In the recent literature, there is a broad consensus on the effectiveness of Applied Behavior Analysis interventions for autism spectrum disorder (ASD). Despite their proven efficacy, research in clinical settings shows that these treatments are not equally effective for all children and the issue of which intervention should be chosen for an individual remains a common dilemma. The current work systematically reviewed studies on predictors and moderators of response to different types of evidence-based treatment for children with ASD. Specifically, our goal was to critically review the relationships between pre-treatment child characteristics and specific treatment outcomes, covering different aspects of functioning (i.e., social, communicative, adaptive, cognitive, motor, global functioning, play, and symptom severity). Our results questioned the binomial "better functioning-better outcome", emphasizing the complex interplay between pre-treatment child characteristics and treatment outcomes. However, some pre-treatment variables seem to act as prerequisites for a specific treatment, and the issue of "what works for whom and why" remains challenging. Future research should focus on the definition of evidence-based decision-making models that capture those individual factors through which a specific intervention will exert its effects.

Associazione Italiana Per L'Assistenza Spastici Onlus Sez Di Cicciano 80033 Cicciano Italy

Department of Humanistic Studies University of Naples Federico 2 80138 Napoli Italy

Disability Research Centre Department of Sociology and Social Research University of International Studies of Rome 00147 Rome Italy

Faculty of Medicine University of Ostrava 70103 Ostrava Czech Republic

Neapolisanit S R L Rehabilitation Center 80044 Ottaviano Italy

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American Psychiatry Association . Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) 5th ed. American Psychiatry Association; Washington, DC, USA: 2022.

Rogers S.J., Vismara L. Handbook of Autism and Pervasive Developmental Disorders. 4th ed. John Wiley & Sons, Ltd.; Hoboken, NJ, USA: 2014. Interventions for Infants and Toddlers at Risk for Autism Spectrum Disorder.

Landa R.J. Efficacy of Early Interventions for Infants and Young Children with, and at Risk for, Autism Spectrum Disorders. Int. Rev. Psychiatry. 2018;30:25–39. doi: 10.1080/09540261.2018.1432574. PubMed DOI PMC

Smith T. Discrete Trial Training in the Treatment of Autism. Focus Autism Other Dev. Disabl. 2001;16:86–92. doi: 10.1177/108835760101600204. DOI

Schreibman L., Dawson G., Stahmer A.C., Landa R., Rogers S.J., McGee G.G., Kasari C., Ingersoll B., Kaiser A.P., Bruinsma Y., et al. Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J. Autism Dev. Disord. 2015;45:2411–2428. doi: 10.1007/s10803-015-2407-8. PubMed DOI PMC

Vivanti G., Zhong H. Naturalistic Developmental Behavioral Interventions for Children with Autism. In: Vivanti G., Bottema-Beutel K., Turner-Brown L., editors. Clinical Guide for Early Interventions for Children with Autism. Best Practices in Child and Adolescence Behavioral Health Care. Springer; Cham, Switzerland: 2020. pp. 93–130.

Hart B., Risley T.R. Incidental Teaching of Language in the Preschool. J. Appl. Behav. Anal. 1975;8:411–420. doi: 10.1901/jaba.1975.8-411. PubMed DOI PMC

McGee G.G., Morrier M.J., Daly T. An Incidental Teaching Approach to Early Intervention for Toddlers with Autism. J. Assoc. Pers. Sev. Handicap. 1999;24:133–146. doi: 10.2511/rpsd.24.3.133. DOI

Koegel R.L., Koegel L.K. Pivotal Response Treatments for Autism: Communication, Social, & Academic Development. Paul H Brookes Publishing; Baltimore, MD, USA: 2006.

Schreibman L., Koegel R.L. Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice. 2nd ed. American Psychological Association; Washington, DC, USA: 2005. Training for Parents of Children With Autism: Pivotal Responses, Generalization, and Individualization of Interventions; pp. 605–631.

