Primary school‐based interventions to support the psychosocial functioning of children with neurodevelopmental diagnoses: A systematic review and meta‐analysis
Abstract Children with neurodevelopmental or mental health diagnoses often face barriers to their successful psychosocial functioning at school. This study aimed to systematically review the key characteristics and quality of primary school‐based interventions that evaluate psychosocial functioning and to conduct a meta‐analysis of the interventions' effectiveness and moderators. The review was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Four databases were searched in July 2024. Eligible randomised controlled trials (RCTs) needed to evaluate school‐based interventions for primary school children with neurodevelopmental or mental health diagnoses. The first author screened all abstracts, with a second reviewer screening 50% of randomly selected abstracts. The same authors appraised the methodological quality of all studies using the Cochrane Risk of Bias 2 Tool and the QualSyst Appraisal Tool. Twenty‐four studies were included, including 11 RCTs and six cluster RCTs involving 17 interventions. Twelve interventions targeted autistic children, and five interventions targeted children with ADHD. Fifteen studies involving children with mental health conditions were screened at the full‐text stage; however, all were excluded because the study design ( n = 8), outcome measures ( n = 3) or intervention design ( n = 4) did not meet the inclusion criteria. Seven studies analysed moderating variables impacting the interventions' psychosocial outcomes. Individualised interventions were the most common ( n = 12), with a range of intervention techniques and outcome measures assessing sub‐constructs of psychosocial functioning. The meta‐analysis showed small, significant treatment effects from the between‐group analysis favouring the intervention groups. Findings from the subgroup analysis revealed that school‐based interventions were more effective for children with ADHD when they were single‐tiered and included children, teachers and parents. Although the review intended to include both neurodevelopmental and mental health diagnoses, all eligible studies involved neurodevelopmental conditions; therefore, conclusions are restricted to autistic children and children with ADHD. Context and implications Rationale for this study: Fostering a supportive school environment is key to supporting children's psychosocial development. Successful psychosocial functioning can enable children to participate academically and socially. We aimed to explore the available school‐based interventions to support children with a neurodevelopmental or mental health diagnosis and improve their psychosocial functioning at school. Why the new findings matter: Overall, we found evidence supporting the effectiveness of school‐based interventions in enhancing the psychosocial functioning of autistic children and children with ADHD in this review. Implications for educational researchers and policy makers: Our findings highlight the ongoing necessity for evidence‐based tier‐two and tier‐three interventions for neurodiverse children to support their psychosocial functioning, whether embedded within a multitiered intervention or as a standalone approach. Psychosocial functioning encapsulates the interrelationship between the person and their environment. Thus, as most interventions focused solely on upskilling neurodiverse children, we encourage future researchers and clinicians to intervene at the environmental level to foster an inclusive and supportive environment for the child.