Cognitive rehabilitation with neurodevelopmental disorder: A systematic review

Abstract

BACKGROUND:

A variety of cognitive rehabilitation has gained popularity in early childhood with neurodevelopmental disorder at clinical rehabilitation settings.

OBJECTIVES:

The purpose of this review was to analyze the cognitive therapies used and to analyze the methods applied in children with neurodevelopmental disorders.

METHODS:

This study searched for experimental studies published between 2006 and 2016 using two databases including EBSCOhost and PubMed. The keywords used included “diagnosis included in the neurodevelopment disorder of DSM-5” AND “cognition” or “cognitive function”. After the searching, this study reviewed the abstracts initially and assessed full articles subsequently, and then we selected total of 26 studies. Two reviewers independently assessed the level of evidence of qualitative studies using the PICO method, and this study analyzed the frequency of participants, intervention information, and methods used were analyzed.

RESULTS:

This study was generated a total of 3,115 publications of literature review. Twenty-six studies were included in this review as for the levels of evidence of the qualitative studies selected. 12 studies was received the cognitive therapy for autism spectrum disorder, and 17 studies was participated grade-schooler (5–12 yrs) to investigate the effects of cognitive therapy. Cognitive therapy showed the level I evidence in participants with Autism spectrum disorder, attention-deficit/hyperactivity disorder, and global developmental disorder.

CONCLUSIONS:

The results of this study provide an indication about the types of cognitive therapies used in children with neurodevelopmental disorders, and provide available and beneficial information of cognitive therapies at research and clinical setting.

Keywords

Children cognitive therapy neurodevelopmental disorders systematic review

1 Introduction

The term “neurodevelopmental disorder” implies a delay in development and impairments in cognitive function, motor function, verbal communication, social skills, and behaviors. “Neurodevelopmental disorder” refers to impairment in the growth and development of the central nervous system, possibly caused by genetic, metabolic, toxic, or traumatic factors (Stores, 2016). American psychiatric association classifies the neurodevelopment disorders into ten disorders: intellectual disabilities, global developmental delay (GDD), communication disorders, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), specific learning disorders, developmental coordination disorders (DCD), stereotypical movement disorders, Tic disorders, and Tourette’s syndrome (American Psychiatric Association, 2013).

Children with a neurodevelopmental disorder have difficulties related to normal development because of cognitive problems from an early stage of development, and fail to achieve the developmental tasks required for the developmental stage (Allen , 2007). Cognitive function is essential for a child to develop initially the ability to participate in play, self-care, and social interactions. Occupational therapy practitioners often place an emphasis on cognitive function in the interventions they use with young children. As children develop, they first demonstrate their cognitive abilities through motor skills (e.g., reaching, grasping, and interacting with objects), play (e.g., sensory–motor exploration), and self-care (e.g., eating, dressing, and grooming etc.) (Case-Smith, Frolek, & Schlabach, 2013). As the child grows to school age and adolescence, neurodevelopmental disorders are also associated with poor social function, and various other negative consequences (Allen & Robin, 2008; Barkley, 2007). Therefore, children with neurodevelopmental disorders should receive cognitive therapy, which can assist with the cognitive problems that occur in early developmental stages.

Previous studies have shown that children with neurodevelopmental disorders have a good prognosis with regard to their ability to participate in tasks when early cognitive treatments are received at an appropriate time point. Cognitive therapy has especially a positive impact on the prognosis of children with neurodevelopmental disorders at the pre-school level (Aarnoudse-Moens, Weisglas-Kuperus, van Goudoever, & Oosterlaan, 2009). In longitudinal studies of children with neurodevelopmental disorders, children who received early intervention had improved cognitive functions, such as reasoning and problem solving skills. Furthermore, cognitive therapy showed the beneficial effects in self-care skills, such as eating, dressing, and activities of daily living, ultimately improving social relationships and occupational performance (Blauw-Hospers, 2009).