Dawson G., Rogers S., Munson J., Smith M., Winter J., Greenson J., Donaldson A., Varley J. Randomized, Controlled Trial of an Intervention for Toddlers with Autism: The Early Start Denver Model. Pediatrics. 2010;125:e17–e23. doi: 10.1542/peds.2009-0958. PubMed DOI PMC

Rogers S.J., Dawson G. Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement. Guilford Press; New York, NY, USA: 2010.

Ingersoll B. Pilot Randomized Controlled Trial of Reciprocal Imitation Training for Teaching Elicited and Spontaneous Imitation to Children with Autism. J. Autism Dev. Disord. 2010;40:1154–1160. doi: 10.1007/s10803-010-0966-2. PubMed DOI PMC

Ingersoll B., Schreibman L. Teaching Reciprocal Imitation Skills to Young Children with Autism Using a Naturalistic Behavioral Approach: Effects on Language, Pretend Play, and Joint Attention. J. Autism Dev. Disord. 2006;36:487–505. doi: 10.1007/s10803-006-0089-y. PubMed DOI

Kasari C., Freeman S., Paparella T. Joint Attention and Symbolic Play in Young Children with Autism: A Randomized Controlled Intervention Study. J. Child Psychol. Psychiatry. 2006;47:611–620. doi: 10.1111/j.1469-7610.2005.01567.x. PubMed DOI

Kasari C., Paparella T., Freeman S., Jahromi L.B. Language Outcome in Autism: Randomized Comparison of Joint Attention and Play Interventions. J. Consult Clin. Psychol. 2008;76:125–137. doi: 10.1037/0022-006X.76.1.125. PubMed DOI

Vivanti G., Prior M., Williams K., Dissanayake C. Predictors of Outcomes in Autism Early Intervention: Why Don’t We Know More? Front. Pediatr. 2014;2:58. doi: 10.3389/fped.2014.00058. PubMed DOI PMC

Stahmer A.C., Schreibman L., Cunningham A.B. Toward a Technology of Treatment Individualization for Young Children with Autism Spectrum Disorders. Brain Res. 2011;1380:229–239. doi: 10.1016/j.brainres.2010.09.043. PubMed DOI PMC

Chen Y.-J., Duku E., Georgiades S. Rethinking Autism Intervention Science: A Dynamic Perspective. Front. Psychiatry. 2022;13:827406. doi: 10.3389/fpsyt.2022.827406. PubMed DOI PMC

Yoder P., Compton D. Identifying Predictors of Treatment Response. Ment. Retard. Dev. Disabil. Res. Rev. 2004;10:162–168. doi: 10.1002/mrdd.20013. PubMed DOI

Kasari C., Sturm A., Shih W. SMARTer Approach to Personalizing Intervention for Children With Autism Spectrum Disorder. J. Speech Lang. Hear. Res. 2018;61:2629–2640. doi: 10.1044/2018_JSLHR-L-RSAUT-18-0029. PubMed DOI PMC

Klinger L.G., Cook M.L., Dudley K.M. Predictors and Moderators of Treatment Efficacy in Children and Adolescents with Autism Spectrum Disorder. J. Clin. Child Adolesc. Psychol. 2021;50:517–524. doi: 10.1080/15374416.2020.1833735. PubMed DOI PMC

Siller M. Editorial: Individualizing Interventions for Young Children With Autism: Embracing the Next Generation of Intervention Research. J. Am. Acad. Child Adolesc. Psychiatry. 2021;60:680–682. doi: 10.1016/j.jaac.2020.11.003. PubMed DOI

Moher D., Liberati A., Tetzlaff J., Altman D.G. PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097. PubMed DOI PMC

Vivanti G., Dissanayake C., Zierhut C., Rogers S.J. Victorian ASELCC Team Brief Report: Predictors of Outcomes in the Early Start Denver Model Delivered in a Group Setting. J. Autism. Dev. Disord. 2013;43:1717–1724. doi: 10.1007/s10803-012-1705-7. PubMed DOI

