Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis.

Arpita Parmar,Douglas Miller,Yuen-Yu Chong,Lesley Barreira,Kayla Esser,Paige Church,Eyal Cohen,Nathalie Major,Julia Orkin,Wanda Smith,Leora Morinis

doi:10.3390/ijerph18158205

Abstract

Context: Acceptance and Commitment Therapy (ACT) is an emerging treatment for improving psychological well-being. Objective: To summarize research evaluating the effects of ACT on psychological well-being in children with special health care needs (SHCN) and their parents. Data Sources: An electronic literature search was conducted in PubMed, Web of Science, Ovid/EMBASE and PsycINFO (January 2000–April 2021). Study Selection: Included were studies that assessed ACT in children with SHCN (ages 0–17y) and/or parents of children with SHCN and had a comparator group. Data Extraction: Descriptive data were synthesized and presented in a tabular format, and data on relevant outcomes (e.g., depressive symptoms, stress, avoidance and fusion) were used in the meta-analyses to explore the effectiveness of ACT (administered independently with no other psychological therapy) compared to no treatment. Results: Ten studies were identified (child (7) and parent (3)). In children with SHCN, ACT was more effective than no treatment at helping depressive symptoms (standardized mean difference [SMD] = −4.27, 95% CI: −5.20, −3.34; p < 0.001) and avoidance and fusion (SMD = −1.64, 95% CI: −3.24, −0.03; p = 0.05), but not stress. In parents of children with SHCN, ACT may help psychological inflexibility (SMD = −0.77, 95% CI: −1.07, −0.47; p < 0.01). Limitations: There was considerable statistical heterogeneity in three of the six meta-analyses. Conclusions: There is some evidence that ACT may help with depressive symptoms in children with SHCN and psychological inflexibility in their parents. Research on the efficacy of ACT for a variety of children with SHCN and their parents is especially limited, and future research is needed.

Highlights

613 titles and abstracts were reviewed and 569 were excluded because of irrelevance based on inclusion criteria. 44 articles were downloaded for further consideration and 10 studies met all inclusion criteria
The findings from our meta-analyses suggest that ACT may help depressive symptoms in children with special health care needs (SHCN)
This differs from findings from a meta-analysis on three studies with a similar age group of children and youth with SHCN with depression that showed ACT did not help depressive symptoms (SMD = 1.02, 95% confidence intervals (CIs) = −0.11, 2.15, p = 0.08, I2 = 86%) [62]

Summary

Introduction

Children with Special Health Care Needs (SHCN). As a result of this epidemiologic shift, millions of children worldwide are facing a new reality: living with special health care needs (SHCN) [1]. Children with SHCN are “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health-related services of a type or amount beyond that required by children generally” [2]. Children with SHCN may have only one condition, or both a chronic physical and emotional condition [1,3] such as co-existing depression with type I diabetes [4]. Psychological Difficulties Experienced by Children with SHCN and Their Parents

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Discussion

Conclusion