purpose of this study was to synthesize the effectiveness of digital interventions in improving various social, cognitive, and adaptive skills for children and adolescents with ASD using a meta-analytic approach. Unlike prior literature reviews (e.g. Chen et al., [<reflink idref="bib16" id="ref110">16</reflink>]; Grynszpan et al., [<reflink idref="bib32" id="ref111">32</reflink>]; Lorenzo et al., [<reflink idref="bib51" id="ref112">51</reflink>]; Odom et al., [<reflink idref="bib62" id="ref113">62</reflink>]; Wu et al., [<reflink idref="bib94" id="ref114">94</reflink>]), this research only included studies with a treatment and comparison group (i.e. QEDs and RCTs). We did this to provide higher-quality evidence and enhance the overall reliability and robustness of the findings. The large number of studies using QEDs and RCTs signifies a growing interest and recognition of the importance of digital interventions to address the needs of children and adolescents with ASD.</p> <p>While earlier meta-analysis studies (e.g. Sandgreen et al., [<reflink idref="bib78" id="ref115">78</reflink>]) used random-effect models to calculate effect sizes for studies, our study used the robust variance estimation model to include all study outcomes and address effect size dependence. Overall, the results suggest a medium to a large overall effect size of digital interventions on treatment outcomes for children and adolescents with ASD. However, there was a moderate degree of heterogeneity across studies, suggesting that the effect size was not universal across studies.</p> <p>The technologies utilized in these digital intervention studies included computers, tablets (e.g. iPads), smartphones, DVDs, VR, and MR, aligning with the findings from previous reviews (Grynszpan et al., [<reflink idref="bib32" id="ref116">32</reflink>]; Pi et al., [<reflink idref="bib68" id="ref117">68</reflink>]). Some prior reviews focused on XR (e.g. Karami et al., [<reflink idref="bib43" id="ref118">43</reflink>]; Zhang et al., [<reflink idref="bib98" id="ref119">98</reflink>]) and reported positive impacts on the different skills of children and adolescents with ASD. Karami et al. ([<reflink idref="bib43" id="ref120">43</reflink>]) demonstrated a large effect size of VR and AR training in improving daily living skills, social skills, and communication skills for children with ASD. In our review, seven studies utilized XR to improve physical skills, social-emotional skills, and cognitive skills. As an innovative technology, XR provides interactive and immersive experiences through visual, auditory, and tactile stimuli, offering a controlled environment without exposing individuals to social pressures found in real environments (Parsons, [<reflink idref="bib64" id="ref121">64</reflink>]; Rajendran, [<reflink idref="bib71" id="ref122">71</reflink>]). Although innovative and exciting, evidence from this meta-analysis suggests that XR is as effective as the other technology modalities. However, we must acknowledge that technology continues to advance rapidly and that some of the technologies (e.g. DVD) included in this meta-analysis are already outdated. Moreover, emerging technologies may have a more significant impact on student outcomes.</p> <p>Furthermore, our analysis of diverse outcomes in digital interventions suggests that there may be varying levels of effectiveness by outcome. Digital interventions targeting improvements in social-emotional skills resulted in larger effect sizes than interventions targeting physical skills, communication skills, and cognitive skills. The smallest effect sizes were found in the study targeting daily living skills. These findings are consistent with a previous review by Pi et al. ([<reflink idref="bib68" id="ref123">68</reflink>]), suggesting that technology-assisted interventions were more successful in enhancing emotional recognition. However, another review (Karami et al., [<reflink idref="bib43" id="ref124">43</reflink>]) showed that XR-based interventions had the most significant impact on improving daily living skills. Due to the majority of studies measuring social emotional or language and communication skills (82%), our analysis cannot ascertain why some outcomes actualized larger or smaller effect sizes, and we caution against over-interpreting the findings. The discrepancies in the findings may be due to how the outcomes were scaled or if the interventions targeted certain skills but measured related skills to evaluate concomitant effects. Yet, the results are important and suggest that more research is needed to learn if digital interventions are better for certain outcomes for children and adolescents with ASD.</p> <p>Moderator analyses revealed that computer-based interventions had larger effect sizes than tablet/smartphone-based interventions. A systematic review by Ramdoss et al. ([<reflink idref="bib73" id="ref125">73</reflink>]) suggested that the effectiveness of computer-based interventions may be due to several advantages over traditional one-to-one or group instruction for individuals with ASD. These advantages include decreased distractions, easier instruction differentiation, individual incorporation, and reliance on relative visual learning strengths. All digital interventions allow for customization, combining words, pictures, speech, and animation in an interactive way to suit various levels of understanding and interests of students (Brown et al., [<reflink idref="bib12" id="ref126">12</reflink>]). These approaches facilitate the delivery of digital learning sessions repetitively, allowing students to practice for multiple iterations until mastery is achieved (Esposito et al., [<reflink idref="bib25" id="ref127">25</reflink>]). However, it may be that computer-based interventions are more adaptable and involved than tablet- and smartphone-based interventions because of computing power. Yet, tablet- and smartphone-based interventions provide educational opportunities through various recreational, educational, and interactive games that can be used anywhere, including home and school settings (Allen et al., [<reflink idref="bib1" id="ref128">1</reflink>]). Even though the effect sizes were smaller, the effect sizes suggest that tablet- and smartphone-based interventions significantly improve the development skills of children and adolescents with ASD. Therefore, it is essential to carefully consider the existing abilities and preferences of children with ASD when designing and choosing computer- and tablet/phone-based interventions to address their needs and sustain their motivation.