Although the effects of various cognitive therapies have been reported in children with neurodevelopmental disorders, there is insufficient to suggest evidence level of the most available type of cognitive interventions or the characteristics of the participants with neurodevelopmental disorders. Therefore, the purpose of this study was to investigate the intervention methods used in relation to cognitive function in children with neurodevelopmental disorders by conducting a systematic review and comparing the study designs, subjects, and intervention methods used. This study provided evidence to support the cognitive therapeutic approaches for children with neurodevelopmental disorders, and to identify the age groups of children with neurodevelopmental disorders applying cognitive therapy. And then this study was to find out the cognitive treatment methods that are effective for each neurodevelopmental disorder.

2 Methods

2.1 Searching keywords

Through a thorough literature search, studies examining the effects of interventions used in relation to cognitive function in children with neurodevelopmental disorders were identified. Articles published in the past 10 years were searched for using PubMed and EBSCOhost, i.e., those published from January 1, 2006 until August 31, 2016. This review identified articles with the following the search keywords: “disease including neurodevelopmental disorder with DSM-5” AND “cognition”, and “disease including neurodevelopmental disorder with DSM-5” AND “cognitive function”. The final search expression was as follows: “cognition” AND “intellectual disability”, “cognitive function” AND “intellectual disability”, “cognition” AND “intellectual developmental disorder”, “cognitive function” AND “intellectual developmental disorder”, “cognition” AND “global developmental delay”, “cognitive function” AND “global developmental delay”, “cognition” AND “autism spectrum disorder”, “cognitive function” AND “autism spectrum disorder”, “cognition” AND “attention deficit hyperactivity disorder”, “cognitive function” AND “attention deficit hyperactivity disorder”, “cognition” AND “developmental coordination disorder”, “cognitive function” AND “developmental coordination disorder”, “cognition” AND “stereotypic movement disorder”, “cognitive function” AND “stereotypic movement disorder”, “cognition” AND “tic disorders”, “cognitive function” AND “Tic disorders”, “cognition” AND “Tourette disorder”, “cognitive function” AND “Tourette disorder”.

2.2 Searching process

This literature search was conducted for original articles that were published in academic journals, written in English, and met our inclusion and exclusion criteria. Using this method, a total of 3,115 articles were identified. Studies that were in accordance with the inclusion criteria or that could not be included based only on the content of the abstract were selected for a full-text review. Since it was not possible to automatically exclude animal trials in this search engine, this was done through hand search. Abstracts of the remaining publications were scrutinized for eligibility by two independent assessors (i.e. the authors, Ahn and Hwang), using the criteria described below. Thus, a total of 80 articles were included in the full-text review by both assessors. The following data were extracted from the selected studies: diagnosis of participants, age of participants, study design, methods of assessment, methods of intervention, and operational definition. The final list consisted of 26 studies (Fig. 1). Inclusion criteria were as follows: studies with the original text written in English; studies involving children as the participants to school age; and studies used for experimental design. The exclusion criteria were as follows: studies based on animals; studies that did not include an intervention (e.g., review articles and cross-sectional studies); and studies using drugs, injections and acupuncture as the intervention.

Fig.1

Search process.

2.3 Data analysis

The level of evidence was used to evaluate the quality of criteria used in studies (Arbesman, Scheer, & Lieberman, 2008). For the purposes of this review, participants were classified according to their diagnoses, chronological ages, and developmental stages. The 26 articles for this literature review were classified according to the conducted intervention methods and the types of neurodevelopmental disorder diagnosis. In addition, the data were presented in accordance with the principle of PICO (Patients, Intervention, Comparison, and Outcome), which is a method used to systematically sort out the results of all of the studies (Appendix. I).

3 Results

3.1 Results of methodological quality

Whether the articles met the different research quality criteria set out or not, the literature review divided the articles into five groups: 11 studies (42.3%) which were classified as randomized controlled trials (RCTs), nine studies (34.6%) which were classified as non-randomized comparative group studies, and six studies (23.1%) which were classified as non-randomized single-group studies. Thus, the RCTs were the majority of 26 articles in this review (Table 1).

