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NIHR Signal School-based self-regulation interventions can improve child academic, health and behavioural outcomes

Published on 24 July 2018

doi: 10.3310/signal-000625

Different types of interventions improve self-regulation in children and young people, which helps children to manage their behaviour and emotions. School curriculum-based interventions show the most consistently positive results. Interventions also improve longer-term academic, health and social outcomes.

Self-regulation encompasses a range of skills, including controlling your own emotions, interacting positively with others, avoiding inappropriate or aggressive actions, and carrying out self-directed learning.

This review looked at universal self-regulation interventions (those that were aimed at whole groups/cohorts of healthy children or teenagers), rather than those aimed at children with particular needs. Activities included mindfulness and yoga, family-based, exercise-based and social and personal skills-based tasks. This is a comprehensive review of rigorous evaluations including 49 trials mainly from the US providing moderate to strong evidence on effectiveness.

The current guidance recommends school curriculum-based interventions for social and emotional wellbeing. This review suggests that interventions in other settings, including exercise-based programmes and social/personal skills programmes, could also be considered. The NICE guidance is due to be updated.

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Why was this study needed?

Self-regulation appears to be important for the development and maintenance of well-being in childhood. Greater self-regulation has been associated with academic achievement and better physical and mental health. Poor self-regulation has been linked to adverse outcomes, such as health risk behaviours, psychiatric disorders, crime and unemployment.

A growing evidence base has led to the development of a number of interventions to improve self-regulation skills. These interventions are diverse, including curriculum-based programmes, exercise programmes, and social and personal-skills development strategies. They are often universal interventions, rather than targeted at particular individuals.

However, there is no evidence about which interventions are most effective, or whether population and setting have an impact on effectiveness. There is also a lack of robust evidence on whether improving self-regulation improves longer-term health and social outcomes. This study aimed to be the first systematic review to fill this gap in the evidence.

What did this study do?

This systematic review found 49 randomised controlled trials that reported on 50 universal interventions designed to improve self-regulation in children and young people. The trials included 23,098 participants aged from 2 to 17 years. The interventions were categorised as curriculum-based, mindfulness and yoga, family-based, exercise-based and other social and personal skills-based strategies. The duration of the interventions varied from just one session to weekly sessions over a number of months, to three sessions over four years.

The researchers first examined the overall effect of the 42 interventions that qualified for meta-analysis. As there was substantial statistical variation (a high I2 statistic of 77%) they were unable to pool all studies and sought to explain the variability and report the results narratively. The clearest explanation was that the methods used to measure self-regulation partly accounted for the variability.

Only one trial was conducted in the UK, 38 were carried out in the United States. The trials dated from 1977 to 2017. Three trials were rated as high quality, 38 as moderate quality and eight as poor quality. Counting the positive studies for a range of intervention types provided a useful summary of research into; curriculum based interventions (21 studies) family-based interventions (9 studies), mindfulness and yoga interventions (8 studies), exercise-based interventions (6 studies), social and personal skills interventions (6 studies). Across these interventions, 29 studies measured self-regulation, and of these 19 studies using task, performance scores could be meta-analysed. Results were summarised at the study level, as meta-analysis was not possible.

What did it find?

  • Consistent improvement in self-regulation was reported for 66% of the interventions (33 out of 50 studies). Improvements were reported in 76% of curriculum-based interventions (16 of 21 studies); 56% of the family-based programmes (5 of 9 studies); 50% of the mindfulness and yoga interventions (4 of 8 studies); 67% of exercise-based programmes (4 of 6 studies); and 67% of social and personal skills interventions (4 of 6 studies).
  • Self-regulation outcomes based on task performance scores (rather than teacher-, parent- or self-reported) were pooled and showed a moderately positive effect of the interventions (pooled effect size 0.42, 95% confidence interval 0.32 to 0.53; 19 studies).
  • Interventions were associated with positive academic achievement (11 of 13 studies).
  • Positive associations were also reported for reducing substance abuse (4 of 5 studies), conduct disorders (all 3 studies), depression (2 studies), behavioural problems (2 studies), and school suspensions (1 study).
  • Social skills improved (2 studies) but there was no effect on psychological well-being (1 study).

