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Protocol for a Systematic Review and Meta- Analysis of Quasi Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2020-038258 on 9 September 2020. Downloaded from Risk factors for disruptive behaviours: protocol for a systematic review and meta- analysis of quasi- experimental evidence Lucy Karwatowska ,1 Simon Russell,1 Francesca Solmi ,2 Bianca Lucia De Stavola,1 Sara Jaffee,3 Jean- Baptiste Pingault,4,5 Essi Viding4 To cite: Karwatowska L, ABSTRACT Strengths and limitations of this study Russell S, Solmi F, et al. Introduction Disruptive behaviour disorders, including Risk factors for disruptive oppositional defiant disorder and conduct disorder, are a behaviours: protocol for a ► The strengths of the current study include systemat- common set of diagnoses in childhood and adolescence, systematic review and meta- ically evaluating quasi- experimental research, which analysis of quasi- experimental with global estimates of 5.7%, 3.6% and 2.1% for any aims to estimate causal effects, of a wide range of evidence. BMJ Open disruptive disorder, oppositional defiant disorder and risk factors for a variety of disruptive behaviours. 2020;10:e038258. doi:10.1136/ conduct disorder, respectively. There are high economic ► The risk factors will not be selected a priori allowing bmjopen-2020-038258 and social costs associated with disruptive behaviours any risk factor to be included in the review and the and the prevalence of these disorders has increased in ► Prepublication history and quality of evidence will be assessed to provide con- additional material for this recent years. As such, disruptive behaviours represent an fidence in the effect estimates. paper are available online. To escalating major public health concern and it is important ► The present study will be the first to synthesise view these files, please visit to understand what factors may influence the risk of these quasi- experimental evidence for disruptive be- the journal online (http:// dx. doi. behaviours. Such research would inform interventions that haviours and will inform future research of the most org/ 10. 1136/ bmjopen- 2020- aim to prevent the development of disruptive behaviours. probable risk factors associated with the develop- 038258). The current review will identify the most stringent ment of these disorders. Received 04 March 2020 evidence of putative risk factors for disruptive behaviour ► The current review will focus on quasi-experimental, Revised 08 June 2020 from quasi- experimental studies, which enable stronger as opposed to experimental, methods which, despite Accepted 17 July 2020 causal inference. being more robust than other non-experimental http://bmjopen.bmj.com/ Methods and analysis The review will be carried out methods, are not immune to bias. according to Preferred Reporting Items for Systematic ► Bias that may be introduced through solely select- Reviews and Meta-Analyses (PRISMA) guidelines. An ing articles published in the English language will be electronic search of references published between 1 lessened by including studies that are conducted in any country as long as the full article is translated January 1980 and 1 March 2020 will be conducted © Author(s) (or their into English. using Medline, Embase, PsycINFO and Web of Science. employer(s)) 2020. Re- use permitted under CC BY. Initial abstract and title screening, full-text screening Published by BMJ. and data extraction will be completed independently by BACKGROUND on September 26, 2021 by guest. Protected copyright. 1Great Ormond Street Institute of two reviewers using Evidence for Policy and Practice Child Health, University College Information (EPPI)-Reviewer 4 software. Quasi- Individuals who display disruptive behaviours London, London, UK experimental studies in the English language examining in childhood (including conduct problems, 2 Division of Psychiatry, the association between any putative risk factor and a conduct disorder and oppositional defiant University College London, clearly defined measure of disruptive behaviour (eg, a disorder) engage in a range of repetitive London, UK validated questionnaire measure) will be included. We will 3Department of Psychology, and troublesome behaviours, such as lying, University of Pennsylvania, conduct meta-analyses if we can pool a minimum of three fighting and stealing. Disruptive behaviour Philadelphia, Pennsylvania, USA similar studies with the same or similar exposures and disorders are estimated to affect 5.7% of 4Department of Clinical, outcomes. children and adolescents globally,1 with Educational and Health Ethics and dissemination The proposed review does prevalence estimates increasing in recent Psychology, University College not require ethical approval. The results will help to years.2 3 Disruptive behaviours