Vivanti G., Dissanayake C. Victorian ASELCC Team Outcome for Children Receiving the Early Start Denver Model Before and After 48 Months. J. Autism Dev. Disord. 2016;46:2441–2449. doi: 10.1007/s10803-016-2777-6. PubMed DOI

Sinai-Gavrilov Y., Gev T., Mor-Snir I., Vivanti G., Golan O. Integrating the Early Start Denver Model into Israeli Community Autism Spectrum Disorder Preschools: Effectiveness and Treatment Response Predictors. Autism. 2020;24:2081–2093. doi: 10.1177/1362361320934221. PubMed DOI PMC

Latrèche K., Kojovic N., Franchini M., Schaer M. Attention to Face as a Predictor of Developmental Change and Treatment Outcome in Young Children with Autism Spectrum Disorder. Biomedicines. 2021;9:942. doi: 10.3390/biomedicines9080942. PubMed DOI PMC

Robain F., Franchini M., Kojovic N., Wood de Wilde H., Schaer M. Predictors of Treatment Outcome in Preschoolers with Autism Spectrum Disorder: An Observational Study in the Greater Geneva Area, Switzerland. J. Autism Dev. Disord. 2020;50:3815–3830. doi: 10.1007/s10803-020-04430-6. PubMed DOI

Contaldo A., Colombi C., Pierotti C., Masoni P., Muratori F. Outcomes and Moderators of Early Start Denver Model Intervention in Young Children with Autism Spectrum Disorder Delivered in a Mixed Individual and Group Setting. Autism. 2020;24:718–729. doi: 10.1177/1362361319888344. PubMed DOI

Fossum K.-L., Williams L., Garon N., Bryson S.E., Smith I.M. Pivotal Response Treatment for Preschoolers with Autism Spectrum Disorder: Defining a Predictor Profile. Autism Res. 2018;11:153–165. doi: 10.1002/aur.1859. PubMed DOI

Schreibman L., Stahmer A.C., Barlett V.C., Dufek S. Brief Report: Toward Refinement of a Predictive Behavioral Profile for Treatment Outcome in Children with Autism. Res. Autism Spectr. Disord. 2009;3:163–172. doi: 10.1016/j.rasd.2008.04.008. PubMed DOI PMC

Tiura M., Kim J., Detmers D., Baldi H. Predictors of Longitudinal ABA Treatment Outcomes for Children with Autism: A Growth Curve Analysis. Res. Dev. Disabil. 2017;70:185–197. doi: 10.1016/j.ridd.2017.09.008. PubMed DOI

Magiati I., Moss J., Charman T., Howlin P. Patterns of Change in Children with Autism Spectrum Disorders Who Received Community Based Comprehensive Interventions in Their Pre-School Years: A Seven Year Follow-up Study. Res. Autism Spectr. Disord. 2011;5:1016–1027. doi: 10.1016/j.rasd.2010.11.007. DOI

Hedvall Å., Westerlund J., Fernell E., Norrelgen F., Kjellmer L., Olsson M.B., Carlsson L.H., Eriksson M.A., Billstedt E., Gillberg C. Preschoolers with Autism Spectrum Disorder Followed for 2 Years: Those Who Gained and Those Who Lost the Most in Terms of Adaptive Functioning Outcome. J. Autism Dev. Disord. 2015;45:3624–3633. doi: 10.1007/s10803-015-2509-3. PubMed DOI

Laister D., Stammler M., Vivanti G., Holzinger D. Social-Communicative Gestures at Baseline Predict Verbal and Nonverbal Gains for Children with Autism Receiving the Early Start Denver Model. Autism. 2021;25:1640–1652. doi: 10.1177/1362361321999905. PubMed DOI

Sherer M.R., Schreibman L. Individual Behavioral Profiles and Predictors of Treatment Effectiveness for Children with Autism. J. Consult. Clin. Psychol. 2005;73:525–538. doi: 10.1037/0022-006X.73.3.525. PubMed DOI