</p> <p>Our study found a higher effect sizes among preK-K children and high school students compared to elementary and middle school students, indicating a different results from previous studies (e.g. Karami et al., [<reflink idref="bib43" id="ref129">43</reflink>]; Sandgreen et al., [<reflink idref="bib78" id="ref130">78</reflink>]). Due to the lack of analysis on skill acquisition across age groups and limited sample size for middle and high school students, it is challenging to make a conclusion about the effectivness of digital interventions for different age groups. However, it is worth noting that there were more studies involving elementary-aged students than preK-K children and adolescents. Most previous studies reviewed the effect of digital interventions on individuals with ASD across ages (i.e. from preschool to elementary), while few specifically focused on adolescents with ASD (e.g. Odom et al., [<reflink idref="bib62" id="ref131">62</reflink>]). Thus, there is a need for more research on digital intervention effectiveness based on different age groups. Additionally, there was a lack of significant differences in effect sizes between QEDs and RCT designs, suggesting that effect sizes were robust even in studies that could not control all possible confounds on the treatment effect. However, the smaller number of quasi-experimental research papers on digital interventions makes it difficult to draw too many direct comparisons.</p> <p>Our analysis also reflected an existing trend in research where females are disproportionately excluded (D'Mello et al., [<reflink idref="bib20" id="ref132">20</reflink>]). This result is likely explained by the higher frequency of ASD diagnoses among males than females. Maenner et al. ([<reflink idref="bib53" id="ref133">53</reflink>]) reported ASD is 3.8 times more prevalent among boys than girls. However, D'Mello et al. ([<reflink idref="bib20" id="ref134">20</reflink>]) revealed that public data on community ASD diagnoses had more balanced sex ratios on ASD diagnoses compared to standardized assessments. Notably, confirmatory Autism Diagnostic Observation Schedule (ADOS) diagnoses tended to exclude females at a rate over 2.5 higher than males with ASD, revealing a limitation in the accuracy of identifying ASD among females using the current "goal-standard" ASD measures (D'Mello et al., [<reflink idref="bib20" id="ref135">20</reflink>]; Ratto et al., [<reflink idref="bib74" id="ref136">74</reflink>]). These "standardized assessment tools" present multiple barriers, using male-centric diagnostic criteria for evaluating social and communication abilities, behavioral patterns, language, and restrictive and repetitive behaviors and interests (Lockwood Estrin et al., [<reflink idref="bib50" id="ref137">50</reflink>]). Therefore, we must acknowledge the results may not generalize to all female children and adolescents with ASD as they were not widely represented in the included studies.</p> <p>Only one research study (Hopkins et al., [<reflink idref="bib37" id="ref138">37</reflink>]) categorized children with ASD into high-functioning (HFA) and low-functioning (LFA) autism based on their varied Kaufman Brief Intelligence Test (KBIT) results (i.e. KBIT greater or lower than 70). Then, they compared the effects of intervention on two groups. The results indicate that children with LFA showed improvements in emotion recognition and social interactions as a result of using digital interventions, including decreases in the avoidance of social overtures made by peers (Hopkins et al., [<reflink idref="bib37" id="ref139">37</reflink>]). Children with HFA also showed improvements in facial recognition, along with emotion recognition and social interactions (e.g. initiations of more social activities with peers) in natural environments. Considering concerns about how well IQ scores accurately represent children's functional abilities (Alvares et al., [<reflink idref="bib2" id="ref140">2</reflink>]), future research may need to consider using comprehensive diagnostic evaluation indicators to better categorize children with ASD instead of relying solely on IQ scores.</p> <hd id="AN0191290376-20">Limitations and Future Directions</hd> <p>While the current study only included studies using QEDs and RCT designs, there are several limitations that need to be considered when interpreting the results. First, we need to interpret the results with considerable caution, given that a substantial proportion of the included studies focused on social-emotional outcomes (68%), employed computer-based interventions (48%), and utilized validated measures (65%) for the moderator analysis. Future studies need to include more studies targeting other skills, such as communication and daily living skills, using varied digital intervention strategies (e.g. tablet- or phone-based intervention, MR, XR). The outcome domains, especially social-emotional and language/communication skills, often exhibit considerable overlap, making it difficult to provide clear-cut or consistently defined categorizations across studies. Therefore, the overlap of categorizations is another limitation that needs to be cautious when interpreting results. Additionally, while our study categorized measures as validated and non-validated to maximize assessment scope, it is critical to analyze different categories (e.g. observational in situ or within condition) for non-validated measures when evaluating skill generalization for children with ASD. Future studies may explore potential differences across these measurement categories.