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This systematic review synthesized 58 studies to examine how physical environmental modification interventions (e.g., modifying lighting, providing visual supports) for autistic individuals have been implemented. Most interventions targeted K–12 segregated settings and autistic individuals with intellectual disabilities; visual schedules were most commonly implemented. Risk of performance and detection biases was high due to inadequate masking of personnel. Single-case studies often measured on-task behavior, while group-design studies assessed broader outcomes, often with limited psychometric rigor. Fewer than half evaluated social validity, frequently omitting autistic perspectives. The evidence base shows variability in intervention quality, design, and reporting, and remains methodologically limited. Future research should report key participant and study characteristics, include autistic input, and develop conceptual frameworks for effective, context-specific interventions.