The effect of Stop Now And Plan (SNAP) program on children with conduct disorder in community settings: a meta-analysis

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Osman, Fatma
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The early identification and treatment of children with conduct disorder (CD) help in preventing future engagements in criminal activities. Literature shows that cognitive-behavioural treatments (CBT) may have desirable results in children under 12 years of age with CD. Stop Now, And Plan (SNAP) as one of the CBT interventions is provided in community settings for children under 12 who act antisocially and aggressively. Some primary studies have been conducted to evaluate the SNAP program’s effectiveness. These evaluations have shown the program’s effectiveness in reducing aggressive, conduct, rule-breaking, antisocial, and overall behavioural problems. The purpose of the study was to conduct a Meta-Analysis that combines data from the SNAP primary evaluation studies to produce a precise total estimate of the program effect. Specifically, the study aimed to (1) determine the effect of SNAP program on the children’s CD in community settings, and (2) determine whether variations in treatment intensity and fidelity affect the program’s outcomes. The outcome summary data from each study that met the inclusion criteria were extracted by using a standardized data extraction form and were meta-analyzed by using the Review Manager. The Random-Effect Meta-Analysis methods were used. The study’s results showed that the SNAP program made a significant moderate reduction in the children's conduct problems (the summary effect size is 0.41 with 95% CI of 0.25 to 0.57, I2 of 58%, and based on four studies with 231 participants) immediately after they participated in the program. This trend has continued to a significant large effect after six months of follow-up with a summary effect size of 0.61, 95% CI of 0.44 to 0.99, I2 of 64%, and based on four studies with 318 participants. The results also showed that the program had a significant reduction in children’s externalizing and internalizing behavioural problems as well as significant improvements in prosocial skills, immediately and at follow-up. Furthermore, the children who participated in the program were less likely involved in criminal convictions according to eleven years’ follow-up observations. A need for well-conducted trials and more extended periods of follow-up are needed to further help in understanding the efficacy of the program.
Children, Conduct disorder, Community settings, SNAP, Program evaluation, Meta-analysis