</p> <p>Secondly, we compared groups with digital interventions and other groups, such as non-digital interventions (e.g. Frolli et al., [<reflink idref="bib28" id="ref141">28</reflink>]; Voss et al., [<reflink idref="bib88" id="ref142">88</reflink>]), or waiting list (e.g. Ip et al., [<reflink idref="bib38" id="ref143">38</reflink>]; Maskey et al., [<reflink idref="bib55" id="ref144">55</reflink>]), or other types of digital interventions (e.g. Rice et al., [<reflink idref="bib76" id="ref145">76</reflink>]; Yerys et al., [<reflink idref="bib95" id="ref146">95</reflink>]), rather than exclusively examining whether digital interventions are superior to non-digital ones. Therefore, we must acknowledge the limitation in our study's scope and generalizability. Future research should consider conducting comparative studies that directly examine the difference between digital and non-digital approaches. Moreover, the scarcity of studies on females with ASD in the review limited our ability to compare results by gender for individuals with ASD. The presence of comorbidities of participants (e.g. ASD with ID, ASD with ADHD) in some studies included in the review could potentially confound the conclusions regarding the effectiveness of digital interventions for children with ASD, highlighting an area in need of further research attention.</p> <p>Despite using three databases and conducting a snowball searching process, there remains a possibility that studies indexed in other databases might have been missed during the search process. Specifically, we must acknowledge that the review was completed in September 2022 and new research may have been published that would have met our inclusion criteria. In addition, limiting our review to English-only peer-reviewed studies might have restricted our access to additional studies, such as these, dissertations, and articles published in other languages. Moreover, several studies (e.g. Dickinson &amp; Place, [<reflink idref="bib22" id="ref147">22</reflink>]; Hanrahan et al., [<reflink idref="bib33" id="ref148">33</reflink>]; Kirst et al., [<reflink idref="bib44" id="ref149">44</reflink>]; Lorenzo et al., [<reflink idref="bib52" id="ref150">52</reflink>]) meeting the inclusion criteria had to be excluded due to incomplete data (e.g. no mean and standard deviation reported) necessary for analyzing effect sizes. However, the results of Fail-Safe N suggest that over 1000 null effect studies are needed to make the overall effect size no longer statistically significant. Therefore, we are confident in the results of the meta-analysis even in light of these limitations..</p> <p>Finally, the screening and coding process involved more than two coders, which may have increased complexity in ensuring consistency across coding decisions. Even though the coders were trained by the first author and demonstrated reliability, it might be better to include the primary and secondary coders to minimize the need for additional training and potential coding inconsistencies. Further research is needed to see if there are coding issues related to the number of coders when conducting systematic literature reviews.</p> <hd id="AN0191290376-21">Conclusion</hd> <p>The current study contributes to the understanding of the effectiveness of digital interventions for improving developmental skills, especially social-emotional skills, for children and adolescents with ASD. Both computer-based and tablet- and smartphone-based interventions are highly customizable, which makes them convenient for tailoring to the needs of different learners with ASD under age 18. Additionally, the portability of tablets and smartphones makes them very appealing for interventions in a variety of contexts and locations. The results suggest that practitioners should consider digital interventions as complementary to traditional behavioral interventions. Furthermore, our study also calls for a need to focus on involving more females and young children and adolescents with ASD in digital intervention research. Overall, the results of this meta-analysis suggest that digital interventions are a promising practice for improving outcomes for children with ASD.</p> <hd id="AN0191290376-22">Author Contributions</hd> <p>The first draft of the manuscript was written by the first, fourth, and fifth authors. The first author contributed the majority of manuscript writing and review. The second author assisted with data analysis and draft review. The third author contributed to the study conception and draft review. The fourth, fifth, and the last two authors were trained by the first author on conducting article screening, coding, and data collection. All listed authors approved the manuscript before submission.</p> <hd id="AN0191290376-23">Funding</hd> <p>We did not receive any funding to support the study.</p> <hd id="AN0191290376-24">Declarations</hd> <p></p> <hd id="AN0191290376-25">Conflict of interest</hd> <p>The authors have no conflicts of interest to declare that are relevant to the content of this article.</p> <hd id="AN0191290376-26">Supplementary Information</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary file1 (DOCX 11 kb)</p> <hd id="AN0191290376-27">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0191290376-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref128" type="bt">1</bibl> <bibtext> Allen ML, Hartley C, Cain K. iPads and the use of "apps" by children with autism spectrum disorder: Do they promote learning?. 