Table 1
Hierarchy of levels of quality among each study (N = 26)

Levels Definition Frequency(%)

I Randomized controlled trials 11 (42.3)

II Non-randomized two group studies 9 (34.6)

III Non-randomized one group studies 6 (23.1)

IV Single experimental studies 0 (0.0)

V Case studies 0 (0.0)

Total 26 (100.0)

Levels	Definition	Frequency(%)
I	Randomized controlled trials	11 (42.3)
II	Non-randomized two group studies	9 (34.6)
III	Non-randomized one group studies	6 (23.1)
IV	Single experimental studies	0 (0.0)
V	Case studies	0 (0.0)
	Total	26 (100.0)

3.2 Participants who received cognitive therapy

This study analyzed the studies to evaluate the effects of cognitive therapy in neurodevelopmental disorders, as classified according to DSM-5 criteria (Table 2). Among the 26 studies that reported the effects of cognitive therapy, 12 studies (44.4%) involved participants with ASD, six articles (22.2%) involved ADHD, four articles (14.8%) involved global developmental disorder, and articles (7.4%) involved developmental coordination disorder. In the remaining three articles, there were in cerebral palsy, intellectual disability, and high risk for autism in each ones. In addition, when studies were classified according to the chronological ages of participants, the most commonly studied participants were of grade-school age (17 studies, 63.0%), followed by children (6 studies, 22.2%) (Table 2).

Table 2
Frequency of participants with neurodevelopmental disorder

Variables Types of participants Frequency (%)^†

Diagnosis Autism spectrum disorder 12 (44.4)

Attention-deficit/hyperactivity disorder 6 (22.2)

Global developmental disorder 4 (14.8)

Developmental coordination disorder 2 (7.4)

Cerebral palsy 1 (3.7)

Intellectual disability 1 (3.7)

High risk for autism 1 (3.7)

Total 27 (100.0)

Chronological age Infants (below 1 yr) 2 (7.4)

Toddlers (1–3 yrs) 6 (22.2)

Preschool (3–5 yrs) 2 (7.4)

Grade-schooler (5–12 yrs) 17 (63.0)

Total 27 (100.0)

Variables	Types of participants	Frequency (%)^†
Diagnosis	Autism spectrum disorder	12 (44.4)
Attention-deficit/hyperactivity disorder	6 (22.2)
Global developmental disorder	4 (14.8)
Developmental coordination disorder	2 (7.4)
Cerebral palsy	1 (3.7)
Intellectual disability	1 (3.7)
High risk for autism	1 (3.7)
Total	27 (100.0)
Chronological age	Infants (below 1 yr)	2 (7.4)
Toddlers (1–3 yrs)	6 (22.2)
Preschool (3–5 yrs)	2 (7.4)
Grade-schooler (5–12 yrs)	17 (63.0)
Total	27 (100.0)

^†This was countered multiple selection.

3.3 Types of cognitive therapy used

This study analyzed the types of cognitive therapy interventions in 26 articles. The results are shown in Table 3. Each article used the specific and various cognitive therapy programs according to the analysis. Each disorder was conducted on a wide variety of cognitive intervention. Seven level I studies met the criteria, four level II studies met the criteria, and two level III studies met for ASD and high risk for ASD. Three level I studies met the criteria, two level II studies met the criteria, and one level III study met the criteria for ADHD. Neurofeedback training, computerized working memory training and complex treatment (sensory and motor integration) were used as interventions in attention deficit/hyperactivity disorder. One level I study and one level III study met the criteria for GDD. One level II study met the criteria for CP and GDD, and two level II studies met the criteria for DCD. The interventions used in those with GDD included computerized programs and institutional-based therapy programs. Table-tennis training and neuromotor task training (Cognitive Orientation to daily Occupational Performance approach) were used in those with DCD. One level II study met the criteria for cochlear implants with ID and CP, and one level III study met the criteria for ID (Table 3).

Table 3
Applied interventions for cognitive therapy with neurodevelopmental disorder

Neurodevelopmental disorder Interventions Evidence level

ASD and high risk for ASD Comprehensive Autism Program (CAP) I

Attention training

SENSE Theatre Intervention

Nonverbal communication, Emotion recognition, and Theory of mind Training (NETT)

Early Start Denver Model intervention

Interpersonal Synchrony

Focused playtime intervention

EIBI program in children”s homes II

Music therapy

Auditory Integration Training

Natural setting-treatment and education of autistic and related communication handicapped children (NS-TEACCH)

Baduk (the Game of Go) III

Applied Behavioral Analysis (ABA)

