Umbrella Review: Mental Health Interventions for Autistic Children and Adolescents: An Overview of Systematic Reviews and Participatory Equity Synthesis

Objective: Autistic children and adolescents experience high rates of mental health conditions. Objectives were to summarize systematic review evidence and describe quantity and quality of evidence on interventions for the mental health of autistic children and adolescents, how systematic reviews categorize and synthesize intervention effectiveness, how equity-relevant characteristics are addressed, and implications of evidence on equity-relevant characteristics. Method: MEDLINE, Embase, PsycINFO, and CINAHL databases were searched from 2014 to 2024 to identify systematic reviews on mental health conditions in autistic children and adolescents. After screening of 4,027 records, 31 reviews were included. Data were extracted and assessed in terms of intervention effectiveness and in relation to equity-relevant characteristics. Participatory synthesis was guided by a research advisory group comprising people with lived experience of autism, whose perspectives were incorporated into multiple stages of the research process. Results: The intervention with the best evidence was cognitive-behavioral therapy, which was effective for all mental health outcomes covered. There was also weak evidence for mindfulness (for depression and anxiety), social skills training (for depression and anxiety) and pharmacological therapies (for anxiety, obsessions, and compulsions). Most reviews were rated as being of low or critically low quality. With few exceptions, reviews did not address equity dimensions of interventions in depth. Conclusion: Current evidence does not highlight the equity dimensions that impact the effectiveness of mental health interventions for autistic children and adolescents. Future work should take an intervention-wide, equity-deep approach to synthesis and to design and analysis of primary trials. Study registration information: Mental health interventions for autistic children and adolescents: overview of systematic reviews and participatory equity synthesis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024612863.