In this systematic review and meta-analysis, we evaluated the association between Attention-Deficit/Deficit Hyperactivity (ADHD) and atypical Sensory Processing Patterns (SPPs). We searched PubMed, Embase, and Web of Science from their inception until June 30^th, 2024. We included studies examining SPP using questionnaires in participants with a diagnosis of ADHD compared with healthy controls. The study risk of bias was assessed using a modified Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted using R software (Version 4.3.1), considering sensory modulation atypicities severity as the primary outcome. We explored the risk of publication bias and conducted sensitivity analyses to test the robustness of the findings. After screening 10,750 references, we included 30 studies (reported in 32 publications) encompassing a total of 5,374 participants, with 23 studies focusing on children, and seven on adults. Patients with ADHD presented significantly more severe sensory atypicities than the control group in multiple domains: sensory sensitivity (k=13; SMD=1.17; 5% CI [0.75;1.59]; I²=87%), sensory avoiding (k=11; SMD=1.15; 95% CI [0.66;1.64]; I²=92%), low sensory registration (k=23; SMD=1.22; 95%CI [0.89;1.56]; I²=92%), and sensory seeking (k=15; SMD=1.23; 95%CI [0.48;1.97]; I²=97%). Heterogeneity was high in all analyses. Only nine studies were deemed at overall low risk of bias. Even though available ADHD clinical guidelines do not specifically mention the need to assess sensory processing in ADHD, our meta-analysis suggests that this should be systematically explored in the evaluation of children and adults referred for ADHD.

While the effectiveness of parent-mediated interventions in the field of autism spectrum disorder is well documented, information on the experience of parents involved in parent-mediated interventions is limited. We performed a systematic review with qualitative evidence synthesis to explore the experience of parent-mediated interventions in parents of children with autism spectrum disorder. PubMed, Scopus, PsycINFO, CINAHL, and Sociology Collection were searched from the date of their creation until 25 February 2022. Qualitative studies reporting parents’ experience of parent-mediated interventions were included. Two independent reviewers assessed the risk of bias. The findings of the selected studies were extracted and synthesized using the meta-aggregation method. The results are reported according to PRISMA and ENTREQ guidelines. A total of 23 studies were synthesized representing 345 participants. We found 34 categories that were summarized in four synthesized themes: barriers to implementation and logistical issues, feeling overwhelmed and stressed (a need for support), facilitators of implementation, and empowerment in the parent and improvement in the child. Parents’ experience of parent-mediated interventions in autism spectrum disorder is balanced between positive outcomes for them and their child, emotional struggles, and some difficulties in implementing parent-mediated interventions. Based on these results, we propose new ways to improve implementation of parent-mediated interventions and research in the field. Lay The effectiveness of parent-mediated interventions in the field of autism spectrum disorder is well documented but information on the experience of parents involved in parent-mediated interventions is limited. This study is the first synthesis of evidence concerning the experience of parents involved in parent-mediated interventions. It synthesizes the voice of 345 parents across the world into four general themes: barriers to implementation and logistical issues, feeling overwhelmed and stressed (a need for support), facilitators of implementation, and empowerment in the parent and improvement in the child. The findings of our study provide evidence that parent-mediated interventions should be adapted to the needs of each family. Specific care and support should be offered to parents in addition to parent-mediated interventions. Our study, however, highlights which outcomes are important to parents and should be considered in future studies.

We conducted an umbrella review of systematic reviews (SRs) - with or without meta-analysis (MA) - of randomized controlled trials (RCTs) assessing non-pharmacological sleep interventions for children and adolescents across various clinical populations. We searched multiple electronic databases up to 24/01/24. Meta-analyzable data from RCTs in the retrieved SRs/MAs were pooled using Metaumbrella. Primary outcomes were subjective/objective child sleep parameters. Additional outcomes included child health/functioning and parental sleep/health. The quality of the MAs/SRs was assessed with AMSTAR-2, and the certainty of evidence using GRADE. We included 93 SRs/MAs covering 393 RCTs, with 25 (17%, 39% and 30%: high, moderate, and low quality) providing data for quantitative synthesis. Behavioral interventions, usually multicomponent including parent training, psychoeducation, and/or specific sleep therapy/strategies, showed beneficial effects on night waking, sleep duration, overall sleep disturbance, mood/depression, and maternal sleep quality (standardized mean difference [SMD]: 0.10 to 0.80) in participants with sleep problems without a formal sleep disorder diagnosis. For those with a formal diagnosis (mainly insomnia), benefits were found for night waking, sleep efficiency (subjective/actigraphically measured), and sleep onset latency (mean SMD: 0.49 to 0.97). Those with ADHD improved in bedtime resistance, night waking, parasomnias, sleep anxiety, ADHD symptoms, sleep disturbance, and quality of life (mean SMD: 0.18 to 0.49). For those with autism, sleep disturbance improved (mean SMD: 0.70). However, all findings were of low to very low certainty of evidence. Among non-pharmacological interventions for sleep difficulties in youth, only behavioral interventions are supported by meta-analytic evidence, yet with small to moderate effect sizes and limited certainty of evidence.

The lack of consensual measures to monitor core change in Autism Spectrum Disorder (ASD) or response to interventions leads to difficulty to prove intervention efficacy on ASD core symptoms. There are no universally accepted outcome measures developed for measuring changes in core symptoms. However, the CARS (Childhood Autism Rating Scale) is one of the outcomes recommended in the EMA Guideline on the clinical development of medicinal products for the treatment of ASD. Unfortunately, there is currently no consensus on the response definition for CARS among individuals with ASD. The aim of this elicitation process was to determine an appropriate definition of a response on the CARS2 scale for interventions in patients with Autism Spectrum Disorder (ASD). An elicitation process was conducted following the Sheffield Elicitation Framework (SHELF). Five experts in the field of ASD and two experts in expert knowledge elicitation participated in an 1-day elicitation workshop. Experts in ASD were previously trained in the SHELF elicitation process and received a dossier of scientific evidence concerning the topic. The response definition was set as the mean clinically relevant improvement averaged over all patients, levels of functioning, age groups and clinicians. Based on the scientific evidence and expert judgment, a normal probability distribution was agreed to represent the state of knowledge of this response with expected value 4.03 and standard deviation 0.664. Considering the remaining uncertainty of the estimation and the available literature, a CARS-2 improvement of 4.5 points has been defined as a threshold to conclude to a response after an intervention. A CARS-2 improvement of 4.5 points could be used to evaluate interventions' meaningfulness in indivudals. This initial finding represents an important new benchmark and may aid decision makers in evaluating the efficacy of interventions in ASD.