Quantitative and qualitative outcomes of Non-Violent Resistance interventions for children and adolescents with emotional and behavioural difficulties and their caregivers – a systematic review

Abstract

Background Non-Violent Resistance (NVR) is an approach of parent training developed to respond to child behavioural difficulties including aggression and risk-taking behaviours. NVR is offered in child and adolescent mental health services across Europe. There has been no published systematic review exploring the effectiveness of this intervention to date. We therefore aimed to examine the outcomes of NVR training for children, adolescents and their caregivers.Methods A systematic literature search was conducted using multiple databases. Critical appraisal skills programme checklists were used to appraise the quality of studies.Results We identified five randomised controlled trials, two simple ‘before and after’ studies, two qualitative studies, one study reporting mixed outcomes and nine articles including case reports. A range of different outcome measures were reported. Overall, the review suggests that NVR shows promise in improving parent-reported child behavioural difficulties, such as externalising symptoms. There is also evidence of improvement in areas of parents’ helplessness, stress and behaviours. However, it is unclear if these outcomes are maintained in the longer term.Conclusions Overall, the evidence base for NVR is relatively limited, especially for informing service provision and commissioning decisions. Further research with RCTs, larger sample sizes and longer follow-up is required to enhance the evidence base.Plain language summaryNon-Violent Resistance (NVR) is a parent training programme that was developed to enable parents and carers to respond constructively towards their child’s challenging behaviours. NVR is offered by some child and adolescent mental health services across Europe. There have been no published reviews of literature exploring the benefits of this intervention so far. In our research, we have analysed the outcomes of NVR training for parents and other carers, such as foster carers. A systematic literature search was completed, and 19 published articles were included in the review. The outcomes from the review were variable. Overall, the review suggests that NVR shows promise in improving parent-reported child behavioural difficulties, such as aggression and self-harm. There is also evidence of improvement in areas of parents’ feelings of helplessness and levels of stress. However, it is unclear if these improvements are maintained over the years. Overall, the existing research for NVR is relatively limited, especially in regard to designing service delivery and interventions. Further research with robust methodology, larger sample sizes and longer follow-up is required to enhance the evidence base.