Systematic review
Effect of interventions to ease transitions for children and adolescents with disabilities
Systematic review
|Updated
The aim of this report is to summarise the effect of interventions to facilitate transitions for children and adolescents with disabilities.
Key message
The aim of this report is to summarise the effect of interventions to facilitate transitions for children and adolescents with disabilities. These interventions can either address early transitions (e.g. the transition from kindergarten to primary school) or (post-) secondary transitions (e.g. the transition between middle and high school, the transition between high school and tertiary education or work).
We included three systematic reviews that addressed (post-) secondary transitions. The three systematic reviews respectively addressed interventions 1) to facilitate social and communication skills, 2) to facilitate planning and coordinating transitions and 3) to improve the development of functional life skills. Each of the three systematic reviews had important methodological limitations.
Key messages
• We are uncertain whether different interventions to facilitate secondary transitions have an effect for adolescents with disabilities. The documentation was of very low quality. This does not mean, however, that these interventions do not work, but that it is uncertain whether we can rely on the available results.
• On the matter of transitions for small children with disabilities, we did not find systematic reviews which met our inclusion criteria.
Summary
Background
Transition between different stages of life implies important challenges for children and adolescents, in particular for those with disabilities. We define the term ‘disabilities’ broadly, comprising both mental and physical disabilities. According to the Norwegian Parliament White Paper No. 18 (2010 – 2011) many parents of children with special needs lack adequate follow up, and many have pointed to difficulties related to transitions and insufficient coordination between the different services involved.
The purpose of this overview over systematic reviews is to answer the following questions:
1) What are the effects of different interventions to facilitate early transitions for children with disabilities?
2) What are the effects of different interventions to facilitate transitions for adolescents with disabilities?
Method
We have produced an overview over systematic reviews on the effectiveness of interventions to facilitate transitions for children and adolescents with disabilities. An overview over systematic reviews synthesises knowledge that has been systematically reviewed before. The evidence presented in this report is based on systematic reviews with at least moderate methodological quality. We have searched the following databases to identify systematic reviews: Campbell Library, Cochrane database of Systematic Reviews, DARE, ERIC, Social Care Online, PsycINFO, MEDLINE, ISI Science/Social Science Citation Index, PEDro, Cinahl, NARIC National Rehabilitation Information Center. In addition we have searched Google to identify grey literature. The search was finished in November 2011 and was updated in August 2012.
Results
We identified three relevant systematic reviews on secondary transitions. These summarised the effects of 1) interventions to strengthen social skills and communication skills, 2) interventions to improve planning and coordination skills related to transitions and 3) interventions to increase functional life skills (e.g. budgeting skills) so that young people with disabilities are better equipped to overcome challenges in everyday life .
We did not find any systematic reviews on early transitions which met our inclusion criteria.
Interventions to increase social skills and communication skills
We present results of nine studies with 246 participants in total. Interventions to increase social skills and communication skills comprised Augmentative and Alternative Communication (AAC) Programs, interventions to improve conversation skills, interventions to strengthen social skills, and interventions to decrease inappropriate behaviour. These nine studies primarily addressed young people with different kinds of mental disabilities. The review authors reported results from two meta- analyses based on five studies (meeting our requirements regarding study design) with 193 participants in total. One analysed three studies with control group and pre-/post-test design, the other two studies with only pre- and post-test, without control group. Both studies analysed studies on the effect of interventions to improve social skills; they only differ in study design. In addition, they reported results from four single studies with 164 participants. We cannot, however, draw any conclusions from the results regarding whether the studied interventions work, due to low quality of the documentation.
Interventions to improve planning and coordination skills
We present the results of 16 primary studies with a total of 644 participants. Interventions were focused on improving student-focused planning to encourage students with disabilities to take a more active role in their own Individualised Education Program; on their development as students; or on other interdisciplinary interventions. These studies targeted young people with many different disabilities and who were often described as multiple handicapped in the primary studies.
The review we identified in this area reported results from two meta-analyses on six single studies which include a total of 164 participants. One comprised studies to facilitate student-focused planning, the other studies to facilitate students’ development. It appears that interventions to improve students’ development have a stronger effect than those that aim to improve student-focused planning interventions or interdisciplinary interventions. Due to low quality of documentation we cannot draw any conclusions on the effect of these interventions with regard to improving planning and coordination skills.
Interventions to increase functional life skills
We present results from one meta-analysis which included eight primary studies (with control groups) with a total of 274 participants, and results from three single studies (without control groups) with a total of 65 participants. Target groups in these single studies were mainly young people with mental retardation of different degrees, blind young people, and young people with multiple handicaps. Even when the interventions in these studies were related to life transitions and to the increase in functional life skills, the primary studies varied considerably in terms of the specific intervention and outcome, e.g., money management skills, leisure and gym skills, and know-how, for example, about buying everyday commodities. We cannot draw any conclusions on the effect of these interventions due to the low quality of the documentation.
Discussion
To answer the broad question on the effect of interventions to facilitate transitions for children and youth with disabilities, we have carried out an overview over systematic reviews. Our aim was to get a picture of existing systematic reviews in the field about which interventions are effective work.
We have identified three systematic reviews on secondary transitions. The review authors, however, synthesised primary studies which were very different from each other, in terms of the given interventions, outcomes and populations.
Among the 33 primary studies included in these reviews, only 17 had comparable control groups, and only one randomised controlled study (with randomised matched pairs) was analysed by the review authors.
Additionally, the reviews comprised studies on interventions at the individual level, with the exception of one study which focused on the collaboration between different services. Thus, our data only gives a limited answer to the question of whether interventions targeting the system level help to facilitate transitions for youth with disabilities.
Conclusion
There is uncertainty about whether interventions to facilitate secondary transitions for youth with disabilities are effective. Drawing on existing knowledge we conclude that there is a need for a systematic review of high methodological quality to address the question of which interventions work for which groups under which conditions. We stress that our conclusions are based on the results of a systematic review of reviews. We cannot say with certainty whether there are primary studies of high quality on interventions to facilitate secondary transitions. We contacted the authors of the included systematic reviews on secondary transitions in order to find out if and when their reviews will be updated, and were informed that updates to draw on studies published after 2004 are planned.
For early transitions there is a need for a systematic review of high quality as we have not identified a systematic review on this issue.