Effects of group interventions for children who experience family disruption
In this systematic review, we have summarised the results of studies that compared group interventions for children in divorce with no intervention.
Children and youth who experience divorce or family break up will generally have an increased risk of emotional and behavioural adjustment problems. Consequently, prevention programs in the form of group intervention have been developed to prevent negative psychosocial consequences in both the short and long term.
In this systematic review, we have summarised the results of studies that compared group interventions for children in divorce with no intervention and we conclude that
⦁ Children who participate in group interventions may experience less anxiety symptoms and improved adaptation to the situation surrounding family break up compared with children who did not attend. It is uncertain whether group intervention affects children's self-esteem, their experience of depression or if they change their perceptions and attitudes towards the divorce.
⦁ Group intervention may lead to parents perceiving the child's social behaviour, problem solving skills and feelings in connection with the divorce as improved. It is uncertain whether the group intervention causes the parents to perceive the children's degree of behavioural and emotional functioning as improved.
⦁ Group intervention may cause the teachers to perceive children's school competencies as improved. It is uncertain whether the group intervention leads to teachers perceiving children's problem behaviour, school attendance and academic performance as improved.
Children and youth who experience family disruption have, at a general level, an increased risk of emotional and behavioural adjustment problems. The average risk difference for these children and children from intact families are not large, but there can be large individual differences. To help and support children and youth of divorce through an emotional crisis and to adjust to all the practical consequences arising from the break up, prevention programs in the form of group intervention have been introduced for those who wish to participate.
Our purpose in this systematic review was to summarise the effects of group interventions for children and youth who are experiencing or have experienced family break up. We examined effects on psychosocial outcomes, including behavioural outcomes, and physiological outcomes.
We searched for primary studies in relevant databases. We completed the search in October 2015. Two people independently screened the literature search set and selected on the basis of title and abstract the publications that seemed relevant. Potentially relevant publications were ordered in full text and considered for inclusion or exclusion with regard to the inclusion criteria. The same two people assessed the included studies for risk of bias for each outcome using a recognised checklist. To assess the possibility for meta-analysis, we assessed heterogeneity of the data by looking at the population, intervention, outcome and design. In particular, the format for presentation of results and study design represented limitations for meta-analysis. We therefore did a descriptive analysis, presenting studies and compiling them in tables with quality assessments of the evidence for each outcome. One researcher rated the quality of evidence using GRADE and another researcher controlled the assessments.
We included 21 studies: 10 randomised controlled trials and 11 observation studies. Most of the studies came from the United States and were conducted in the 1980s and 90s. Mostly, we judged the risk of bias as unclear in the randomised controlled trials and as high in observational studies. Common features of the interventions was that they were of short duration, between 6 and 16 weeks, consisted of regular meetings and used psychoeducational methods with emphasis on teaching, support and use of problem solving exercises to train coping skills. All studies compared the intervention to no intervention. All studies included children in elementary school / middle school, two studies also included kindergarten children. Group leaders could be school counsellors, psychologists or social workers. Many outcomes were measured, often with different tools. We therefore had to make a choice and we chose outcomes that met our inclusion criteria, with preference of outcomes being measured in two or more studies.
Nine studies measured how children perceived their self-image, four measured the children's perceptions of family break ups, six measured anxiety and five measured depression symptoms, three studies measured adaptation to the break up situation and four studies measured attitudes to family disruption. Parents reported how they perceived the child's social relations, emotions and problem solving skills (four studies), degree of behavioural and emotional functioning (four studies). Teachers reported how they judged the pupils competence (six studies) and problem behaviour (eight studies). Two studies reported school attendance and academic grades.
The results for most outcomes was variable and inconsistent across studies. The evidence does support that children receiving group intervention may experience less anxiety and better adaptation to circumstances in relation to the break up. Moreover, parents may assess children's social behaviour, problem-solving skills and degree of negative emotions as improved and teachers may assess children's competence as strengthened.
The evidence is characterised by studies with few participants, unclear or high risk of bias and varying findings between trials. After an overall assessment, we drew conclusions only for some outcomes. When results are inconsistent and the quality of evidence considered low or very low, it becomes difficult to draw definite conclusions. Only further research may then provide answers that are more definitive.
Children of divorce who participate in a preventive group intervention compared with no intervention may perceive less anxiety symptoms and improved adaptation to the divorce situation. It is uncertain whether group intervention affects children's self-esteem, feelings of depression or if it changes perceptions and attitudes towards the family break up. Group intervention may cause the parents to perceive the child's social behaviour, problem solving skills and feelings they have in connection with the break up as improved. It is uncertain whether a group intervention causes the parents to perceive the children's degree of behavioural and emotional functioning as improved. Teachers may think that kids improve their school competencies. However, it is uncertain whether the group intervention affects school attendance or whether teachers will perceive children's problem behaviour and academic performance as affected.