ADHD Neurofeedback training I

Computerized working memory training

Visuospatial working memory

Neurofeedback training II

Neurofeedback self-regulation training

Complex treatment (sensory and motor integration) III

GDD Home activity program I

Computerized program, Vis-á-Vis (VAV) III

CP and GDD Center-based setting and developmental treatments (speech, occupational therapy, physical therapy) II

DCD Table-tennis training II

Neuromotor task training (CO-OP approach)

Cochlear implants with ID and CP Augmentative and alternative communication (AAC) intervention II

ID Mathematical model based on PASS Remedial Program III

Neurodevelopmental disorder	Interventions	Evidence level
ASD and high risk for ASD	Comprehensive Autism Program (CAP)	I
Attention training
SENSE Theatre Intervention
Nonverbal communication, Emotion recognition, and Theory of mind Training (NETT)
Early Start Denver Model intervention
Interpersonal Synchrony
Focused playtime intervention
EIBI program in children”s homes	II
Music therapy
Auditory Integration Training
Natural setting-treatment and education of autistic and related communication handicapped children (NS-TEACCH)
Baduk (the Game of Go)	III
Applied Behavioral Analysis (ABA)
ADHD	Neurofeedback training	I
Computerized working memory training
Visuospatial working memory
Neurofeedback training	II
Neurofeedback self-regulation training
Complex treatment (sensory and motor integration)	III
GDD	Home activity program	I
Computerized program, Vis-á-Vis (VAV)	III
CP and GDD	Center-based setting and developmental treatments (speech, occupational therapy, physical therapy)	II
DCD	Table-tennis training	II
Neuromotor task training (CO-OP approach)
Cochlear implants with ID and CP	Augmentative and alternative communication (AAC) intervention	II
ID	Mathematical model based on PASS Remedial Program	III

ADHD: Attention-deficit/hyperactivity disorder; ASD: Autism spectrum disorder; CO-OP: Cognitive orientation to daily occupational performance; CP: Cerebral palsy; DCD: Developmental coordination disorder; EIBI: Early intensive behavioral program; GDD: Global Developmental Disorder; ID: Intellectual Disability.

RCTs have the highest qualitative criteria, which included independence from variables and randomization (Portney & Watkins, 2008). The cognitive therapies that were most commonly used in RCT studies for ASD and those at high risk for ASD included comprehensive autism program (CAP), attention training, SENSE theatre intervention, nonverbal communication, emotion recognition, and theory of mind training (NETT), early start Denver model intervention, interpersonal synchrony, and focused playtime intervention. The cognitive therapies most commonly used in RCTs for ADHD included neurofeedback training, computerized working memory training, and visuospatial working memory. The cognitive therapy most commonly used in RCTs for GDD was a home activity program.

As resulted analysis of this study, most interventions applied cognitive training were therapies related to attention for ASD and high risk for ASD, neurofeedback training for ADHD, computer based activities for GDD, and therapies based cognitive theory for DCD.

4 Disscussion

The purposes of this study were to analyze the cognitive therapies used in children with neurodevelopmental disorders, and to analyze the available therapeutic methods. Many studies were classified as RCTs according to the qualitative criteria of the studies used in the analysis.

4.1 Autism spectrum disorder (ASD)

ASD was the neurodevelopmental disorder that was most commonly investigated in studies using the cognitive therapy was CAP, which is used to teach communication and social behavior skills (Young, Falco, & Hanita, 2016). SENSE theatre intervention was used to improve social relationships and adaptive behaviors through video modeling and concentration training to visually trace the opposite screen (Corbett et al., 2016). Nonverbal communication, emotion recognition, and theory of mind training (NETT), a treatment using a top-down approach as cognitive behavior therapy, was also used (Soorya et al., 2015). Early start Denver model intervention was used to train parents (Dawson et al., 2010). Focused playtime interventions were also used to educate parents (Kasari et al., 2014). Early intensive behavioral intervention (EIBI) was used to increase focus in early interactions and communication (Smith, Flanagan, Garon, & Bryson, 2015). In addition, music therapy, Natural setting-treatment and education of autistic and related communication handicapped children (NS-TEACCH), computer games, and application behavior analysis were also used (Panerai et al., 2009). These results suggest that cognitive therapy in children with ASD mostly involves training related to social relationships and adaptive behaviors, or parental education.

