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

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.

An Overview of Reviews on the Effects of Acceptance and Commitment Therapy (ACT) on Depression and Anxiety

“…All studies were of moderate to high quality. These studies have investigated the effects of ACT on depression and anxiety in populations of children ( 26 , 29 , 36 , 45 ) or adults, mental health patients ( 23 , 28 , 30 , 38 , 40 , 41 , 44 ), patients with different cancers or multiple sclerosis ( 25 , 31 , 34 , 37 , 42 ), people with audiological problems ( 32 ), parents or caregivers of children with mental or physical illnesses ( 22 , 24 , 26 , 39 ) as well as normal people. Most of the findings of these studies have been reported by comparing ACT effects with waiting list control groups, treatment as usual and CBT.…”

“…), instead of focusing on comparative experiments investigating two different therapeutic approaches. In addition, although most studies found ACT to be effective in improving the symptoms of anxiety and depression in children and adolescents ( 26 , 29 , 36 , 45 ), some studies considered the available evidence to be insufficient for its effectiveness in this population ( 28 , 40 ). Thus, future research with large sample sizes should focus on treating anxiety and depression symptoms in children and adolescents to determine the true effect size of ACT in this important population.…”

Inflammatory bowel disease: Crohn’s disease and ulcerative colitis.

“…Having a counselor or school psychologist available to periodically monitor these students can help facilitate timely support and treatment. Therapeutic interventions, such as cognitive behavior therapy, acceptance and commitment therapy, and general supportive and reflective listening in the spirit of unconditional positive regard, can be helpful (Levy et al, 2016;Parmar et al, 2021). If these resources are not available in the school setting, faculty may provide the families referrals for further treatment.…”

Psychological Care of Children and Families with Variations or Differences in Sex Development

“…These studies provide advice on promising new directions and evidence for the effectiveness of psychological interventions that can be used in V/DSD [7][8][9].…”

“…Searching paediatric psychology intervention studies in English language peer-reviewed journals reveals intervention studies and reviews of effectiveness reporting outcomes of psychological interventions conducted with larger clinical groups such as children and young people with cancer, diabetes, epilepsy, colorectal disease, or cystic fibrosis. These studies provide advice on promising new directions and evidence for the effectiveness of psychological interventions that can be used in V/DSD [7‒9].…”