Media-based behavioural treatments for behavioural problems in children

  • Review
  • Intervention

Authors


Abstract

Background

Many approaches are used to address behavioural problems in childhood including medication or, more usually, psychological treatments either directly with the child and/or his/her family. Behavioural and cognitive-behavioural interventions have been shown to be effective but access to these treatments is limited due to factors such as time and expense. Presenting the information parents need in order to manage these behaviour problems in booklet or other media-based format might reduce the cost and increase access to these interventions.

Objectives

To review the effects of media-based cognitive-behavioural therapies for any young person with a behavioural disorder (diagnosed using a recognised instrument) compared to standard care and no-treatment controls.

Search methods

We searched: CENTRAL (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1980 to August 2005), PsycINFO (1887 to August 2005), CINAHL (1982 to August 2005), Biosis (1985 to August 2005) and Sociofile (1974 to August 2005). Bibliographies of all selected trials were checked and experts in the field were contacted for additional information.

Selection criteria

Randomised and quasi-randomised controlled trials (e.g. trials which used sequential randomisation) of media-based behavioural treatments for behaviour problems in children.

Data collection and analysis

Abstracts and titles of studies identified from searches of electronic databases were read to determine whether they met the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by the reviewers and queries were resolved by discussion. Data were analysed using RevMan 4.2.

Main results

Eleven studies including 943 participants were included within this review. In general, media-based therapies for behavioural disorders in children had a moderate, if variable, effect when compared with both no-treatment controls with effects sizes ranging from -0.12 (-1.65, 1.41) to -32.60 (-49.93, -15.27) and as and adjunct to medication with effect sizes ranging from -2.71 (-5.86, -0.44) to -39.55 (-75.01, -4.09). Significant improvements were made with the addition of up to two hours of therapist time.

Authors' conclusions

These formats of delivering behavioural interventions for carers of children are worth considering in clinical practice. Media-based interventions may, in some cases, be enough to make clinically significant changes in a child's behaviour, and may reduce the amount of time primary care workers have to devote to each case. They can also be used as the first stage of a stepped care approach. Consequently this would increase the number of families who could possibly benefit from these types of intervention, releasing clinician time that can be reallocated to more complex cases. Media-based therapies would therefore appear to have both clinical and economic implications as regards the treatment of children with behavioural problems.

摘要

背景

對有行為問題孩童進行媒體形式的行為治療(Mediabased behavioural treatments)

許多治療孩童行為問題的方法,包含藥物,或更普遍的直接與孩童和/或與其家人進行心理治療。行為和認知行為措施非常有效,但受限於時間和費用,並不是所有人都可享有此治療。用手冊或其他媒體形式,給父母控制行為問題需要的資訊,最可能減少花費,且增加這些治療的可取得性。

目標

回顧對有行為異常狀況 (經認可的工具診斷) 的年輕人,使用媒體形式的認知行為治療,或用標準療法或沒有治療的對照組,比較各組療效。

搜尋策略

以下電子資料庫經過系統性搜尋:CENTRAL (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1980 to August 2005), PsycINFO (1887 to August 2005), CINAHL (1982 to August 2005), Biosis (1985 to August 2005) and Sociofile (1974 to August 2005). 在選定試驗的參考資料中,尋找是否有其他試驗。已向此領域的專家詢問進一步的資訊。

選擇標準

隨機分配和半隨機對照試驗(例如:使用序列隨機分配 (sequential randomisation)),對有行為問題孩童進行媒體形式的行為治療。

資料收集與分析

閱讀由電子資料庫挑出的試驗摘要和題目,以確定是某符合納入條件。可能符合的文章全文由閱覽者評估,問題經討論解決。使用 RevMan 4.2分析資料。

主要結論

本回顧包含11個試驗,943受試者。一般來說,對有行為問題孩童進行媒體形式的行為治療,比起沒治療的對照組,有中度效果,療效為介於 −0.12 (−1.65,1.41) 到 −32.60 (−49.93, −15.27) ,若加上藥物治療則療效介於 −2.71 (−5.86, −0.44) 至 −39.55 (−75.01, −4.09). 若再加上治療師最長2小時治療,則有顯著進步。

作者結論

在臨床上,這種針對兒童照護者的行為介入值得於考慮。媒體形式的行為治療,在某些案例中,足以臨床顯著地改善兒童行為,且減少初級照護人員花於個案的時間。媒體形式的行為治療,可當成階段療法的第一階段,可增加正面受益的家庭數,節省醫師時間以處理較複雜的個案。因此媒體形式的行為治療,對兒童行為問題有臨床和經濟上的意義。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

認知行為介入對減少兒童行為問題有效,但是受限於是否有此治療的提供,時間和費用,並不是所有人都可享有此治療。用手冊或其他媒體形式,像是DVD,錄影帶或電腦程式,給父母控制行為問題需要的資訊,可減少花費,且增加這些治療的可取得性。一般來說,對有行為問題孩童進行媒體形式的行為治療,與沒治療的對照組或合併藥物治療組相比,有中度效果。

Plain language summary

Media-based behavioural treatments for behavioural problems in children

Cognitive-behavioural interventions have been shown to be effective for reducing behavioural problems in children, but access to these treatments is limited by factors including the availability of therapists, time and expense. Providing the information required to manage these problems in booklet or other media-based format such as DVDs, cassettes or computer programmes, would reduce the cost and increase access to these interventions. In general, this review found that media-based therapies for behavioural disorders in children had a moderate effect versus no-treatment and as an adjunct to medication.

Ancillary