What does current guidance say on this issue?

NICE has published guidance on social and emotional well-being in primary education (2008), secondary education (2009) and early years (2012). The guidance for early years focuses on vulnerable children, while the guidance for primary and secondary education looks at universal interventions.

Recommendations include integrating social and emotional skills development within all areas of the curriculum. These skills include motivation, self-awareness, problem-solving, conflict management and resolution, understanding and managing feelings and relationships. No recommendations are made about specific interventions or programmes.

Following a review in 2017, the guidelines for primary and secondary education are due to be amalgamated and updated.

What are the implications?

A wide variety of interventions appear to be successful in improving both self-regulation and longer-term academic, health and social outcomes.

The current guidance recommends universal school-curriculum-based interventions. This systematic review provides moderate to strong evidence that confirms those recommendations. It also suggests that other interventions could be adopted successfully, although costs of providing alternatives to curriculum-based interventions haven’t been covered in the review.

Most of the included studies were carried out in the US which may have a different school curriculum, so it isn’t clear if the conclusions are equally as applicable to the UK population.  Fourteen studies were over ten years old and may not reflect current practice or context for schools and child mental wellbeing services.

Citation and Funding

Pandey A, Hale D, Das S, et al. Effectiveness of universal self-regulation-based interventions in children and adolescents: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(6):566-75.

This study was commissioned and funded by the Policy Research Programme in the Department of Health, and supported by the Wellcome Trust and the Jacobs Foundation.

Bibliography

NICE. Social and emotional wellbeing in primary education. PH12. London: National Institute for Health and Care Excellence; 2008.

NICE. Social and emotional wellbeing in secondary education. PH20. London: National Institute for Health and Care Excellence; 2009.

NICE. Social and emotional wellbeing: early years. PH40. London: National Institute for Health and Care Excellence; 2012.

Why was this study needed?

Self-regulation appears to be important for the development and maintenance of well-being in childhood. Greater self-regulation has been associated with academic achievement and better physical and mental health. Poor self-regulation has been linked to adverse outcomes, such as health risk behaviours, psychiatric disorders, crime and unemployment.

A growing evidence base has led to the development of a number of interventions to improve self-regulation skills. These interventions are diverse, including curriculum-based programmes, exercise programmes, and social and personal-skills development strategies. They are often universal interventions, rather than targeted at particular individuals.

However, there is no evidence about which interventions are most effective, or whether population and setting have an impact on effectiveness. There is also a lack of robust evidence on whether improving self-regulation improves longer-term health and social outcomes. This study aimed to be the first systematic review to fill this gap in the evidence.

What did this study do?

This systematic review found 49 randomised controlled trials that reported on 50 universal interventions designed to improve self-regulation in children and young people. The trials included 23,098 participants aged from 2 to 17 years. The interventions were categorised as curriculum-based, mindfulness and yoga, family-based, exercise-based and other social and personal skills-based strategies. The duration of the interventions varied from just one session to weekly sessions over a number of months, to three sessions over four years.

The researchers first examined the overall effect of the 42 interventions that qualified for meta-analysis. As there was substantial statistical variation (a high I2 statistic of 77%) they were unable to pool all studies and sought to explain the variability and report the results narratively. The clearest explanation was that the methods used to measure self-regulation partly accounted for the variability.

Only one trial was conducted in the UK, 38 were carried out in the United States. The trials dated from 1977 to 2017. Three trials were rated as high quality, 38 as moderate quality and eight as poor quality. Counting the positive studies for a range of intervention types provided a useful summary of research into; curriculum based interventions (21 studies) family-based interventions (9 studies), mindfulness and yoga interventions (8 studies), exercise-based interventions (6 studies), social and personal skills interventions (6 studies). Across these interventions, 29 studies measured self-regulation, and of these 19 studies using task, performance scores could be meta-analysed. Results were summarised at the study level, as meta-analysis was not possible.

