Effectiveness of Universal Self-regulation-Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis

Abstract

Importance: Childhood and adolescence self-regulation (SR) is gaining importance as a target of intervention because of mounting evidence of its positive associations with health, social and educational outcomes.

Objective: To conduct a systematic review and meta-analysis of rigorously evaluated interventions to improve self-regulation in children and adolescents.

Data sources: Keyword searches of the PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development and Adolescent Studies, and CENTRAL were used to identify all studies published through July 2016.

Study selection: To be eligible for this review, studies had to report cluster randomized trials or randomized clinical trials, evaluate universal interventions designed to improve self-regulation in children and adolescents aged 0 to 19 years, include outcomes associated with self-regulation skills, and be published in a peer-reviewed journal with the full text available in English.

Data extraction and synthesis: A total of 14 369 published records were screened, of which 147 were identified for full-text review and 49 studies reporting 50 interventions were included in the final review. Results were summarized by narrative review and meta-analysis.

Main outcomes and measures: Self-regulation outcomes in children and adolescents.

Results: This review identified 17 cluster randomized trials and 32 randomized clinical trials evaluating self-regulation interventions, which included a total of 23 098 participants ranging in age from 2 to 17 years (median age, 6.0 years). Consistent improvement in self-regulation was reported in 16 of 21 curriculum-based interventions (76%), 4 of the 8 mindfulness and yoga interventions (50%), 5 of 9 family-based programs (56%), 4 of 6 exercise-based programs (67%), and 4 of 6 social and personal skills interventions (67%), or a total of 33 of 50 interventions (66%). A meta-analysis evaluating associations of interventions with self-regulation task performance scores showed a positive effect of such interventions with pooled effect size of 0.42 (95% CI, 0.32-0.53). Only 24 studies reported data on distal outcomes (29 outcomes). Positive associations were reported in 11 of 13 studies (85%) on academic achievement, 4 of 5 studies on substance abuse (80%), and in all studies reporting on conduct disorders (n = 3), studies on social skills (n = 2), studies on depression (n = 2), studies on behavioral problems (n = 2), and study on school suspensions (n = 1). No effect was seen on 2 studies reporting on academic achievement, 1 study reporting on substance abuse, and 1 additional study reporting on psychological well-being.

Conclusions and relevance: A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distal academic, health, and behavioral outcomes in most intervention groups compared with controls.

Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-analysis Flow Diagram

Figure 2.. Forest Plot of Intervention Results

Data were pooled under the assumption of a random-effects model; τ² = 0.05; χ²₄₁ = 178.14; P < .001; I² = 77%; overall effect z = 9.16; P < .001. Kumpfer et al includes 2 separate analyses. SR indicates self-regulation.

Figure 3.. Forest Plot of the Effect Sizes of Self-regulation Task Performance Scores

Data were pooled under the assumption of a random-effects model. For curriculum-based interventions, τ² = 0.02; χ²₅ = 14.35; P = .01; I² = 65%; overall effect z = 4.04; P < .001. For yoga and mindfulness interventions, τ² = 0.00; χ²₂ = 0.08; P = .96; I² = 0%; overall effect z = 3.66; P < .001. For social and personal skills interventions, τ² = 0.00; χ²₄ = 1.61; P = .81; I² = 0%; overall effect z = 5.74; P < .001. For exercise-based interventions, τ² = 0.00; χ²₄ = 2.50; P = .64; I² = 0%; overall effect z = 5.41; P < .001. In total, for curriculum-based interventions, τ² = 0.02; χ²₁₈ = 30.85; P = .03; I² = 42%; overall effect z = 8.16; P < .001. For subgroup differences, χ²₃ = 4.94; P = .18; I² = 39.3%. SR indicates self-regulation.