Montgomery P
University Section of Child and Adolescent Psychiatry, University of Oxford, Park Hospital for Children, Old Road, Headington, Oxford, UK, OX3 7LQ.
Cochrane Database Syst Rev. 2001(1):CD002206. doi: 10.1002/14651858.CD002206.
Prevalence studies show that behaviour problems in children are quite common (10-15% in preschoolers). These problems may manifest as, for example anxiety, sadness, over-activity and tantrums. Some studies have shown that these problems can be persistent, and that they lead to a range of problems in adolescence and adulthood. Many approaches are used to address behavioural problems such as medication, or more usually, psychological treatments either directly with the child and/or his/her family. Behavioural interventions have been shown to be highly 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 would reduce the cost and thus increase access to these interventions. In the adult population it seems that media-based interventions such as these can be moderately effective. Given that the cost of media-based treatment is so low it is useful to know how effective they are when given to parents. It was hypothesised that media-based treatments would be less effective than conventional psychological treatments and that efficacy would improve with increasing amounts of therapist intervention.
To review the effects of media-based behavioural therapies (definitions below), for any young person with a behavioural disorder (however diagnosed) compared to standard care and no treatment controls.
A range of electronic databases were systematically searched using a specified search strategy. Individual journals of interest were hand-searched where necessary, references in all selected trials were checked for other trials and, where it was thought to be of possible use, individual authors were contacted for additional information.
Randomised controlled trials of behavioural media-based treatments for behaviour problems in children.
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 reviewer and queries were resolved by discussion with an independent rater. Data were analysed using Revman.
In general, media-based therapies for behavioural disorders in children had a moderate effect when compared with both no-treatment controls and with standard care. Significant improvements were often made with the addition of up to 2 hours of therapist time.
REVIEWER'S CONCLUSIONS: These formats of delivering behavioural interventions for carers of children are possibly worth considering in clinical practice. For straightforward cases media-based interventions may be enough to make clinically significant changes in a child's behaviour, and reduce the amount of time primary care workers have to devote to each case. Consequently this would increase the number of families who could possibly benefit from this type of intervention. Media-based therapies would therefore appear to have both clinical and economic implications as regards the treatment of children with behavioural problems.
患病率研究表明，儿童行为问题相当普遍（学龄前儿童中占10 - 15%）。这些问题可能表现为焦虑、悲伤、多动和发脾气等。一些研究表明，这些问题可能会持续存在，并在青少年和成年期引发一系列问题。人们采用多种方法来解决行为问题，如药物治疗，或者更常见的是直接对儿童及其家庭进行心理治疗。行为干预已被证明非常有效，但由于时间和费用等因素，获得这些治疗的机会有限。以手册或其他基于媒体的形式向家长提供管理这些行为问题所需的信息，将降低成本，从而增加获得这些干预措施的机会。在成人人群中，这类基于媒体的干预措施似乎有一定效果。鉴于基于媒体的治疗成本如此之低，了解其对家长的效果如何很有必要。据推测，基于媒体的治疗效果不如传统心理治疗，且随着治疗师干预量的增加，疗效会有所提高。
比较基于媒体的行为疗法（定义见下文）与标准护理及无治疗对照，对任何患有行为障碍（无论如何诊断）的年轻人的效果。
使用特定检索策略系统检索一系列电子数据库。必要时对手感兴趣的个别期刊进行手工检索，检查所有入选试验的参考文献以查找其他试验，并且在认为可能有用时，联系个别作者获取更多信息。
针对儿童行为问题的基于行为媒体治疗的随机对照试验。
阅读从电子数据库检索中识别出的研究摘要和标题，以确定它们是否符合纳入标准。评审员对从电子或其他检索中可能符合这些标准的研究进行全文评估，并通过与独立评分员讨论解决疑问。使用Revman进行数据分析。
总体而言，与无治疗对照和标准护理相比，基于媒体的儿童行为障碍治疗有一定效果。增加最多2小时的治疗师时间通常会有显著改善。
在临床实践中，这些为儿童照顾者提供行为干预的形式可能值得考虑。对于简单病例，基于媒体的干预可能足以使儿童行为产生临床上的显著变化，并减少初级保健工作者处理每个病例所需的时间。因此，这将增加可能从这类干预中受益的家庭数量。因此，基于媒体的疗法在治疗有行为问题的儿童方面似乎具有临床和经济意义。
