Efficacy of behavioral classroom programs in primary school. A meta-analysis focusing on randomized controlled trials

ObjectiveThis meta-analysis evaluated the efficacy of behavioral classroom programs on symptoms of Attention-deficit Hyperactivity Disorder or Oppositional Defiant and/or Conduct Disorder in primary school children.MethodOnline database searches (in PubMed, Embase, Psycinfo, and Eric) yielded nineteen randomized controlled trials (N = 18,094), comparing behavioral classroom programs (including multimodal programs involving a classroom program) to no treatment/treatment as usual. Random-effects meta-analyses were conducted for teacher-rated and classroom-observed disruptive classroom behavior and for classroom-observed on-task behavior. Post-hoc analyses investigated whether effects depended on type and severity of problem behavior. Meta-regressions studied the moderating effects of age, gender, and intervention duration.ResultsSmall positive effects were found on teacher-rated disruptive behavior (d = -0.20) and classroom-observed on-task behavior (d = 0.39). Program effects on teacher-rated disruptive behavior were unrelated to age, gender, type and severity, but negatively associated with intervention duration (R2 = 0.43).ConclusionBehavioral classroom programs have small beneficial effects on disruptive behavior and on-task behavior. Results advocate universal programs for entire classrooms to prevent and reduce disruptive classroom behavior.

研究目的：本项元分析评估了行为课堂干预方案对小学儿童注意缺陷多动障碍（Attention-deficit Hyperactivity Disorder, ADHD）、对立违抗障碍（Oppositional Defiant Disorder, ODD）及/或品行障碍（Conduct Disorder, CD）症状的干预疗效。
研究方法：通过PubMed、Embase、PsycINFO及ERIC数据库开展在线检索，最终纳入19项随机对照试验（randomized controlled trial, RCT），总样本量为18094例，对比行为课堂干预方案（包含结合课堂干预的多模态干预方案）与无治疗/常规治疗的干预效果。针对教师评定的课堂破坏性行为、课堂观察到的破坏性行为及课堂观察到的任务专注行为，分别进行随机效应模型元分析。事后分析探究干预效应是否因问题行为的类型与严重程度存在差异；元回归分析则考察年龄、性别及干预时长的调节效应。
研究结果：教师评定的破坏性行为（d=-0.20）与课堂观察到的任务专注行为（d=0.39）均呈现小幅正向干预效应。干预方案对教师评定破坏性行为的效应与年龄、性别、问题行为类型及严重程度均无显著关联，但与干预时长呈负相关（R²=0.43）。
研究结论：行为课堂干预方案对儿童课堂破坏性行为与任务专注行为具有小幅有益效果。本研究结果支持面向全班级的通用干预方案，以预防和降低课堂破坏性行为的发生。