Does mindfulness training work for young people?

A meta-analysis published in Journal of Child Psychology and Psychiatry aims to establish the efficacy of mindfulness-based interventions (MBIs) for children.

Darren Dunning and colleagues carried out a systematic literature search of randomised controlled trials (RCTs) of MBIs conducted up to October 2017. Thirty-three studies (3,666 children, ages 18 years or younger) were included in the meta-analysis, with outcome measures categorised into cognitive, behavioural, and emotional. In addition, a separate meta-analysis was completed for 17 RCTs (1,762 children) that had an active control condition (ie, something else that might be expected to benefit participants, but did not include mindfulness).

Across all RCTs, the researchers found small positive effects of MBIs, compared with control groups, for all measures (overall effect size = +0.19). In particular, MBIs led to greater improvements for mindfulness (effect size = +0.24), executive functions (effect size = +0.30), and attention (effect size = +0.13). However, for the RCTs with active control groups, children who completed an MBI improved significantly more than those in the active control groups on outcomes of mindfulness (effect size = +0.42), depression (effect size = +0.47), and anxiety/stress (effect size = +0.18) only.

Source: Research review: The effects of mindfulness‐based interventions on cognition and mental health in children and adolescents – a meta‐analysis of randomized controlled trials (October 2018), The Journal of Child Psychology and Psychiatry doi:10.1111/jcpp.12980

How much is enough?

There have now been many controlled studies of preventive mental health interventions for young people. For these studies to be useful, practitioners need to know whether the effects shown for a particular intervention are modest, moderate, or large.

Emily Tanner-Smith and colleagues summarised more than 400 mean effect size estimates from 74 meta-analyses that synthesised findings from many trials. All the trials were of programmes aimed at preventing problematic behaviour or emotional problems for young people aged 5-18. The results, published in Prevention Science, indicate that, with few exceptions, the median average effect sizes on various outcomes fell within the range of +0.07 to +0.16. The authors advise that these indicate the level of improvement that has been achieved to date and can serve as a benchmark for assessing the value of new findings.

The report also points out that prevention programmes yielded larger effects on knowledge than on actual behaviour. Providing information to increase knowledge (e.g., about the risks of drug use) is an important component of many programmes, but knowledge does not always correlate strongly with actual behaviour.

Source: Empirically Based Mean Effect Size Distributions for Universal Prevention Programs Targeting School-Aged Youth: A Review of Meta-Analyses (August 2018) Prevention Science

The impact of a classroom management programme on children’s mental health

Tamsin Ford and colleagues evaluated the effectiveness of the Incredible Years Teacher Classroom Management (IYTCM) programme. The IYTCM programme aims to improve teachers’ classroom management skills and build strong relationships with students and their parents. Teachers are trained to ignore low-level bad behaviour that often disrupts classrooms and instead develop effective behaviour plans that encourage and promote emotional regulation skills.

The study, published in Psychological Medicine, used a cluster randomised controlled trial, in which children ages four to nine from schools across the southwest of England were randomly allocated to undertake the IYTCM programme or continue their usual practice over a 30-month period (with outcomes assessed at 9, 18, and 30 months). One class in each of 80 schools (40 IYTCM, 40 usual practice; 2,075 children in total) participated. Effects of the intervention on students’ mental health were assessed via the Total Difficulties score from the teacher-report version of the Strengths and Difficulties Questionnaire (SDQ). Data on a range of secondary outcomes (e.g., children’s disruptive behaviour, service use), was also collected in addition to detailing the costs of IYTCM compared to usual practice.

The report concludes that IYTCM may provide a small short-term improvement to children’s mental health, particularly for children who are already struggling. The results of the trial showed there was a small reduction in the SDQ Total Difficulties score at 9 months, but not at 18 or 30 months.

Source: The effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management programme in primary school children: Results of the STARS cluster randomised controlled trial. Psychological Medicine, 1-15.

School-based mental health services for primary children

School-based services delivered by teachers and other school-based professionals can help reduce mental health problems in primary-age children, reports a study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

The findings are based on a meta-analysis of 43 controlled trials involving almost 50,000 primary school children. The study examined the overall effectiveness of school-based mental health services, as well as the relative effectiveness of various school-based intervention models that differed according to treatment target, format and intensity.

Overall, school-based services had a small to medium effect (effect size = +0.39) in reducing mental health problems. Interventions that targeted child behaviour problems demonstrated the largest effect sizes (+0.76). Interventions that were implemented multiple times per week were found to be more than twice as effective as those that were only implemented on a weekly (or less) basis.

Source: The effectiveness of school-based mental health services for elementary-aged children: A meta-analysis (March 2018), Journal of the American Academy of Child & Adolescent Psychiatry, Volume 57, Issue 3

One in five pupils in the UK experience emotional and behavioural problems

Around one in five children and young people in the UK experience emotional and behavioural problems according to the first findings from a survey of over 30,000 young people (aged 11 to 14), which were collected as part the National Lottery-funded HeadStart programme.

Pupils in the 114 participating HeadStart schools were asked to complete the online Wellbeing Measurement Framework. This report, by Jessica Deighton and colleagues, explores the data related to the prevalence of mental health problems in young people and how this varies by gender, ethnicity, special educational needs status, free school meal eligibility, and child-in-need status. The findings reveal that:

  • Pupils in Year 9 are more likely to report mental health problems than those in Year 7.
  • Girls are more likely to say they had experienced emotional problems (with 25% of girls saying they had a problem compared to 11% of boys) but in contrast, boys are more likely to say they have experienced behavioural problems (with 23% of boys saying they had experienced them compared with 15% of girls).
  • Pupils from Asian, Black, Mixed, and other ethnic groups were less likely to indicate they were experiencing emotional problems than young people in the White ethnic group.
  • Pupils with special educational needs, those eligible for free school meals, and those classified as children in need were also more likely to say they were experiencing both emotional and behavioural problems.

The report concludes that there is a consistent association between deprivation and mental health problems, however, the schools involved in HeadStart are typically located in less socially and economically advantaged areas of the UK and differ from the national average in terms of proportions with special educational needs and proportions of white pupils, so all results must be understood in this context.

Source: Mental health problems in young people, aged 11 to 14: Results from the first HeadStart annual survey of 30,000 children (January 2018), Evidence Based Practice Unit (EBPU) Evidence Briefing #1:11

Later school start time may produce benefits but more evidence is needed

Many studies have been conducted to examine the impact for pupils of later school start times, some of which can be found in previous issues of Best Evidence in Brief. This Campbell systematic review summarises the findings from 17 studies to examine the evidence on the impact of later school start times on pupils’ mental health and academic performance.

The studies included in the review were randomised controlled trials, controlled before-and-after studies and interrupted time series studies with data for pupils aged 13 to 19 and that compared different school start times. The studies reported on 11 interventions in six countries, with a total of almost 300,000 pupils.

The main results of the review suggest that later school starts may be associated with positive academic benefits and psychosocial outcomes. Later school start times also appear to be associated with an increase in the amount of sleep children get. Effect sizes ranged from +0.38 to +2.39, equivalent to an extra 30 minutes to 2 hours of sleep each night. However, the researchers point out that, overall, the quality of the body of evidence is very low, and so the effects of later school start times cannot be determined with any confidence.

Source: Later school start times for supporting the education, health, and well-being of high school students: a systematic review (December 2017), A Campbell Systematic Review 2017:15