Smith I.M., Koegel R.L., Koegel L.K., Openden D.A., Fossum K.L., Bryson S.E. Effectiveness of a Novel Community-Based Early Intervention Model for Children with Autistic Spectrum Disorder. Am. J. Intellect. Dev. Disabil. 2010;115:504–523. doi: 10.1352/1944-7558-115.6.504. PubMed DOI

Sallows G.O., Graupner T.D. Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. Am. J. Ment. Retard. 2005;110:417–438. doi: 10.1352/0895-8017(2005)110[417:IBTFCW]2.0.CO;2. PubMed DOI

Smith T., Klorman R., Mruzek D.W. Predicting Outcome of Community-Based Early Intensive Behavioral Intervention for Children with Autism. J. Abnorm. Child Psychol. 2015;43:1271–1282. doi: 10.1007/s10802-015-0002-2. PubMed DOI

Klintwall L., Eikeseth S. Number and Controllability of Reinforcers as Predictors of Individual Outcome for Children with Autism Receiving Early and Intensive Behavioral Intervention: A Preliminary Study. Res. Autism Spectr. Disord. 2012;6:493–499. doi: 10.1016/j.rasd.2011.07.009. DOI

Pellecchia M., Connell J.E., Kerns C.M., Xie M., Marcus S.C., Mandell D.S. Child Characteristics Associated with Outcome for Children with Autism in a School-Based Behavioral Intervention. Autism. 2016;20:321–329. doi: 10.1177/1362361315577518. PubMed DOI PMC

Ben-Itzchak E., Watson L.R., Zachor D.A. Cognitive Ability Is Associated with Different Outcome Trajectories in Autism Spectrum Disorders. J. Autism Dev. Disord. 2014;44:2221–2229. doi: 10.1007/s10803-014-2091-0. PubMed DOI

Remington B., Hastings R.P., Kovshoff H., degli Espinosa F., Jahr E., Brown T., Alsford P., Lemaic M., Ward N. Early Intensive Behavioral Intervention: Outcomes for Children with Autism and Their Parents after Two Years. Am. J. Ment. Retard. 2007;112:418–438. doi: 10.1352/0895-8017(2007)112[418:EIBIOF]2.0.CO;2. PubMed DOI

Eldevik S., Hastings R.P., Jahr E., Hughes J.C. Outcomes of Behavioral Intervention for Children with Autism in Mainstream Pre-School Settings. J. Autism Dev. Disord. 2012;42:210–220. doi: 10.1007/s10803-011-1234-9. PubMed DOI PMC

Arick J., Loos L., Falco R., Krug D. The STAR Program (Strategies for Teaching Based-on Autism Research) Pro-Ed, Inc.; Austin, TX, USA: 2015.

Mullen E.M., American Guidance Service . Mullen Scales of Early Learning. AGS; Circle Pines, MI, USA: 1995.

Lord C., Luyster R.J., Gotham K., Guthrie W. Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Manual (Part II): Toddler Module. Western Psychological Services; Torrance, CA, USA: 2012.

Alpern G.D. Developmental Profile III. Western Psychological Services; Los Angeles, CA, USA: 2007.

Fenson L., Marchman V.A., Thal D.J., Dale P.S., Reznick J.S. Macarthur-Bates Communicative Development Inventories: Users Guide and Technical Manual. 2nd ed. Brookes Pub; Baltimore, MD, USA: 2006.

Sparrow S.S. Vineland Adaptive Behavior Scales. In: Kreutzer J.S., DeLuca J., Caplan B., editors. Encyclopedia of Clinical Neuropsychology. Springer; New York, NY, USA: 2011. pp. 2618–2621.

Griffiths R. The Abilities of Young Children: A Comprehensive System of Mental Measurement for the First Eight Years of Life. Test Agency Ltd.; London, UK: 1984. Revised edition.

Roid G., Sampers J. Merrill-Palmer-Revised Scales of Development—PsycNET. Stoelting; Wood Dale, IL, USA: 2004.

Schopler E., Lansing M., Reichler R., Marcus L. Psychoeducational Profile: Third Edition (PEP-3) Pro-Ed; Austin, TX, USA: 2005.

