Emotion regulation interventions for autistic children and adolescents: A panoramic comparison through systematic review and network meta-analysis.

Children and adolescents with autism spectrum disorder (ASD) frequently experience emotion regulation (ER) difficulties, yet the comparative effectiveness of available interventions remains unclear. This network meta-analysis (NMA) aimed to rank non-pharmacological ER interventions for autistic children and adolescents and to examine moderators of treatment effects. Ten databases were searched from inception to March 2026. Randomized and controlled trials evaluating ER interventions in autistic youth (mean age < 18 years) were included. A frequentist NMA was conducted using random-effects models. Effect sizes were expressed as standardized mean differences (Hedges'g), with rankings estimated using surface under the cumulative ranking curve (SUCRA) values. Thirty-eight studies (1895 participants) were included; 32 contributed to the NMA. Technology-aided instruction and intervention (TAII) ranked first (SMD = 0.90, SUCRA = 79.4%), followed by drawing therapy (SMD = 0.88, SUCRA = 73.0%) and floortime (SMD = 0.81, SUCRA = 68.4%). Cognitive behavioral therapy showed moderate effects (SMD = 0.52, SUCRA = 43.7%). Subgroup analyses indicated that intervention rankings varied by duration, setting, informant, and age. This NMA establishes the evidence-based hierarchy of ER interventions for autistic youth. TAII and CBT are most effective overall, but effectiveness is context-dependent, supporting a personalized, stepped-care approach.