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 A Tol

doi:10.1111/jcpp.12894

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

J Child Psychol Psychiatry. 2018 Sep;59(9):982-993. doi: 10.1111/jcpp.12894. Epub 2018 Apr 6.

Authors

Matthew D Burkey^{1

2}, Megan Hosein³, Isabella Morton⁴, Marianna Purgato^{1

5}, Ahmad Adi⁶, Mark Kurzrok⁷, Brandon A Kohrt⁸, Wietse A Tol¹

Affiliations

¹ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² University of British Columbia, Vancouver, BC, Canada.
³ New York University, New York, NY, USA.
⁴ University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
⁵ University of Verona, Verona, Italy.
⁶ Duke University School of Medicine, Durham, NC, USA.
⁷ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ George Washington University, Washington, DC, USA.

PMID: 29633271
DOI: 10.1111/jcpp.12894

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.

Keywords: Child behaviour; disruptive behaviour disorders; low-income countries; meta-analysis; psychosocial interventions.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Systematic Review

MeSH terms

Adolescent
Attention Deficit and Disruptive Behavior Disorders / therapy*
Child
Child Behavior Disorders / therapy*
Child, Preschool
Developing Countries*
Humans
Problem Behavior*
Psychotherapy / statistics & numerical data*

Grants and funding

KL2 TR001077/TR/NCATS NIH HHS/United States