Aim
To review the evidence for behavioural interventions to reduce drooling in children with neurodisability.
Method
A detailed search in eight databases sought studies that: (1) included participants aged 0 to 18 years with neurodisability and drooling; (2) provided behavioural interventions targeting drooling or a drooling‐related behaviour; and (3) used experimental designs. Two reviewers extracted data from full‐text papers independently. Results were tabulated for comparison. The Risk of Bias assessment in N‐of‐1 Trials scale for single case experimental designs (SCEDs) and the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs) were applied.
Results
Of an initial yield of 763, seven SCEDs and one RCT were included. Behavioural interventions included the use of reinforcement, prompting, self‐management, instruction, extinction, overcorrection, and fading. Each assessed body functions or structures’ outcomes (drooling frequency and severity); three included activity outcomes (mouth drying, head control, eye contact, and vocalizations) and none assessed participation or quality of life. While each study reported positive effects of intervention, risk of bias was high.
Interpretation
Low‐level evidence suggests behavioural interventions may be useful for treatment of drooling in children with neurodisability. Well‐designed intervention studies are urgently needed to determine effectiveness.
What this paper adds
Behavioural interventions used to treat drooling included reinforcement, prompting, self‐management, extinction, overcorrection, instruction, and fading.
Interventions targeted body structures and function‐level outcomes and activity‐level outcomes.
Low‐level evidence supports the use of behavioural intervention to treat drooling.
Attention-deficit hyperactivity disorder (ADHD) is a prevalent developmental disorder affecting between 5% and 7% of children (Thomas et al., 2015). The social and behavioural difficulties of children with ADHD are profoundly greater than those experienced by their typically developing peers. A recent meta-analysis of 109 studies of children with ADHD found within social functioning, children had most substantial difficulty with peer functioning and social skills (Ros & Graziano, 2018). These difficulties are known to lead to adverse outcomes in later life if left unaddressed (Mrug
Introduction The objective of this systematic review was to synthesise the evidence for cognitive strategy training to determine its effectiveness to improve performance of activities of daily living in an adult neurological population. Method Medline, CINAHL, EMBASE, PSYCInfo, PsycBITE and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched until August 2019. Studies examining the effect of cognitive strategy training on functional performance were included. Population criteria included adults with non-progressive neurological conditions. External and internal validity of included studies was systematically evaluated using an appropriate methodological quality assessment for each study design. A content analysis was conducted of the methodologies used. Findings Forty-one studies met the inclusion criteria and were appraised for content, 16 randomised or quasi-randomised trials were meta-analysed. Trial quality was generally ‘good’, Physiotherapy Evidence Database scale scores ranged from 3 to 8 (out of 10). For activity performance outcomes post-intervention, there was a significant benefit of cognitive strategy training over usual care (standardised mean difference 0.79, 95% confidence interval 0.49–1.09; P < 0.00001). Conclusion More high-quality research is needed to strengthen the evidence base for cognitive strategy interventions to improve activity performance outcomes for adults with non-progressive neurological conditions. Systematic review registration PROSPERO CRD42016033728
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