Psychosocial interventions for children and adolescents with adverse childhood experiences: A systematic review and meta-analysis

BACKGROUNDS: Exposure to adverse childhood experiences (ACEs) is associated with adverse neurobiological, developmental, cognitive, behavioral, psychological, and social consequences among children and adolescents. Psychosocial interventions hold promise for mitigating the negative impacts of ACEs, but there is a lack of updated and comprehensive evidence summarizing their effects qualitatively and quantitatively. AIMS: We performed a systematic review and meta-analysis of existing evidence on the effectiveness of psychosocial interventions on children's outcomes, including internalizing and externalizing problems. METHODS: We searched five database sources from inception to April 2024 for studies on the effectiveness of any psychosocial intervention in any outcome among children and adolescents aged 6-18 who experienced ACEs. We qualitatively synthesized the characteristics of the studies, samples, interventions, and outcomes. We quantitatively estimated the pooled effects of psychosocial interventions on a range of outcomes encompassing internalizing problems, externalizing problems, family relationships, coping, and self-esteem using meta-analysis. Additionally, we conducted a series of subgroup meta-analyses to compare the intervention effects based on sample and intervention characteristics. RESULTS: Forty-four studies were included, with 20 randomized controlled trials, nine controlled trials, and 15 pre-post trials. Significant intervention effects were observed in internalizing problems (standardized mean difference, SMD = -0.36) and externalizing problems (SMD = -0.57), but not in family relationships, coping, or self-esteem. Subgroup analyses have identified various effective interventions for internalizing problems and externalizing problems, respectively. CONCLUSIONS: The evidence suggests that psychosocial interventions are effective in preventing internalizing and externalizing problems among children and adolescents who have experienced ACEs. Recommendations are provided for designing and evaluating future psychosocial interventions.