4.2 Attention-deficit/hyperactivity disorder (ADHD)

In ADHD, the most commonly investigated cognitive therapy was Neurofeedback training, i.e., electroencephalogram (EEG) training using biofeedback, followed by computerized working memory training, and visuospatial working memory training to facilitate time, hearing, memory, and visual tracking using computer programs (Bigorra, 2014). Besides that, there was also a complex treatment used that integrated visual-motor training, core body exercises, and visual-auditory stimulation (Park et al., 2013). Children with ADHD are characterized by attentional and behavioral problems, and so visual and auditory perception activities that promote increased attention and memory, and cognitive correction integrating sensory and motor activities, are used.

4.3 Global developmental disorder (GDD)

The cognitive function-related interventions used in GDD include computerized programs to increase eye tracking, emotion recognition and consideration, working memory, Vis-á-Vis (VAV), and home activity programs (Glaser et al., 2012). It is thought that interventions related to vision, perception and memory were applied in GDD because overall development is impaired.

4.4 Developmental coordination disorder (DCD)

The cognitive therapies used in DCD included table tennis activities, task-based training, and a Cognitive Orientation to daily Occupational Performance (CO-OP) approach to use problem-solving strategies based on tasks (Niemeijer, Smits-Engelsman, & Schoemaker, 2007). It is thought that training related to motor skills, such as the CO-OP approach, is appropriate because children with DCD mainly show problems related to motor function.

4.5 Suggestions

Children with neurodevelopmental disorders are not able to detect, process, or utilize various stimuli from the environment due to a variety of problems. In particular, their cognitive problems prevent them from performing tasks relevant to their developmental stage. As a result of this study, negative effects in relation to self-management and academic performance are seen as these children turn into adolescents, resulting in their limited participation in social activities. As mentioned in introduction, three challenges for the present systematic review would therefore be as followings: first challenge of this study was to suggest the cognitive therapeutic approaches for children with neurodevelopmental disorders. Second challenge was to identify the age group of children with neurodevelopmental disorders applying cognitive therapy. Finally challenge was to find out the cognitive treatment methods that are effective for each neurodevelopmental disorder. This study suggests that it is more beneficial to receive the intervention related cognitive function that promotes cognitive development in children with neurodevelopmental disorders as effective as possible when they are young. Cognitive therapy would have particularly a positive impact on cognitive function, motor learning, social participation and adaptive behaviors as well as cognitive therapy. Based on the results of this study, the intervention can be used to select the therapeutic approaches which can be verified to apply, and to select the clinical assessment tools to evaluate the problems of the cognitive function in children with neurodevelopmental disorder.

4.6 Study limitations

In this study, only published articles were reviewed in the search process, which may be a limitation since unpublished data and review papers or reports were excluded. Therefore, further research should be conducted through a broader search for studies on school-aged children. Nevertheless this study suggests various intervention methods to promote the cognitive function development of the children in the developmental stages. The cognitive function obtained at the early stage of development is essential for the achievement of the child. This study suggests that various cognitive approaches to rehabilitation therapy should be considered as it is an important skill for preparation for learning and learning.

5 Conclusion

Finally, the purpose of this study was to investigate the effects of cognitive therapy on children with neurodevelopmental disorders and to present the basis of cognitive therapy applied to children’s rehabilitation by analyzing the subjects and intervention methods. The results of this study are summarized as the number of children with neurodevelopmental disabilities was significantly higher than that of children with neurodevelopmental disabilities. Based on the result of this study, it will be helpful as a basis for the application of cognitive therapy to children with neurodevelopmental disorder in clinical settings.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

