From Self-Regulation to Function: A Systematic Review and Meta-Analysis of Randomised Controlled Trials in Autistic...

Background and Objectives: Self-regulation is important for children's learning, social participation and everyday functioning, yet intervention evidence for autistic children and young people is fragmented across intervention approaches and regulatory constructs. This systematic review and meta-analysis aimed to characterise and critically evaluate non-pharmacological randomised controlled trials targeting self-regulation in autistic children and young people and to quantify effects on both self-regulation and separate child functional outcomes. Methods: MEDLINE, PubMed, PsycINFO, CINAHL and ERIC were searched to 24 May 2026. Eligible studies were randomised controlled trials involving autistic children and young people aged 0-18 years that targeted at least one domain of self-regulation and assessed both self-regulation and child function. Risk of bias was assessed using RoB-2. Random-effects meta-analyses were conducted for self-regulation and functional outcomes, with moderator, meta-regression and sensitivity analyses examining sources of variation. Functional proximity and intervention-mechanism moderator analyses were exploratory and were not prespecified in the registered protocol. Results: Twenty-five studies involving 1655 randomised participants were included. Self-regulation improved significantly across 27 intervention-comparator effects from 25 studies (Hedges' g = 0.605, 95% CI 0.454-0.756; 95% prediction interval 0.027-1.183). Functional outcomes also improved across 25 effects from 23 studies (g = 0.527, 95% CI 0.356-0.698; 95% prediction interval -0.158-1.212). Functional effects were substantially larger for direct/target-aligned outcomes (g = 0.761) than for distal/generalisation outcomes (g = 0.250; Q_β = 11.034, p < .001). The direct-distal contrast attenuated when restricted to active-comparator studies (Q_β = 3.770, p = .052), although distal effects remained positive. Comparator type moderated both outcome streams, whereas self-regulation construct coverage, age, intervention duration, target-skill application and explicit generalisation support did not significantly moderate effects. Conclusions: Self-regulation-focused interventions produce beneficial average effects on both regulatory and functional outcomes. Functional improvement is strongest when outcomes align closely with intervention targets, although smaller positive effects also extend to distal outcomes. Future trials should distinguish proximal regulatory change from target-aligned and distal functional outcomes and explicitly test pathways of generalisation.