Effects of Tactile and Vibrotactile Prompting on Response Initiation, Attention Re-Engagement and Functional Task Participation in Autistic Children: A Systematic Review and Meta-Analysis of Experimental and Single-Case Studies

This systematic review and meta-analysis aims to evaluate the effects of tactile and vibrotactile prompting on response initiation, attention re-engagement, and functional task participation among children with Autism Spectrum Disorder (ASD). Children with ASD frequently experience difficulties in initiating responses, sustaining attention, shifting attention between tasks, and participating in functional and goal-directed activities. Tactile and vibrotactile prompting have been explored as potential intervention strategies to facilitate engagement and improve responsiveness through sensory-based cues. However, the effectiveness of these approaches across different tasks, settings, and outcome measures remains insufficiently synthesized. The primary objective of this review is to systematically identify, critically appraise, and synthesize experimental and single-case studies investigating the effects of tactile and vibrotactile prompting on response initiation in autistic children. Secondary objectives include evaluating their effects on attention re-engagement following distraction or disengagement, functional task participation, task completion, behavioral responsiveness, and maintenance and generalization of intervention effects. A comprehensive literature search will be conducted across relevant electronic databases to identify eligible experimental, quasi-experimental, and single-case experimental studies involving children diagnosed with ASD. Studies examining tactile or vibrotactile prompting as an intervention, cue, or facilitation strategy will be considered. Relevant outcomes will include response initiation latency, response accuracy, frequency of prompted and independent responses, duration of task engagement, attention recovery, task completion, participation, and other objectively measured behavioral outcomes. Data extraction will include participant characteristics, age, diagnostic criteria, intervention characteristics, type and intensity of tactile or vibrotactile stimulation, prompting procedures, comparator conditions, outcome measures, intervention duration, follow-up, and reported effects. Methodological quality and risk of bias will be assessed using appropriate tools based on the study design, including tools suitable for randomized and non-randomized studies and single-case experimental designs. Where sufficient methodological and clinical homogeneity exists, quantitative synthesis will be performed using appropriate effect size measures and meta-analytic models. Heterogeneity will be explored using statistical methods and, where feasible, subgroup analyses based on prompting modality, intervention characteristics, participant age, task type, and study design. Single-case experimental studies will be synthesized using suitable single-case effect size metrics, with consideration of the compatibility of these estimates with group-design findings. Where quantitative pooling is inappropriate, findings will be synthesized narratively and systematically. The anticipated outcomes of this review include establishing the extent to which tactile and vibrotactile prompting facilitates response initiation, attention re-engagement, and functional participation in autistic children; identifying the most promising prompting approaches and contexts of application; and examining the consistency, generalizability, and limitations of the available evidence. This review is expected to provide clinically relevant evidence to inform pediatric occupational therapy, physiotherapy, behavioral intervention, educational practices, and individualized rehabilitation approaches while identifying important gaps and priorities for future experimental research.