Footnotes

Appendix

Characteristics of included studies

Study	Design	Patients (n)	Intervention		Outcome measure	Outcome
			Intervention/groups	Session/time
Lee, Jeong, & Kim, 2013	Non-randomized two group studies	5–12 years children with cochlear implants (CIs) with mental retardation and/or cerebral palsy	·augmentative and alternative communication (AAC) intervention · mental retardation and/or cerebral palsy (n = 5), control group (n = 5)	24sessions, a week for 6 months	monosyllabic word test; Assessment of Phonology and Articulation for Children; Peabody Picture Vocabulary Test – Korean version	AAC intervention using a VOCA was very useful and effective on improving communicative skills in children with multiple disabilities.
Lansbergen, van Dongen-Boomsma, Buitelaar, & Slaats-Willemse, 2011	a double-blind randomized placebo-controlled	8–15 years children with attention-deficit/hyperactivity disorder (n = 14)	· EEG-neurofeedback training · EEG-neurofeedback (n = 8), placebo feedback (n = 6)	4 months with 2 sessions per week, in total 30 sessions	MRI data	Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups.
Elisabeth et al., 2015	Non-randomized one group studies	7–12 years children with ASD (n = 17)	· Baduk (the Game of Go)	two hour/day, 5 days/week Go lessons during the 16-week study period	EEG; Digit span forward/backwards test; Children’s Color Trails Test 1, 2; DuPaul’s ADHD Rating Scales; Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime version	The playing Go would be effective for children with ADHD by activating hypoarousal prefrontal function and enhancing executive function.
Glaser et al., 2012	Non-randomized one group studies	7–10 years children with idiopathic developmental delay (n = 10)	· computerized program, Vis-á-Vis (VAV) with adult	four 20-min weekly sessions of VAV for 12 weeks	Raven’ Colored; Benton Face Recognition; Emotion-recognition task	Subjects improved on all three modules during training and on emotion recognition and nonverbal reasoning post-VAV.
Itzchak, Watson, & Zachor, 2014	Non-randomized one group studies	17–33 months children diagnosed with ASD (n = 46)	· Applied Behavioral Analysis (ABA)	20 h per week of 1 : 1 intervention following 1 year and 2 years	Autism Diagnostic Observation Scales; Vineland Adaptive Behavior Scales; Mullen Scales of Early Learning	The entire group progressed with intervention, but only children with higher cognitive levels at baseline transferred their acquired socio-communication skills into daily functioning.
Itzchak, Lahat, Burgin, & Zachor, 2008	Non-randomized two group studies	16–31 months cerebral palsy and global developmental delay	· cerebral palsy (n = 18), ·global developmental delay (n = 17), · Non-available information (n = 2).	45 h/week	Bayley Scales of Infant Development Second Edition; Mental Developmental Index; Stanford-Binet Intelligence Scale Fourth Edition; ADI—semi-structured interview; Autism Diagnosis Observation Schedule	IQ scores increased significantly more in the autism group than in the DD group.
Drechsler, et al., 2007	Non-randomized two group studies	below 12year children with ADHD (n = 30)	· neurofeedback training (n = 17), · group therapy (n = 13)	45 minutes/30 sessions	German standardized DSM IV- questionnaire for ADHD; Conners’ Parent Rating Scale; Behavior Rating Inventory for Executive Function; Child Behavior Checklist; German WISC III	In the parents’ and teachers’ ratings, neurofeedback training group improved more than children who had participated in a group therapy program.
Young, Falco, & Hanita, 2015	RCT	teachers (n = 84) and 3–5 year old students (n = 302) with autism spectrum disorder	· Comprehensive Autism Program (CAP) (n = 44 teachers and 178 students), business as usual (BAU) public schools (n = 40 teachers and 124 students)	1 day per month, for at least 6 months	Vineland Adaptive Behavior Scales; Battelle Developmental Inventory-2-Cognitive Domain; Expressive One Word Picture Vocabulary Test; ASIEP-3 Sample of Vocal Behavior; Receptive One Word Picture Vocabulary Test; Receptive One Word Picture Vocabulary Test; Autism Screening Instrument for Educational Planning; Social Skills Rating System	CAP had small positive impacts on the students” receptive language. Treatment effects were moderated by severity of ASD.
