How are behavioural interventions delivered to children (5–11 years old): a systematic mapping review - Brigden, Crawley et al Dec 2019

[Sly Saint]

Abstract
Context Behavioural interventions are used to prevent, manage and treat a wide variety of conditions including obesity, diabetes, chronic pain, asthma and emotional difficulties. There has been inadequate attention to the delivery of behavioural interventions to younger children (5–11 years old).

Objective Our objectives were to describe the characteristics of behavioural interventions for children aged 5–11 years.

Data sources We searched five databases: CINAHL, EMBASE, PsycINFO, MEDLINE and Cochrane Library, from January 2005 to August 2019.

Study selection The inclusion criteria were (1) children aged 5–11, (2) cognitive and/or behavioural interventions, (3) randomised controlled trials and (4) 2005 onward. Two researchers independently identified studies for inclusion.

Data extraction Two researchers independently extracted data from eligible papers.

Results The search identified 10 541 papers. We extracted information on 117 interventions (from 152 papers). Many of the interventions were categorised as complex. This was particularly true for clinical populations; 78.7% were delivered to both the child and parent, and 33.9% took place across multiple settings, typically health and school settings. Most (70.9%) were ‘First Wave’ (behavioural) interventions, and few (4.3%) were ‘Third Wave’ (characterised by metacognition, acceptance and mindfulness). Thirty-nine per cent used interactive techniques (play, arts, story and/or games). Purely digital and paper-based interventions were rare, but around a third used these tools as supplements to face–face delivery. There were differences in interventions for younger (5–7 years) and older (8–11 years) children.

Conclusions Interventions designed and delivered to children should be developmentally sensitive. This review highlights characteristics of interventions delivered to children 5–11 years old: the involvement of the child’s parent, using behavioural (rather than cognitive) modalities, using interactive techniques and some interventions were delivered across multiple settings.

full paper here
https://bmjpaedsopen.bmj.com/content/3/1/e000543

 

[Esther12]

How would they classify LP?

 

[dave30th]

Of course her 12 corrections do not appear to have slowed her down...

 

[Jonathan Edwards]

How do you get a 'should' out of an observational meta study?

 

[NelliePledge]

How would they classify LP?

An interactive paper based approach perhaps - all that jumping onto paper squares..........or is it circles

 

[rvallee]

Of course her 12 corrections do not appear to have slowed her down...

Want to laugh? And cry. At the same time.

This review highlights issues about trial design in this field. A clearly defined and pre-specified primary outcome is important; it reduces the risks of selective reporting of outcomes and false-positive from analysing too many outcomes.

(This is actually a real paragraph found in a Crawley paper, seriously)

 

[MEMarge]

"What this study adds?

• This review highlights intervention characteristics to consider when designing and delivering interventions for children 5–11 years old. Interventions for children aged 5–11 years typically involve parents, span multiple settings, use a ‘First Wave’ behavioural modality and integrate interactive techniques (play, arts, story and/or game-based techniques)."

So, basically, this review adds ..... nothing.

For anyone interested:
Behavioural interventions (‘First Wave’) are based on the theory that all behaviours are learnt (through classical and operant conditioning)11 and that maladaptive behaviours can be changed using principles such as reinforcement, modelling, graded tasks and habit formation.12 Cognitive-behavioural (CBT, ‘Second Wave’) interventions are based on the principle that thoughts, feelings, physical sensations and actions are interconnected; individuals are supported to identify negative/unhelpful patterns in their cognitions, emotions, behaviours, physical sensations and supported to adopt more adaptive patterns.13 The ‘Third Wave’ of cognitive-behavioural interventions are characterised by techniques such as metacognition, acceptance, mindfulness, compassion and spirituality.11

 

[Amw66]

Stating the obvious has become an art form, but perhaps cognitive reinforcement is required for the consultant team.

I sat in on an educational psychology feedback workshop, which due to parents present was mainly concerned with autism, dyslexia and placing kids in appropriate schools at primary and at secondary transition.

This is pretty well done locally and was a bit of a compliment fishing exercise, but did raise a few points that staff had not thought of/ thought through including recommending CBT for a non verbal autistic teenager (!) His mum was good about it - I don't think she thought they were serious.
They had not heard of DBT - seemed to be a bit if a one trick pony.