What did it find?

  • Consistent improvement in self-regulation was reported for 66% of the interventions (33 out of 50 studies). Improvements were reported in 76% of curriculum-based interventions (16 of 21 studies); 56% of the family-based programmes (5 of 9 studies); 50% of the mindfulness and yoga interventions (4 of 8 studies); 67% of exercise-based programmes (4 of 6 studies); and 67% of social and personal skills interventions (4 of 6 studies).
  • Self-regulation outcomes based on task performance scores (rather than teacher-, parent- or self-reported) were pooled and showed a moderately positive effect of the interventions (pooled effect size 0.42, 95% confidence interval 0.32 to 0.53; 19 studies).
  • Interventions were associated with positive academic achievement (11 of 13 studies).
  • Positive associations were also reported for reducing substance abuse (4 of 5 studies), conduct disorders (all 3 studies), depression (2 studies), behavioural problems (2 studies), and school suspensions (1 study).
  • Social skills improved (2 studies) but there was no effect on psychological well-being (1 study).

What does current guidance say on this issue?

NICE has published guidance on social and emotional well-being in primary education (2008), secondary education (2009) and early years (2012). The guidance for early years focuses on vulnerable children, while the guidance for primary and secondary education looks at universal interventions.

Recommendations include integrating social and emotional skills development within all areas of the curriculum. These skills include motivation, self-awareness, problem-solving, conflict management and resolution, understanding and managing feelings and relationships. No recommendations are made about specific interventions or programmes.

Following a review in 2017, the guidelines for primary and secondary education are due to be amalgamated and updated.

What are the implications?

A wide variety of interventions appear to be successful in improving both self-regulation and longer-term academic, health and social outcomes.

The current guidance recommends universal school-curriculum-based interventions. This systematic review provides moderate to strong evidence that confirms those recommendations. It also suggests that other interventions could be adopted successfully, although costs of providing alternatives to curriculum-based interventions haven’t been covered in the review.

Most of the included studies were carried out in the US which may have a different school curriculum, so it isn’t clear if the conclusions are equally as applicable to the UK population.  Fourteen studies were over ten years old and may not reflect current practice or context for schools and child mental wellbeing services.

Citation and Funding

Pandey A, Hale D, Das S, et al. Effectiveness of universal self-regulation-based interventions in children and adolescents: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(6):566-75.

This study was commissioned and funded by the Policy Research Programme in the Department of Health, and supported by the Wellcome Trust and the Jacobs Foundation.

Bibliography

NICE. Social and emotional wellbeing in primary education. PH12. London: National Institute for Health and Care Excellence; 2008.

NICE. Social and emotional wellbeing in secondary education. PH20. London: National Institute for Health and Care Excellence; 2009.

NICE. Social and emotional wellbeing: early years. PH40. London: National Institute for Health and Care Excellence; 2012.

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

Published on 2 May 2018

Pandey, A.,Hale, D.,Das, S.,Goddings, A. L.,Blakemore, S. J.,Viner, R. M.

JAMA Pediatr , 2018

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 14369 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 23098 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.

Expert commentary

Self-regulation is important for emotional-behavioural regulation and young people’s wellbeing. This study synthesised published evidence to ascertain whether or not young people’s self-regulatory skills could be enhanced by psychosocial interventions.

Different interventions are available for use by practitioners, teachers, young people and families. Evidence of their effectiveness is of reasonable size and modest quality. Analysis suggests interventions may have a small, positive effect on self-regulation but provide no clear recommendations to target interventions or optimise outcomes for a particular group. 

Data suggest possible benefits for longer-term outcomes, most notably educational attainment, but further evaluation is required. Until then, intervention choice may be guided as much by implementation feasibility as by anticipated effect.

Dr Penny Bee, Professor of Applied Health Research, University of Manchester