In this article, we provide a demonstration of a basic critical appraisal of a systematic review. The article critically appraised is “Social Skills Teaching for Individuals with Autism Spectrum Disorder: a Systematic Review” authored by Radley et al. (2020). The Critical Appraisal Skills Programme (CASP) checklist for systematic reviews (CASP, 2018) guided the critical appraisal.  

Validity of the Results

The target population in the systematic review by Radley et al. (2020) comprised children with ASD aged between three and 17 years. The investigated interventions were social skills teaching (SST) while the outcomes of interest were discrete social skills. Although the researchers did not directly state the research question, the clear description of the population, intervention, and outcome is an indication that the study was focused (CASP, 2018).

The inclusion criteria for the selection of articles specified that only single-case design studies would be systematically reviewed considering the need to cover the gap left by previous reviews. Preceding systematic reviews included group-based social skills intervention studies and randomized controlled trials or their combinations, which mainly present broad social functioning as reported by the observer. A single-case design is appropriate for collecting data on discrete social skills (Ledford et al., 2019). Hence, synthesizing several single-case studies with SST as the intervention as in the systematic review by Radley et al. (2020) can reveal the effect of SST on discrete social skills.     

Comprehensive Inclusion of Articles

The search for relevant articles was comprehensive since it was done in several unspecified databases. It was limited to scholarly databases accessible via EBSCOhost instead of targeting all databases where relevant articles could be located (Bramer et al., 2018). The authors did not consider non-English and non-published articles. Besides, they did not contact experts for updates on related research (CASP, 2018). Therefore, the inclusion of articles may not have been exhaustive.

Quality Assessment

Four authors assessed the identified articles to determine whether they met the strict inclusion criteria specified for the systematic review. The selection of 201 articles from the 986 that were retrieved from the search was a rigorous process since each study was assessed for suitability individually and verified by the first and third authors, who categorized the data from relevant articles (Radley et al., 2020).

Combining the Results

According to Radley et al. (2020), the 201 included articles can be accessed by contacting the first author. Since all the selected articles were variants of experimental single case research design including AB design, multiple probe design, concurrent and non-concurrent multiple baseline designs, withdrawal/reversal design, alternating treatments design, and complex phase design, their findings could be combined. The combination of findings was based on predetermined variables through coded categorization, hence their variations were considered (CASP, 2018). Therefore, it was reasonable to combine the results.  

The Results  

Radley et al. (2020) found that there are 12 intervention categories related to SST. They include video modeling, behavioral skills training, social stories, peer-mediated antecedent strategies, manualized curriculum, pivotal response training (PRT) and milieu interventions, script fading, discrete trial training, self-management, and rules. Video modeling, behavioral skills training, and social stories were the main interventions since they were the most researched, with 39, 32, and 31 studies respectively covering them (Radley et al., 2020).

The results were presented in a table whereby numbers and particulars of studies focusing on each of the identified intervention categories were described. Then, each of the intervention categories was described thematically based on the information synthesized from the included studies. Since Radley et al. (2020) leveraged coding to analyze the qualitative data from the studies included in the systematic review, the expression of findings in terms of the number of articles that tackled the various intervention categories and their attributes was adequate. Since the synthesized findings were qualitative, it is not possible to determine their precision based on confidence intervals (CASP, 2018). However, the truth value of the findings can be considered as high since the authors specifically outlined the set of coding procedures they applied to generate the findings (Noble & Smith, 2015; Radley et al. (2020).         

Recommendations based on the Results  

The systematic review by Radley et al. (2020) focused on studies whose participants were 3-17 years old and had a documented diagnosis of ASD. Thus, the findings can only be applied to a population of children and adolescents diagnosed with ASD. However, the demographics of the participants such as their countries of residence and economic status are not summarized, hence it is not possible to specify the subpopulation that would best benefit from the intervention strategies identified in the systematic review.  

The systematic review did not entail meta-analyzing results on the effectiveness of the 12 intervention strategies, thus it is not possible to determine which among them is the most effective. Nevertheless, practitioners such as occupational therapists intending to apply any of the 12 strategies to impart social skills to children and adolescents can leverage the thematic analysis of the strategies in the systematic review to identify the most appropriate considering their population characteristics, available resources, and targeted outcomes. Since the systematic review only included single-case design studies, its findings should only be applied upon the consideration of the findings of systematic reviews and meta-analyses that combine the results of studies using group designs.  

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References

Bramer, W. M., De Jonge, G. B., Rethlefsen, M. L., Mast, F., & Kleijnen, J. (2018). A systematic approach to searching: an efficient and complete method to develop literature searches. Journal of the Medical Library Association: JMLA, 106(4), 531. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148622/

Critical Appraisal Skills Programme (CASP). (2018). CASP (Systematic Review) Checklist. Available at https://casp-uk.net/images/checklist/documents/CASP-Systematic-Review-Checklist/CASP-Systematic-Review-Checklist-2018_fillable-form.pdf

Ledford, J. R., Barton, E. E., Severini, K. E., & Zimmerman, K. N. (2019). A primer on single-case research designs: Contemporary use and analysis. American Journal on Intellectual and Developmental Disabilities, 124(1), 35-56. https://doi.org/10.1352/1944-7558-124.1.35

Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative research. Evidence-based nursing, 18(2), 34-35. http://eprints.hud.ac.uk/id/eprint/23995/1/SmithIssues.pdf

Radley, K. C., Dart, E. H., Brennan, K. J., Helbig, K. A., Lehman, E. L., Silberman, M., & Mendanhall, K. (2020). Social skills teaching for individuals with autism spectrum disorder: A systematic review. Advances in Neurodevelopmental Disorders, 4(3), 215-226. https://doi.org/10.1007/s41252-020-00170-x