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Psychosocial Interventions for Children With Externalized Behavior Problems: An Updated Meta-analysis of Moderator Effects

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Abstract

Over the last decades, ambulatory psychosocial interventions aimed at treating child externalized behavior problems have been developed and tested. In recent years, however, it has become clear that the reported effects of psychotherapies have been considerably overestimated due to publication bias. In addition, previous meta-analyses of psychosocial interventions aimed at treating child disruptive behaviors have not accounted for potential interaction effects among moderators. The purpose of this meta-analysis was to examine the effects of interventions while accounting for publication bias and dependencies among moderators. We searched electronic databases to identify randomized controlled trials targeting child externalized behavior problems treated in ambulatory settings. A total of 111 randomized controlled trials with 11,623 participating children were analyzed. Interventions targeting children with symptom severity below the clinical range demonstrated a non-significant effect (adjusted g = 0.12), while interventions targeting children with symptom severity within the clinical range demonstrated a small to moderate effect size (adjusted g = 0.38) that was sustained at follow-up (adjusted g = 0.27). We found the highest pooled effect size for individually administered treatments involving both the parent and the child (g = 1.11; no indication of publication bias). No other differences were found between delivery formats, including assisted self-help interventions. Publication bias was relatively smaller in high-quality studies. These findings suggest that the most effective treatment regime involves both the parent and the child, however, only when they are treated in an individual setting. Our results highlight the importance of accounting for interaction effects, publication bias and trial quality in future meta-analyses.

Highlights

  • Interventions for children with symptoms within the clinical range are effective.

  • Individual treatments involving both the parent and child had the highest effect.

  • Child involvement was not associated with better outcome in group administered interventions.

  • Analysis indicates that high quality studies reduce the risk of publication bias.

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Authors and Affiliations

  1. Department of Community Mental Health, University of Haifa, Haifa, Abba Khoushy Ave 199, 3498838, Haifa, Israel

    Amit Baumel

  2. Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Queens, NY, 11004, USA

    Nandita Mathur

  3. Child & Adolescent Psychiatry, Massachusetts General Hospital/McLean Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Aditya Pawar

  4. Partnership for Drugfree Kids, 485 Lexington Ave, New York, NY, 10017, USA

    Fred Muench

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  1. Amit Baumel
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  3. Aditya Pawar
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  4. Fred Muench
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Correspondence to Amit Baumel.

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Appendices

Appendix A

PsycInfo search terms (time limits were set through the search engine’s platform)

Table 5
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Appendix B. Characteristics of included trials

Table 6
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Appendix C

Forest plot of immediate effect sizes (Hedges’ g, positive favoring the intervention), 95% confidence interval lower and upper limits, and significance measurement

Table 7
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Appendix D

Forest plot of short-term follow-up effect sizes (Hedges’ g, positive favoring the intervention), 95% confidence interval lower and upper limits, and significance measurement

Table 8
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Baumel, A., Mathur, N., Pawar, A. et al. Psychosocial Interventions for Children With Externalized Behavior Problems: An Updated Meta-analysis of Moderator Effects. J Child Fam Stud 30, 65–86 (2021). https://doi.org/10.1007/s10826-020-01863-6

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