Abstract
To determine construct validity and reliability indicators of the Cochrane risk of bias (RoB) tool in the context of randomized clinical trials (RCTs) for autism spectrum disorder (ASD). Confirmatory factor analysis was used to evaluate a unidimensional model consisting of 9 RoB categorical indicators evaluated across 94 RCTs addressing interventions for ASD. Only five of the nine original RoB items returned good fit indices and so were retained in the analysis. Only one of this five had very high factor loadings. The remaining four indicators had more measurement error than common variance with the RoB latent factor. Together, the five indicators showed poor reliability (ω = 0.687; 95% CI: 0.613-0.761). Although the Cochrane model of RoB for ASD exhibited good fit indices, the majorities of the items have more residual variance than common variance and, therefore, did not adequately capture the RoB in ASD intervention trials.
Highlights
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in reciprocal social interaction and stereotyped and repetitive behaviors
A 1-factor solution with nine items was tested, but the model was not admissible because the Protection against contamination (PAC) item contained less than two categories
Excluding PAC and rerunning the model with eight items returned a statistical problem because the minimum covariance coverage was not fulfilled
Summary
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in reciprocal social interaction and stereotyped and repetitive behaviors. Several empirically supported behavioral interventions have been shown to improve core features of ASD, including social communication [e.g., Ref. Psychopharmacological treatments have been shown to decrease secondary symptoms, such as aggression, irritability, and hyperactivity [e.g., Ref. As diagnoses are being made at younger ages and as the prevalence of ASD increases, research has increasingly focused on the development of cost-effective, community viable interventions. This is especially relevant as resources are limited and as clinicians aim to effectively and efficiently guide families in making treatment decisions. Hundreds of RCTs are published every year, making it nearly impossible for practicing professionals to keep abreast of the effectiveness literature. RCT results may often contradict one another, and though some studies are well designed, others may be poorly designed and executed
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