place a consid- London, London, UK identify risk factors for which there is strong evidence of 5Social, Genetic, and erable economic, social and emotional causal effects on disruptive behaviours and also highlight 4 5 Developmental Psychiatry, burden on society and are therefore a King’s College London, London, potential risk factors that require further research. The major public health concern. There has been findings will be disseminated via publication in a peer- UK a long- standing interest in understanding reviewed scientific journal and through presentations at what factors increase (or decrease) the risk of Correspondence to international meetings and conferences. these behaviours. Despite the large numbers Ms Lucy Karwatowska; PROSPERO registration number CRD42020169313. lucy. karwatowska. 18@ ucl. ac. uk of studies that have investigated this question, Karwatowska L, et al. BMJ Open 2020;10:e038258. doi:10.1136/bmjopen-2020-038258 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-038258 on 9 September 2020. Downloaded from much of the existing evidence draws on research that between risk factors and outcomes as quasi- experimental. has used unrepresentative samples (ie, high-risk or clin- Hence as well as including quasi- experimental study ical samples), has explored a restricted number of risk designs (eg, natural experiments, twin studies) we will factors and/or has only focused on identifying associ- also include studies where the propensity for exposure ations between putative risk factors and outcomes.6 7 In to a particular risk factor is controlled for by using analyt- comparison, quasi- experimental studies can address most ical methods, leading to estimates of causal effects under of these limitations: they often use large, representative certain assumptions (online supplementary appendix A). samples, they are able to investigate risk factors for which Given the increase in quasi-experimental designs and the classical randomised control trials are unethical, imprac- use of causal inference methods in recent years, we antic- tical or too costly, and, under certain assumptions, they ipate that there will be a sufficient number of studies to can produce causal estimates.8 Given the high societal perform meta- analyses. By systematically combining and cost of disruptive behaviours it is important that research summarising all relevant literature, the current review attempts to identify the causal, as opposed to correla- will aim to: tional, risk factors associated with these behaviours. Such 1. Identify risk factors for disruptive behaviours from research would inform efforts to design more effective quasi- experimental designs that provide more strin- interventions that aim to prevent the development of gent evidencefor causal inference. disruptive behaviour and its associated adverse long-term 2. Examine whether the results from these studies indi- outcomes. cate evidence of causal effects. To date, only one narrative review of quasi- 3. Establish whether the results vary by: experimental evidence for risk factors for antiso- i. Outcome (ie, conduct disorder, conduct prob- cial behaviour, a common symptom of disruptive lems, oppositional defiant disorder or antisocial behaviour disorders, has been published.9 The authors personality disorder); concluded that there was evidence that harsh parental ii. Sex; discipline, maltreatment, parental divorce, adoles- iii. Study design (eg, natural experiment); cent motherhood, maternal depression, parental iv. Analytical methods (eg, g- methods); and/or antisocial behaviour, peer deviance and poverty had v. Data quality (eg, bias induced by the rater assess- causal effects on antisocial behaviour. However, there ing the exposure while knowing the outcome). was no evidence of causal effects for smoking during pregnancy, paternal depression, parental alcohol METHODS use or neighbourhood disadvantage. The review was The current protocol has been registered with the limited to eight categories of risk factors and seven PROSPERO database (CRD42020169313)and has been types of quasi- experimental design as, at the time, an reported using the PRISMA- Protocols guidelines10 insufficient number of existing studies had included http://bmjopen.bmj.com/ (online supplementary appendix B). Any amendments to other types of risk factors and/or quasi-experimental the protocol will be made through PROSPERO. designs to warrant inclusion in the review. There- fore the review did not include many risk factors that have been proposed to have causal effects on disrup- Definition of key terms tive behaviour, including father absence, domestic Quasi-experimental studies violence and bullying victimisation. It also did not Quasi- experimental studies assess causality by aiming to include specific
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