Systematic Review and Meta-Analysis of Interventions in Adaptive Behavior for Children and Adolescents with Intellectual Disabilities




Adaptive behavior, intellectual disability, interventions, children, systematic review, meta-analysis


Intellectual disability (ID) represents limitations in intellectual functioning and in adaptive behavior that originate before 22 years of age. Adaptive behavior is a set of conceptual, social, and practical skills that have been learned and are performed by people in their daily lives. Early intervention, followed by continuous and focused adaptive behavior, can increase the quality of life and improve ID presentation. This systematic review and meta-analysis aim to investigate adaptive behavior interventions for children and adolescents with ID and to analyze their effectiveness. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement guidelines. The 20 identified studies vary in terms of participant characteristics and type and duration of interventions. We performed the meta-analysis by examining the differences in the standardized mean or mean differences. Heterogeneity was tested using the I² test. The meta-analysis results indicate a lack of general consensus in the field of ID studies regarding interventions for adaptive behavior. This does not imply that there are insufficient foundations for the construct or the interventions, just a lack of evidence and consensus for using a specific intervention protocol. In subgroup sensitivity analysis, ABA-based interventions showed significant improvement in the experimental group's adaptive behavior compared to the control group. The findings provide information for researchers and practitioners, highlighting areas that need future research and offering implications for practice.


Schalock RL, Luckasson R, Tassé MJ. Intellectual disability: Definition, diagnosis, classification, and systems of supports (12th ed.). American Association on Intellectual and Developmental Disabilities 2021.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.) 2013.

World Health Organization. ICD-11 beta draft 2018.

Karam SM, Barros AJ, Matijasevich A, Dos Santos IS, Anselmi L, Barros F, et al. Intellectual Disability in a Birth Cohort: Prevalence, Etiology, and Determinants at the Age of 4 Years. Public Health Genomics 2016; 19(5): 290-297.

Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S. Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in Developmental Disabilities 2011; 32(2): 419-436.

Salvador-Carulla L, Reed GM, Vaez-Azizi LM, Cooper SA, Martinez-Leal R, Bertelli M, et al. Intellectual developmental disorders: towards a new name, definition, and framework for "mental retardation/intellectual disability" in ICD-11. World psychiatry: official journal of the World Psychiatric Association (WPA), 2011; 10(3): 175-180.

Tassé MJ, Schalock RL, Balboni G, Bersani H, Jr, Borthwick-Duffy SA, Spreat S, et al. The construct of adaptive behavior: its conceptualisation, measurement, and use in the field of intellectual disability. American Journal on Intellectual and Developmental Disabilities 2012; 117(4): 291-303.

American Association for Intellectual Disability and Development (AAIDD). Marc Tassé - Adaptive behavior and the diagnostic adaptive behavior scale [Video]. YouTube (2015, February 11).

Saulnier CA, Klaiman C. Introduction and history of adaptive behavior. In Saulnier CA, Klaiman C. (Eds.), Essentials of adaptive behavior assessment of neurodevelopmental disorders. John Wiley & Sons 2018; pp. 1-16.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 2009; 6(7): e1000097.

Ke X, Liu J. Deficiência Intelectual. In Rey JM, (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. International Association for Child and Adolescent Psychiatry and Allied Professions 2015.

Banerjee A, Miller M, Li K, Sur M, Kaufmann W. Towards a better diagnosis and treatment of Rett syndrome: A model synaptic disorder. Brain 2019; 142(2): 239-248.

Butler MG, Kimonis V, Dykens E, Gold JA, Tamura R, Miller, JL, Driscoll DJ. Birth seasonality studies in a large Prader-Willi syndrome cohort. American Journal of Medical Genetics 2019; 179: 1531-1534.

Davies JR, Wilkinson LS, Isles AR, Humby T. Prader-Willi syndrome imprinting centre deletion mice have impaired baseline and 5-HT2CR-mediated response inhibition. Human Molecular Genetics 2019; 28(18): 3013-3023.

Schalock RL, Borthwick-Duffy SA, Bradley VJ, Buntinx WHE, Coulter DL, Craig EM, et al. Definition, Classification, and Systems of Supports (11th ed.). American Association on Intellectual and Development Disabilities 2010.

Schalock RL, Borthwick-Duffy SA, Bradley VJ, Buntinx WHE, Coulter DL, Craig EM, et al. User's Guide To accompany the 11th edition of intellectual disability: Definition, classification, and systems of supports (11th ed.). Association on Intellectual and Development Disabilities 2012.

Sparrow SS, Cicchetti DV, Saulnier CA. Vineland adaptive behavior scales (3rd ed.). Pearson 2016.

Adibsereshki N, Shaydaei M, Movallali G. The effectiveness of emotional intelligence training on the adaptive behaviors of students with intellectual disability. International Journal of Developmental Disabilities 2016; 62(4): 245-252.