der Schuit, Eliane Segers, van Balkom, & Verhoeven, 2011	Non-randomized one group studies	7–13 year old with attention deficit/hyperactivity disorder in children. (n = 47)	· complex treatment (visual &auditory stimuli, core muscle exercise, targeting ball exercise, ocular motor exercise, and visual motor integration)	60 min/day, 2-3 times/week for more than 12 weeks	Neurosync program, Stroop Color-Word Test, and test of nonverbal intelligence	complex treatment using visual and auditory stimuli alleviated the symptoms of ADHD and improved cognitive function in children.
Smith, Flanaga, Garon, & Bryson., 2015	Non-randomized three group studies	Preschoolers with autism spectrum disorder (n = 118)	· EIBI program in children”s homes and/or in community childcare centres. · Higher IQ group (n = 36), Mod/Low IQ group (n = 40), Very low IQ group (n = 42)	a maximum of 15 h per week (3 h per day) for 6 months, then about 10 h per week for the next 3 months, and 5–6 h per week for the final 3 months	Expressive Communication domain of the Preschool Language Scale; Clinical Evaluation of Language Fundamentals; Auditory Comprehension domain of the PLS-4; Peabody Picture Vocabulary Test; Merrill-Palmer-Revised Scales of Development; Vineland Adaptive Behavior Scales; Social Responsiveness Scale; Child Behavior Checklist;	Results are encouraging for this relatively low-intensity community-based intervention program.
LaGasse., 2014	Non-randomized two group studies	6–9 aged children with autism (n = 22)	· music therapy group(n = 10), · non music therapy group(n = 12)	50-min/10 sessions/5 weeks	Social Responsiveness Scale; Autism Treatment Evaluation Checklist; Video analysis in social behavior	initial support for the use of music therapy social groups to develop joint attention
Sokhad, Casano, Tasman, & Brockett, 2016	Non-randomized two group studies	8–14 years Children with Autism Spectrum Disorder (n = 18)	· Auditory Integration Training (n = 18), · typically developing children (n = 16)	30-min/20 sessions	EEG; Auditory Oddball Test; Aberrant Behavior Checklist; Repetitive Behavior Scale-Revised	behavioral and psychophysiological changes and to provide explanation of the neural mechanisms of how auditory integration training children with ASD
Powell, Wass, Erichsen, & Leekam, 2016	RCT	3–9 years children with autism	· attention training (n = 9), control group; · same eye tracker as the training sessions (n = 8)	120 min/over six sessions	Visual sustained attention; Anticipatory saccades; Attentional disengagement latencies/saccadic RT	within-task training improvements was found. A number of untrained tasks to assess transfer of training effects were administered pre- and post-training.
Tsai., 2009	Non-randomized three group studies	9–10 years Children with developmental coordination disorder (n = 43)	· DCD non-training group and table-tennis training DCD group (n = 27), typically developing group (n = 16)	3 times a week/10 weeks	Overall error rate; Congruent condition; Incongruent condition	Table tennis raining resulted in significant improvement of cognitive and motor functions for the children with DCD.
Corbett et al., 2016	RCT	8–14 years with autism spectrum disorder (n = 30)	· SENSE Theatre Intervention (n = 17), · control (n = 13)	4 h/10 sessions	Social Responsiveness Scale; Adaptive Behavior Assessment System; Peer Interaction Paradigm; Memory for Faces Delayed; ERP	provide initial support for the efficacy of the theatre-based intervention
Bigorra, Garolera, Guijarro, & Hervás, 2015	RCT	7–12 yr old with attention deficit/hyperactivity disorder in children. (n = 66)	· computerized working memory training group (n = 36), · control group (n = 30)	25 sessions/5-week	Behavior rating inventory of executive function; Conners’ Rating Scales; Child behavior checklist and Teacher’s report Form; Strengths and Difficulties Questionnaire; Weiss Functional Impairment Rating Scale; WISC -IV	There were also significant improvements in PBMEF, ADHD symptoms, and functional impairment.
Niemeijer, Smits-Engelsman, & Schoemaker, 2007	Non-randomized two group studies	6–10 years children with developmental coordination disorder	· neuromotor task training (n = 26), · non-treated children (n = 13)	30-min/sessions/9 weeks	Movement Assessment Battery for Children; Test of Gross Motor Development – 2; Child Behavior Checklist	only the treated group improved on the MABC and the TGMD-2.
