Cognitive Behavior Modification of Hyperactivity-Impulsivity and Aggression: A Meta-Analysis of School-Based Studies

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NICHCY’s Structured Abstract 59 describes the following:

Title | Cognitive Behavior Modification of Hyperactivity-Impulsivity and Aggression: A Meta-Analysis of School-Based Studies

Authors | Robinson, R.T., Smith, S.W., & Brownell, M.T.

Source Journal of Educational Psychology, 91(2), 195-203.

Year Published | 1999

Cognitive behavior modification (CBM)* has been used for the past 25 years to mitigate maladaptive behaviors through the use of covert self-statements. Yet few reviewers have examined the use of CBM in school settings to reduce hyperactive-impulsive and aggressive behaviors in children and youth. This meta-analysis examined the outcomes of 23 studies. The mean effect size across all the studies was 0.74, and 89% of the studies had treatment participants who experienced greater gains than their control counterparts on posttest and maintenance measures when exposed to a treatment with a cognitive component. These results are discussed in terms of study characteristics and design, and recommendations for future research are made.

Cognitive behavior modification (CBM) is a remedial approach used in behavior therapy to influence various classes of disorders such as anxiety, fears, phobias, aggression, and disorders of conduct. CBM combines elements of behavior therapy (e.g. modeling, feedback, reinforcement) with cognitive approaches (e.g. cognitive think aloud) to teach individuals to self-regulate for the purpose of changing their own behavior.

This meta-analysis expands on the work of three previous CBM researchers in particular: Abikoff, 1991; Whalen et al., 1985; and Dush, 1989. Abikoff (1991) and Whalen et al. (1985) emphasized that research on the power of CBM techniques to improve behavioral and academic outcomes has been inconclusive. Dush and colleagues (1989), on the other hand, found that self-statement modification (SSM), a specific form of cognitive therapy, produced an effect size (ES) of about ½ of a standard deviation* on childhood behavior disorders, consistent with moderate effects of treatment.  In expanding on the work of these researchers, this meta-analysis examines the outcomes of CBM interventions in school settings on the hyperactivity-impulsivity and aggression of children and adolescents.

Research Questions

  1. Are cognitive-behavioral interventions effective in decreasing hyperactivity-impulsivity and aggression in children and youth?
  2. Do cognitive-behavioral interventions help students maintain self-control following intervention?

Research Design

  • Number of Studies Included | 23
  • Number of Subjects | 1,132
  • Years Spanned | 1971-1993

Research Subjects
Children who are nonpsychotic. In all studies except one, participants were treated in either a self-contained special education classroom or a regular education classroom.

Age/Grade of Subjects
School-age children (K-12). The majority of participants were in elementary school (K-5).

Specified Disability
Behavioral deviancy including aggression, hyperactivity, impulsivity, lack of self-control, inattention, and disrespect toward authority.

The intervention examined in this meta-analysis was cognitive behavior modification (CBM). CBM refers to techniques that provide individuals with the necessary tools to control their own behavior. The self-regulation of behavior is accomplished by providing individuals with a cognitive framework through which to address a range of self-control, academic, and interpersonal problems. Specifically, CBM uses the principles of behavior therapy to change underlying thought processes that lead to overt behavior.

Duration of Intervention
The researcher chose not to code length of sessions and length of treatment because of missing data.


  1. CBM interventions reduce the occurrence of hyperactive-impulsive and aggressive behaviors.
  2. CBM represents a good treatment match for both types of behavior, because its use allows students to control behavior.
  3. Interventions including a cognitive component can significantly reduce inappropriate behaviors of children and youth in school settings.
  4. Cognitive behavioral interventions continue to reduce inappropriate and maladaptive behavior after the cessation of treatment.

Combined Effects Size
Mean effect size across all the studies was 0.74. Eighty-nine percent (89%) of the studies had treatment participants who experienced greater gains than their control counterparts on posttests and maintenance measures when exposed to a treatment with a cognitive component.

As troublesome behavior seems to become more prevalent in public schools, ensuring school safety and increasing the number of appropriate student social interactions are critical. CBM represents a choice for practitioners. However, the efficient and effective use of CBM is far from certain; despite the overall efficacy of cognitive-behavioral treatments in this analysis, little is actually known about which CBM components facilitate effective and efficient behavior change.

The authors note the following limitations in the studies included in this meta-analysis: (a) Experimental variation, missing data, and vague or ambiguous reporting techniques made it difficult to code variables precisely. (b) Few researchers reported reliability and validity data for instruments used, whether commercial or self-developed.  These two factors, in turn, limit the conclusions that may be drawn about the effectiveness of CBM.

In the future, the authors suggest, researchers should pay attention to control of variables so that the effective aspects of treatment can be identified. Researchers must also design investigations that are methodologically sound. Instruments used to measure different constructs must be identified, and reliability and validity data should be reported.


* Terms Defined

Cognitive-Behavioral Interventions (CBIs) |  CBI is a broad term that encompasses Cognitive-Behavioral Modification (CBM) and Cognitive-Behavioral Therapy (CBT). It is a behavior modification approach that promotes self-control skills and reflective problem-solving strategies. Interventions combine elements of behavior therapy (modeling, feedback, reinforcement) with cognitive approaches (problem solving, self-monitoring, self-instruction, communication skill building, relaxation, and situational self-awareness training) to teach individuals to recognize difficult situations, think of possible solutions, and select the most appropriate response.

Meta-Analysis | A widely-used research method in which (1) a systematic and reproducible search strategy is used to find as many studies as possible that address a given topic; (2) clear criterion are presented for inclusion/exclusion of individual studies into a larger analysis; and (3) results of included studies are statistically combined to determine an overall effect (effect size) of one variable on another.

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