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| Items | – Name: Title Label: Title Group: Ti Data: The Use of Digital Interventions for Children and Adolescents with Autism Spectrum Disorder--A Meta-Analysis – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Fang+Xu%22">Fang Xu</searchLink> (ORCID <externalLink term="http://orcid.org/0009-0004-5557-2089">0009-0004-5557-2089</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nicholas+Gage%22">Nicholas Gage</searchLink><br /><searchLink fieldCode="AR" term="%22Songtian+Zeng%22">Songtian Zeng</searchLink><br /><searchLink fieldCode="AR" term="%22Madian+Zhang%22">Madian Zhang</searchLink><br /><searchLink fieldCode="AR" term="%22Anastasiia+Iun%22">Anastasiia Iun</searchLink><br /><searchLink fieldCode="AR" term="%22Margaret+O'Riordan%22">Margaret O'Riordan</searchLink><br /><searchLink fieldCode="AR" term="%22Eunsuk+Kim%22">Eunsuk Kim</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2026 56(2):499-515. – Name: Avail Label: Availability Group: Avail Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 17 – Name: DatePubCY Label: Publication Date Group: Date Data: 2026 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Information Analyses – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Skill+Development%22">Skill Development</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Emotional+Learning%22">Social Emotional Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Technology+Uses+in+Education%22">Technology Uses in Education</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Technology%22">Educational Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Skills%22">Language Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Skills%22">Communication Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Development%22">Cognitive Development</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Development%22">Physical Development</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescent+Development%22">Adolescent Development</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s10803-024-06563-4 – Name: ISSN Label: ISSN Group: ISSN Data: 0162-3257<br />1573-3432 – Name: Abstract Label: Abstract Group: Ab Data: This comprehensive meta-analysis aimed to assess the effectiveness of digital interventions in improving developmental skills for children and adolescents with autism spectrum disorder (ASD). We conducted a systematic literature search based on three databases. A pre-test adjusted between-group standardized effect size was computed for effect size synthesis. We utilized a robust variance estimation model to analyze overall treatment effect. Moderator analyses and publication bias were also addressed. Twenty-eight studies (150 effect sizes) using randomized control trials (RCT; n = 22) or quasi-experimental designs (QED; n = 6) were included. Most studies (n = 22) included social-emotional skills as primary outcomes. The meta-analysis revealed a medium to large overall effect size, with Hedges' g = 0.62, 95% CI [0.36, 0.88], p < 0.001. We found that digital interventions have a statistically significantly large effect on enhancing social-emotional skills compared with language and communication skills, cognitive skills, daily living skills, and physical skills. The results of moderator analyses indicated that computer-based interventions have larger effect sizes in comparison to tablet/smartphone-based interventions. No statistically significant differences were observed between studies utilizing RCT and those using QED. We recommended the integration of digital interventions as supplemental resources in behavioral and educational interventions. Further research needs to focus on more females, young children, and adolescents with ASD in digital intervention research. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2026 – Name: AN Label: Accession Number Group: ID Data: EJ1504756 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1504756 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10803-024-06563-4 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 17 StartPage: 499 Subjects: – SubjectFull: Intervention Type: general – SubjectFull: Skill Development Type: general – SubjectFull: Children Type: general – SubjectFull: Adolescents Type: general – SubjectFull: Autism Spectrum Disorders Type: general – SubjectFull: Social Emotional Learning Type: general – SubjectFull: Technology Uses in Education Type: general – SubjectFull: Educational Technology Type: general – SubjectFull: Language Skills Type: general – SubjectFull: Communication Skills Type: general – SubjectFull: Cognitive Development Type: general – SubjectFull: Daily Living Skills Type: general – SubjectFull: Physical Development Type: general – SubjectFull: Child Development Type: general – SubjectFull: Adolescent Development Type: general Titles: – TitleFull: The Use of Digital Interventions for Children and Adolescents with Autism Spectrum Disorder--A Meta-Analysis Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Fang Xu – PersonEntity: Name: NameFull: Nicholas Gage – PersonEntity: Name: NameFull: Songtian Zeng – PersonEntity: Name: NameFull: Madian Zhang – PersonEntity: Name: NameFull: Anastasiia Iun – PersonEntity: Name: NameFull: Margaret O'Riordan – PersonEntity: Name: NameFull: Eunsuk Kim IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 0162-3257 – Type: issn-electronic Value: 1573-3432 Numbering: – Type: volume Value: 56 – Type: issue Value: 2 Titles: – TitleFull: Journal of Autism and Developmental Disorders Type: main |
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