Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries

A systematic review and meta-analysis

Matthew D. Burkey, Megan Hosein, Isabella Morton, Marianna Purgato, Ahmad Adi, Mark Kurzrok, Brandon A. Kohrt, Wietse Anton Tol

Research output: Contribution to journalArticle

Abstract

Background: Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods: We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results: Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95% confidence interval (CI): -0.41 to -0.09; I2: 78%) and of treatment studies was -0.56 (95% CI: -0.51 to -0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95% CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95% CI: -0.66 to -0.20), and that interventions were effective across age ranges. Conclusions: Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.

Original languageEnglish (US)
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
DOIs
StateAccepted/In press - Jan 1 2018

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Meta-Analysis
Confidence Intervals
Parenting
Randomized Controlled Trials
Patient Selection
Mental Health
Problem Behavior
Therapeutics
Research

Keywords

  • Child behaviour
  • Disruptive behaviour disorders
  • Low-income countries
  • Meta-analysis
  • Psychosocial interventions

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries : A systematic review and meta-analysis. / Burkey, Matthew D.; Hosein, Megan; Morton, Isabella; Purgato, Marianna; Adi, Ahmad; Kurzrok, Mark; Kohrt, Brandon A.; Tol, Wietse Anton.

In: Journal of Child Psychology and Psychiatry and Allied Disciplines, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods: We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results: Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54{\%}) prevention interventions targeted general or at-risk populations, whereas 13 (46{\%}) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96{\%}) and half (50{\%}) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95{\%} confidence interval (CI): -0.41 to -0.09; I2: 78{\%}) and of treatment studies was -0.56 (95{\%} CI: -0.51 to -0.24; I2: 74{\%}). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95{\%} CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95{\%} CI: -0.66 to -0.20), and that interventions were effective across age ranges. Conclusions: Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.",
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T2 - A systematic review and meta-analysis

AU - Burkey, Matthew D.

AU - Hosein, Megan

AU - Morton, Isabella

AU - Purgato, Marianna

AU - Adi, Ahmad

AU - Kurzrok, Mark

AU - Kohrt, Brandon A.

AU - Tol, Wietse Anton

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AB - Background: Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods: We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results: Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95% confidence interval (CI): -0.41 to -0.09; I2: 78%) and of treatment studies was -0.56 (95% CI: -0.51 to -0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95% CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95% CI: -0.66 to -0.20), and that interventions were effective across age ranges. Conclusions: Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.

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KW - Meta-analysis

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