Review of Systematic Review Methods: The Science of Research Synthesis

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The Absence of Presence: A Systematic Review and Meta-Analysis of Indicated Interventions to Increase Student Attendance

The present study utilized systematic review methods and meta-analysis to quantitatively synthesize research and systematically examine the effects of indicated intervention programs on school attendance behaviors of elementary and secondary school students. A comprehensive search strategy resulted in the identification 11 randomized studies, 9 quasi-experimental studies and 13 single group pre-post test studies that met inclusion criteria. Effect sizes data and study, participant, and intervention characteristics were coded and analyzed. Analyses of the randomized and quasi-experimental studies were performed separately from the single group pre-post test studies. The meta-analytic findings showed overall positive and moderate effects of indicated attendance interventions on attendance outcomes. There was, however, significant heterogeneity found between studies. Moderator analyses were conducted to examine potential variables related to study, participant and intervention characteristics that may explain the variability in effect sizes. Behavioral interventions were found to be more effective than other interventions and, when combined with parental interventions, demonstrated greater effects than behavioral interventions alone. Attendance groups were also found to be effective, especially when combined with attendance monitoring and contracting/awards. Court-based, school-based and clinic-based programs produced similar effects. The available evidence did not support the use of family therapy or mentoring as indicated interventions. The findings of this meta-analysis also did not support the use of multi-modal or collaborative programs over simpler, non-collaborative interventions, even though multi-modal and/or collaborative interventions are often recommended as best practice. Although the interventions demonstrated a moderate mean effect, the mean absence rates at post-test for the majority of the studies remained above 10%; thus it appears that the majority of interventions are falling short in their attempts to improve student attendance to the point of achieving an acceptable level of regular attendance. In addition to evaluating the effects of interventions, this systematic review and meta-analysis uncovered a number of methodological shortcomings, absence of important variables and data as well as gaps in the evidence base. The author calls for a critical analysis of the practices, assumptions and social-political context underlying the extant evidence base. Implications for practice, policy and research are discussed as well as limitations of the present study

Public or private religiosity: which Is protective for adolescent substance use and by what pathways?

While it is well understood that adolescent religiosity is associated with the use and abuse of licit and illicit substances, few studies have revealed the pathways through which religiosity buffers youth against involvement in such behavior. The aim of this study is to examine the complexity of the relationships between religiosity, sensation seeking, injunctive norms, and adolescent substance use. Using a national sample of adolescents (N = 18,614), negative binomial regression and path analysis were used to examine the various components of the relationship between religiosity and the use of cigarettes, alcohol, and marijuana. Results indicate that private religiosity moderates the relationship between key risk factors and substance use. Public and private religiosity were associated with tolerant injunctive substance use norms which, in turn, were associated with substance use. Implications for research and theory related to religiosity and adolescent substance use are discussed

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Treatment for School Refusal Among Children and Adolescents: A Systematic Review and Meta-Analysis

Objective: School refusal is a psychosocial problem associated with adverse short- and long-term consequences for children and adolescents. The authors conducted a systematic review and meta-analysis to examine the effects of psychosocial treatments for children and adolescents with school refusal. Method: A comprehensive search process was used to find eligible randomized controlled trials and quasi-experimental studies assessing the effects of psychosocial treatments on anxiety or attendance outcomes. Data were quantitatively synthesized using meta-analytic methods. Results: Eight studies including 435 children and adolescents with school refusal were included in this review. Significant effects were found for attendance but not for anxiety. Conclusions: Evidence indicates that improvements in school attendance occur for children and adolescents with school refusal who receive psychosocial treatment. The lack of evidence of short-term effects on anxiety points to the need for long-term follow-up studies to determine whether increased attendance ultimately leads to reduced anxiety

Psychosocial Interventions for School Refusal with Primary and Secondary School Students: A Systematic Review

