Psychosocial interventions for disruptive behavior problems in children in low- and middle-income countries: A systematic review and meta-analysis

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 metaanalysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behavior 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.