Wechsler D., Psychological Corporation. PsychCorp (Firm) WAIS-IV Technical and Interpretive Manual. Pearson; San Antonio, TX, USA: 2008.

Michalec D. Bayley Scales of Infant Development: Third Edition. In: Goldstein S., Naglieri J.A., editors. Encyclopedia of Child Behavior and Development. Springer; Boston, MA, USA: 2011. p. 215.

Reynell J.K., Huntley M. Reynell Developmental Language Scales. NFER-NELSON Publishing Co.; Windsor, PA, USA: 1985.

Cohen I.L., Schmidt-Lackner S., Romanczyk R., Sudhalter V. The PDD Behavior Inventory: A Rating Scale for Assessing Response to Intervention in Children with Pervasive Developmental Disorder. J. Autism Dev. Disord. 2003;33:31–45. doi: 10.1023/A:1022226403878. PubMed DOI

Harrison P., Oakland T.T. In: Adaptive Behavior Assessment Syste. John B., editor. Harcourt Assessment; San Antonio, TX, USA: 2000.

Dunn L.M., Dunn L.M., Whetton C., Burley J. British Picture Vocabulary Scale. 2nd ed. NFER-Nelson; Windsor, PA, USA: 1997.

Michalec D., Henninger N. Expressive One-Word Picture Vocabulary Test. In: Kreutzer J.S., DeLuca J., Caplan B., editors. Encyclopedia of Clinical Neuropsychology. Springer; New York, NY, USA: 2011. pp. 1000–1002.

Elliot C.D. Differential Ability Scales. 2nd ed. Harcourt Assessment; San Antonio, TX, USA: 2007.

Lord C., Rutter M., Le Couteur A. Autism Diagnostic Interview-Revised: A Revised Version of a Diagnostic Interview for Caregivers of Individuals with Possible Pervasive Developmental Disorders. J. Autism Dev. Disord. 1994;24:659–685. doi: 10.1007/BF02172145. PubMed DOI

Bodfish J.W., Symons F.J., Parker D.E., Lewis M.H. Varieties of Repetitive Behavior in Autism: Comparisons to Mental Retardation. J. Autism Dev. Disord. 2000;30:237–243. doi: 10.1023/A:1005596502855. PubMed DOI

Gadow K.D., Sprafkin J.N. Child Symptom Inventory 4: Screening and Norms Manual. Checkmate Plus; Stony Brook, NY, USA: 2002.

Berument S.K., Rutter M., Lord C., Pickles A., Bailey A. Autism Screening Questionnaire: Diagnostic Validity. Br. J. Psychiatry. 1999;175:444–451. doi: 10.1192/bjp.175.5.444. PubMed DOI

Krug D.A., Arick J., Almond P. Behavior Checklist for Identifying Severely Handicapped Individuals with High Levels of Autistic Behavior. J. Child Psychol. Psychiatry. 1980;21:221–229. doi: 10.1111/j.1469-7610.1980.tb01797.x. PubMed DOI

Iovino L., Canniello F., Simeoli R., Gallucci M., Benincasa R., D’Elia D., Hanley G.P., Cammilieri A.P. A New Adaptation of the Interview-Informed Synthesized Contingency Analyses (IISCA): The Performance-Based IISCA. Eur. J. Behav. Anal. 2022:1–12. doi: 10.1080/15021149.2022.2093596. DOI

Tiger J.H., Hanley G.P., Bruzek J. Functional Communication Training: A Review and Practical Guide. Behav. Anal. Pract. 2008;1:16–23. doi: 10.1007/BF03391716. PubMed DOI PMC

Rogers S.J., Yoder P., Estes A., Warren Z., McEachin J., Munson J., Rocha M., Greenson J., Wallace L., Gardner E., et al. A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism. J. Am. Acad. Child. Adolesc. Psychiatry. 2021;60:710–722. doi: 10.1016/j.jaac.2020.06.013. PubMed DOI PMC