This Campbell systematic review assesses the effects of psychosocial interventions for school refusal. The review summarizes the findings from eight studies. Medium quality evidence shows that cognitive‐behavioural therapy (CBT) increases school attendance but has no effect on anxiety. The effect of the psychosocial interventions on anxiety was not statistically significant. The effects on attendance were significant. Several risks of bias were present in most studies included in the review, which could upwardly bias the estimated effects. Many included studies did not clearly describe how they randomly assigned participants to treatment or control groups. Therefore, the current estimate of treatment effects from the eight rigorous studies should be treated with caution. Executive Summary/Abstract BACKGROUND School refusal is a psychosocial problem characterized by a student's difficulty attending school and, in many cases, substantial absence from school (Heyne & Sauter, 2013). It is often distinguished from truancy, in part because of the severe emotional distress associated with having to attend school and the absence of severe antisocial behavior. Truancy, on the other hand, is not typically associated with emotional distress and is commonly associated with severe externalizing behavior. The emotional distress associated with school refusal is often in the form of fear or anxiety, and sometimes in the form of depression. School refusal occurs for about 1‐2% of young people, and estimates among clinically referred youth are considerably higher. There is substantial heterogeneity in both the presentation of school refusal and its associated risk factors. Significant adverse consequences may occur in the short‐ and long‐term, including school dropout and problems with social adjustment. Family members and school staff are also affected by school refusal. The most commonly studied interventions for school refusal are behavioral approaches and cognitive‐behavioral therapy (CBT). The overarching aim of these interventions is the reduction of the young person's emotional distress and an increase in school attendance to help the young person follow a normal developmental pathway (Heyne & Sauter, 2013). Behavioral interventions include exposure‐based interventions, relaxation training, and/or social skills training with the student, and contingency management procedures with the parents and school staff. CBT manuals additionally focus attention on the identification and modification of maladaptive cognition that may maintain the young person's emotional distress and absenteeism. In some instances parent cognition is also targeted. Other interventions have been used to treat school refusal (e.g., psychodynamic treatment, family therapy, medication) but CBT has been the most studied intervention and most prior reviews have focused on CBT and/or behavioral interventions. While prior reviews have found some support for CBT and behavioral interventions for reducing anxiety and/or improving attendance, the reviews have been mixed (Maynard et al., 2013). Prior reviews have also been limited to published research, have not adequately assessed the quality of evidence, and have primarily employed either qualitative or vote‐counting methods for synthesizing study outcomes. No prior meta‐analysis of interventions targeting school refusal has been located. OBJECTIVES The purpose of this review was to inform practice and policy by evaluating the effects of psychosocial interventions for school refusal. The following research questions guided this study: 1) Do psychosocial interventions targeting school refusal reduce anxiety? 2) Do psychosocial interventions targeting school refusal increase attendance? SEARCH METHODS Electronic searches were conducted in 15 databases and 4 research registers, and internet searches were conducted for conference proceedings and other grey literature. Searches were conducted using the following keywords: (anxiety OR “school refus*” OR “school phobia”) AND (attendance OR absen*) AND (evaluation OR intervention OR treatment OR outcome OR program) AND (student* OR school* OR child* OR adolescen*). Reviews of reference lists of included studies and prior reviews and personal contact with authors of prior studies of school refusal were also conducted to identify potential studies for this review. SELECTION CRITERIA Published or unpublished studies assessing effects of psychosocial interventions to improve attendance or reduce anxiety with school‐age youth who met criteria for school refusal were included in this review. To be eligible for inclusion in this review, studies must have been conducted or reported between January 1980 and November 2013 and employed an experimental or quasi‐experimental design. In addition, studies must have used statistical controls or reported baseline data on outcomes regardless of study design. Studies that assessed effects of medications only or studies conducted in residential treatment centers were excluded from this review. DATA COLLECTION AND ANALYSIS Titles and abstracts of the studies found through the search procedures were screened for relevance, and those that were obviously ineligible or irrelevant were screened out. Documents that were not obviously ineligible or irrelevant based on the abstract review were retrieved in full text for final eligibility screening. Two reviewers independently screened the full‐text articles for inclusion. Studies that met eligibility criteria were coded independently by two coders. Two review authors also independently assessed the risk of bias in each study using the Cochrane Collaboration's ‘Risk of Bias’ tool (Higgins et al., 2011). Coders met to review the coding agreement and any discrepancies were discussed and resolved by consensus. Effect sizes were calculated in Comprehensive Meta‐Analysis (CMA) version 2.0 (Borenstein, Hedges, Higgins, & Rothstein, 2005). We adjusted for differences at baseline by computing the pre‐test effect size and subtracting it from the post‐test effect size. The standardized mean difference effect size statistic, employing Hedges' g to correct for small sample size bias (Hedges, 1981), was used. When an author used more than one measure of an outcome, an effect size was calculated for each measure and a mean ES was calculated so each study contributed only one effect size per study for each outcome. Four meta‐analyses were performed; two meta‐analyses were performed to synthesize studies assessing effects of psychosocial interventions on anxiety and attendance and two were performed to synthesize effects of studies assessing effects of medication in combination with psychotherapy on anxiety and attendance. A weighted mean effect was calculated by weighting each study by the inverse of its variance using random effects statistical models. We assessed statistical heterogeneity using the Q‐test and I2 statistic. Several moderator and sensitivity analyses were planned, but due to the small number of studies included in this review and lack of heterogeneity, we limited additional analyses performed. RESULTS A total of eight studies examining effects of interventions on anxiety or attendance with 435 school‐age participants exhibiting school refusal were included in this review. Six studies examining effects of psychosocial interventions and two studies assessing comparative effects of psychosocial interventions with and without medication met inclusion criteria for this review. Six of the included studies were randomized controlled trials (RCT) and two were quasi‐experimental design (QED) studies. The majority (75%) of the studies were published in peer‐reviewed journals. Five of the interventions took place in a clinic setting, one in the school, one in the school and home and one in an undisclosed setting. All but one of the six psychosocial intervention studies in this review assessed the effects of a variant of cognitive‐behavioral therapy (CBT) compared to no treatment control (k = 1), an unspecified control (k = 1) or alternative treatment control group (k = 4). For the two studies assessing effects of medication, the same CBT intervention was applied across treatment and control groups with either Fluoxetine or imipramine as the treatment and placebo or no placebo as the control. The mean effect of the psychosocial interventions at post‐test on anxiety was g = 0.06 (95% CI [‐0.63, 0.75], p = .86), demonstrating a non‐significant effect. The homogeneity analysis indicated a moderate degree of heterogeneity (Q = 11.13, p = .01, I2 = 73.05%, τ2 = .36). Effects on attendance were significant (g = 0.54 (95% CI [0.22, 0.86], p = .00). The homogeneity analysis indicated a small degree of heterogeneity (Q = 8.82, p = .12, I2 = 43.32%, τ2 = .06). Similar results were found for the mean effects of medication + CBT studies, with effects on anxiety being not significant (g= ‐0.05, 95% CI [‐0.40, 0.31], p = .80) and effects on attendance being positive and statistically significant (g = 0.61 (95% CI [0.01, 1.21], p = .046). Studies were homogenous for the medication + CBT studies for both anxiety (Q = .30, p = .58; I2 = 0.00% and τ2 = .00) and attendance (Q = 1.93, p = .17, I2 = 48.23%; τ2 = .09). AUTHORS' CONCLUSIONS The present review found relatively few rigorous studies of interventions for school refusal. Seven of the eight included studies assessed effects of a variant of cognitive behavioral therapy (CBT), thus there appears to be a lack of rigorous evidence of non‐CBT interventions for school refusal. Findings of the current review were mixed. While both the CBT only and CBT plus medication interventions found, on average, positive and significant effects on attendance compared to control, effects on anxiety at post‐test across both sets of studies were not significantly different from zero. Moreover, the magnitude of treatment effects on anxiety varied across the psychosocial only studies, and thus current estimates of treatment effects should be evaluated with caution. The current evidence provides tentative support for CBT in the treatment of school refusal, but there is an overall lack of sufficient evidence to draw firm conclusions of the efficacy of CBT as the treatment of choice for school refusal. Most of the studies in this review compared effects against other, and sometimes very similar, interventions that could mask larger effects if compared to wait list control or other disparate interventions. Furthermore, most studies only measured immediate effects of interventions; only one study reported comparative longer‐term effects on both attendance and anxiety. Thus, there is insufficient evidence to indicate whether or not treatment effects sustain, and whether or not anxiety might further decrease over time with continued exposure to school. Several risks of bias were present in most studies included in this review, particularly related to blinding of participants and assessors, which must be considered when interpreting the results of this review. Performance and detection bias resulting from inadequate blinding of participants and assessors to condition could upwardly bias the mean effects. In addition, insufficient details related to random sequence generation and allocation concealment were provided to adequately assess selection bias in most studies, and two studies reported non‐random allocation to condition. While most studies in this review reported to use random assignment procedures, it is uncertain whether selection bias is present due to inadequate generation of randomization or concealment of allocation prior to assignment. The few rigorous studies found for this review and the risks of bias present in most of the included studies indicate a need for better‐controlled studies. Moreover, independent replications of the manualized interventions examined in this review are needed, as are longer‐term evaluations of effects of interventions. Assessing long‐term effects could provide additional answers and insights as to the mixed findings of the effects of interventions on attendance and anxiety. Future studies should also consider other types of interventions for rigorous evaluation. Furthermore, future studies could benefit from larger sample sizes and attention to mitigating potential biases to improve statistical power and causal inference