Bordini D, Paula CS, Cunha GR, Caetano SC, Bagaiolo LF, Ribeiro TC, et al. A randomised clinical pilot trial to test the effectiveness of parent training with video modelling to improve functioning and symptoms in children with autism spectrum disorders and intellectual disability. Journal of Intellectual Disability Research: JIDR 2020; 64(8): 629-643.

Chou MY, Chang NW, Chen C, Lee WT, Hsin YJ, et al. The effectiveness of music therapy for individuals with Rett syndrome and their families. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 2019; 118(12): 1633-1643.

Connolly B, Morgan S, Russell FF, Richardson B. Early intervention with Down syndrome children: follow-up report. Physical Therapy 1980; 60(11): 1405-1408.

Connolly BH, Morgan S, Russell FF. Evaluation of children with Down syndrome who participated in an early intervention program. Second follow-up study. Physical Therapy 1984; 64(10): 1515-1519.

Connolly BH, Morgan SB, Russell FF, Fulliton WL. A longitudinal study of children with Down syndrome who experienced early intervention programming. Physical Therapy 1993; 73(3): 170-181.

Dykens EM, Roof E, Hunt-Hawkins H. Cognitive and adaptive advantages of growth hormone treatment in children with Prader-Willi syndrome. Journal of Child Psychology and Psychiatry, and Allied Disciplines 2017; 58(1): 64-74.

Eldevik S, Eikeseth S, Jahr E, Smith T. Effects of low-intensity behavioral treatment for children with autism and mental retardation. Journal of Autism and Developmental Disorders 2006; 36(2): 211-224.

Eldevik S, Jahr E, Eikeseth S, Hastings RP, Hughes CJ. Cognitive and adaptive behavior outcomes of behavioral intervention for young children with intellectual disability. Behavior Modification 2010; 34(1): 16-34.

Heller JH, Spiridigliozzi GA, Crissman BG, Sullivan JA, Eells RL, Li JS, et al. Safety and efficacy of rivastigmine in adolescents with Down syndrome: a preliminary 20-week, open-label study. Journal of Child and Adolescent Psychopharmacology 2006; 16(6): 755-765.

Kishnani PS, Heller JH, Spiridigliozzi GA, Lott I, Escobar L, Richardson S, et al. Donepezil for treatment of cognitive dysfunction in children with Down syndrome aged 10-17. American Journal of Medical Genetics. Part A 2010; 152A(12): 3028-3035.

Lancioni GE, O'reilly MF, Van Dijk J, Klaase M. An environmental enrichment programme to promote adaptive responding in two children with multiple disabilities. Scandinavian Journal of Behaviour Therapy 1998; 27(3): 130-134.

Matson JL, Taras ME, Sevin JA, Love SR, Fridley D. Teaching self-help skills to autistic and mentally retarded children. Research in Developmental Disabilities 1990; 11(4): 361-378.

Peters-Scheffer N, Didden R, Mulders M, Korzilius H. Low-intensity behavioral treatment supplementing preschool services for young children with autism spectrum disorders and severe to mild intellectual disability. Research in Developmental Disabilities 2010; 31(6): 1678-1684.

Peters-Scheffer N, Didden R, Mulders M, Korzilius H. Effectiveness of low-intensity behavioral treatment for children with autism spectrum disorder and intellectual disability. Research in Autism Spectrum Disorders 2013; 7(9): 1012-1025.

Russell PS. Al John JK, Lakshmanan JL. Family intervention for intellectually disabled children. Randomised controlled trial. The British Journal of Psychiatry: The Journal of Mental Science 1999; 174: 254-258.

Saint-Georges C, Pagnier M, Ghattassi Z, Hubert-Barthelemy A, Tanet A, Clément MN, et al. A developmental and sequenced one-to-one educational intervention (DS1-EI) for autism spectrum disorder and intellectual disability: A three-year randomised, single-blind controlled trial. EClinical Medicine 2020; 26: 100537.

Spiridigliozzi GA, Heller JH, Crissman BG, Sullivan-Saarela JA, Eells R, Dawson D, et al. Preliminary study of the safety and efficacy of donepezil hydrochloride in children with Down syndrome: a clinical report series. American Journal of Medical Genetics. Part A 2007; 143A(13): 1408-1413.

Spiridigliozzi GA, Hart SJ, Heller JH, Schneider HE, Baker JA, Weadon C, et al. Safety and efficacy of rivastigmine in children with Down syndrome: A double-blind placebo-controlled trial. American Journal of Medical Genetics. Part A 2016; 170(6): 1545-1555.

van Vonderen A, de Swart C, Didden R. Effectiveness of instruction and video feedback on staff's use of prompts and children's adaptive responses during one-to-one training in children with severe to profound intellectual disability. Research in Developmental Disabilities 2010; 31(3): 829-838.





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