CRD summary

This review assessed the effectiveness of behavioural parent-training (BPT) and cognitive-behavioural therapy (CBT) for treating antisocial behaviour in young people. BPT and CBT have small to medium effects on antisocial behaviour; this was based on average effects of various interventions on various outcomes. The review methods could have favoured positive findings.

Authors' objectives

The main objective was to determine the differential effectiveness of behavioural parent-training (BPT) and cognitive-behavioural therapy (CBT) for youth antisocial behaviour. The second objective was to identify which youth demographic variables were potential effect modifiers.

Searching

Studies published prior to 2005 were sought by searching PsycINFO and Psychological Abstracts; the search terms were reported. The reference lists of the selected studies and two published meta-analyses (see Other Publications of Related Interest no.1-2) were checked for additional studies.

Study selection

Assessment of study quality

A coding system used in a published meta-analysis was modified for use in this review, to assign a composite quality score to each included study. One point was assigned for each of six criteria: sample size at least 30 per group; random assignment; at least one 'normed' or blinded behavioural outcome measure; attention placebo control group; intention-to-treat design; and post-test data reported for all measures assessed at pre-test. This was done as part of the data extraction process.

Data extraction

One reviewer coded all the studies then a second reviewer independently coded a random 15%. Kappa coefficients were calculated to assess inter-rater reliability. Any discrepancies were resolved by consensus.

The outcome data extracted were mean and standard deviation (SD) values for the experimental and control groups in each study. If these were not reported, p-values, t-values and f-values were extracted to estimate the treatment effect. Data were extracted for five potential moderators of effect: intervention type (BPT or CBT), intervention approach (group or individual), age (mean), gender and ethnicity. The length of follow-up (months between post-treatment and follow-up assessment) was also extracted.

Data were extracted for four possible confounding variables: length of the intervention (number of 1-hour sessions), outcome source (parent report, teacher report or observational techniques), degree of disturbance (at risk or DSM-diagnosed) and setting (clinical or non-clinical).

Methods of synthesis

Results of the review

Seventy-five studies were included in the review. Thirty-two studies (1,892 participants) were included in the analysis of BPT, while 45 studies (2,745 participants) were included in the analysis of CBT.

Two studies that met the inclusion criteria were excluded from the meta-analysis after a preliminary analysis of post-treatment ES showed their values to be outliers.

The meta-analysis showed that BPT and CBT had small to moderate beneficial effects.

The overall post-treatment ES was 0.4 (95% CI: 0.34, 0.47), based on 71 studies (30 BPT and 41 CBT). There was significant heterogeneity between the studies. The average quality score was 3.3 out of 6. Higher quality studies produced a significantly lower ES. After controlling for study quality, BPT had a significantly higher ES than CBT in the subset of studies with participants aged 6 to 12 years (7 BPT and 21 CBT). The differential effect between BPT and CBT was not seen when the intervention setting was included as a control variable in the regression. The overall follow-up ES was 0.22 (95% CI: 0.11, 0.34), based on 17 studies (4 BPT and 13 CBT).

For BPT, the overall post-treatment ES was 0.47 (95% CI: 0.34, 0.61); there was significant heterogeneity between the 30 studies. Sufficient data were available to conduct a regression analysis on age and intervention approach: after controlling for study quality neither showed a significant relationship with ES. There were insufficient data to calculate the follow-up ES for BPT.

For CBT; the overall post-treatment ES was 0.35 (95% CI: 0.25, 0.47); there was significant heterogeneity between the 41 studies. Sufficient data were available to conduct a regression analysis on age and ethnicity: after controlling for study quality there was a significant positive relationship between ES and age. The follow-up ES was 0.31 (95% CI: 0.13, 0.48).

Authors' conclusions

BPT and CBT had small to medium average effect sizes and could, therefore, be effective for treating aggressive behavioural problems in youths.

CRD commentary

The review addressed a clear question and had defined inclusion criteria. The number of sources searched for relevant studies was limited. The restriction to published studies could have increased bias towards studies with positive findings (not only limit the generalisability of the findings, as the authors stated). All of the included studies appeared to be published in English although a language restriction was not mentioned. There was no information to determine whether steps were taken to minimise reviewer bias and errors in the study selection process. Adequate methods were used to reduce bias and errors in the extraction and coding of the data, including the quality assessment. It was not possible to determine the specific limitations of the individual studies from the composite quality scores or which studies, if any, were randomised.

The analysis was conducted using accepted methods but was limited, and to some extent driven, by the data that were available. The pooled estimates of ES cannot be translated into units of any of the outcome measurement scales used in the included studies. It is important to note that BPT and CBT were assessed in different studies; there was no direct comparison (only 2 studies tested both interventions). The authors' conclusion might have been over influenced by positive findings, hence some caution is warranted.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that outcome research dealing with more diverse populations (particularly African-American and female), and with better classification of research participants on different developmental trajectories of antisocial behaviour, are needed.

Bibliographic details

McCart M R, Priester P E, Davies W H, Azen R. Differential effectiveness of behavioral parent-training and cognitive-behavioral therapy for antisocial youth: a meta-analysis. Journal of Abnormal Child Psychology 2006; 34(4): 527-543. [PubMed: 16838122]

Other publications of related interest

1. Bennett DS, Gibbons TA. Efficacy of child cognitive-behavioral interventions for antisocial behavior: a meta-analysis. Child Fam Behav Ther 2000;22:1-15. (DARE abstract number 12000002485). 2. Serketich WJ, Dumas JE. The effectiveness of behavioral parent training to modify antisocial behavior in children: a meta-analysis. Behav Ther 1996;27:171-86.

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Antisocial Personality Disorder /therapy; Cognitive Therapy /methods; Humans; Models, Psychological; Parent-Child Relations; Parents; Teaching /methods

AccessionNumber

12006004804

Database entry date

30/09/2007

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.