Landa, Holman, O’Neill, & Stuart, 2011	RCT	toddlers with autism spectrum disorder (n = 48)	· Interpersonal Synchrony (n = 24), · Non-Interpersonal Synchrony (n = 24)	10 hours per week in classroom with parent training (2.5 hours per day/four days per week)	Communication and Symbolic Behavior Scales Developmental Profile; Socially engaged imitation;	A significant treatment effect was found for socially engaged imitation with more than doubling of imitated acts paired with eye contact in the Interpersonal Synchrony group.
Deaño, Alfonso, & Das, 2015	Non-randomized one group studies	students of 3rd and 6th grade of Primary Education with low intelligence IQ < 75 (n = 20)	· mathematical model based on the program PASS Remedial Program	60 min./35 sessions	Standard Progressive Matrices; Evalu' a-2; D.N: CAS; PASS Remedial Program of arithmetic	Performance of children from the experimental group was significantly higher than that of the control group in cognitive process and arithmetic.
Soorya et al., 2015	RCT, follow up	8–11 years children with ASD (n = 69)	· Nonverbal communication, Emotion recognition, and Theory of mind Training (NETT) group (n = 34), · Control group (n = 34)	90-minute weekly/12-session	Social Responsiveness Scale; Griffith Empathy Measure; Children”s CommunicationChecklist-2; Diagnostic Analysis of NonverbalAccuracy-2; Strange Stories Task; Reading the Mind in the Eyes Test; Behavior assessment System forChildren, Second Edition; parent satisfaction measure	NETT improve social communication deficits in verbal, school-aged children with ASD
Kasari et al., 2014	RCT	toddlers at high risk for autism	· Focused playtime intervention (n = 32), · Monitoring group intervention (n = 34)	90 min/per session/12 in-home training sessions	Parent–child play; The early social communication scale; The Mullen scales of early learning	Parental responsiveness improved significantly in the treatment group but not the control group. There were no treatment effects on child outcomes of joint attention or language.
Dawson et al., 2010	RCT	18 to 30 months children diagnosed with ASD (n = 48)	· Early Start Denver Model intervention group (n = 24), · Assess-and-monitor group (n = 23)	2-hour sessions/twice per day/5 days per week/2 years	Autism Diagnostic Interview–.Revised; Autism Diagnostic Observation Schedule; Mullen Scales of Early Learning; Vineland Adaptive Behavior Scales; Repetitive Behavior Scale	comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis.
Streh et al., 2006	Non-randomized one group studies	8–13 years Children With Attention-Deficit/Hyperactivity Disorder (n = 23)	· Neurofeedback self-regulation training of slow cortical potentials	5 days per week/each phase lasted 2 weeks with daily training/3 phases of 10 sessions/30 sessions	EEG; IQ scores	electroencephalographic data during the course of slow cortical potential neurofeedback are reported. After training, significant improvement in behavior, attention, and IQ score was observed.
Panerai et al., 2009	Non-randomized three group studies	average 9 aged male children with autistic disorder (n = 34)	· natural setting-treatment and education of autistic and related communication handicapped children (NS-TEACCH) program group (n = 13), residential TEACCH (R-TEACCH) group (n = 11), inclusive nonspecific program (n = 10)	4 weeks	Psycho-Educational Profile-Revised (PEP-R); Vineland Adaptive Behavior Scale	Effectiveness of TEACCH appeared to be confirmed, showing positive outcomes in the natural setting, and revealing its inclusive value.
Tang et al., 2011	RCT	infants and toddlers with motor or global developmental delay (n = 70)	· Institutional-based therapy Program (ITP) group (n = 35), · ITP plus a structured home activity program (HAPs) group (n = 35)	ITP for 45 minutes/each session/12 weeks, 30 minutes ITP combined with 15 minutes of HAPs/each session/12 weeks	Comprehensive Developmental Inventory for Infants and Toddlers; Pediatric Evaluation of Disability Inventory	Early intervention programs are helpful for these children, and the addition of structured home activity programs may augment the effects on developmental progression.
Dongen-Boomsma, Vollebregt, Buitelaar, & Slaats-Willemse, 2014	RCT	5–7 years Children With Attention-Deficit/Hyperactivity Disorder	· visuospatial working memory group (n = 26) placebo group (n = 21)	15 min/5 days a week/25 sessions	ADHD Rating Scale IV; Behavior Rating Inventory of Executive Function; WISC-III (DS); Clinical Global Impressions-Improvement; Children”s Global Assessment Scale	No significant treatment effect on any of the primary or other secondary outcome measurements was found.

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