A Randomized Controlled Trial Comparing Reverse Psychology with Other Nonpharmacological Behavior Management...

Reverse psychology (RP) has recently emerged as a promising behavioral approach to enhance compliance in young children by leveraging psychological reactance-the natural tendency to assert autonomy when the choice is perceived as restricted. Encouraging cooperation through a playful challenge rather than directive instruction may foster intrinsic motivation, making RP a valuable alternative to traditional nonpharmacological techniques. This randomized controlled trial aimed to compare the effectiveness of RP with tell-show-do (TSD) and positive reinforcement (PR) techniques in promoting cooperative behavior among preschool children aged 4-6 years in Bhubaneswar, India.

Thirty preschool children were randomly assigned to one of three groups: RP, TSD, or PR. Each participant completed a standardized toy-sorting task within 5 min. Primary outcome measures included task compliance (percentage of toys sorted), while secondary outcomes comprised task completion time, child-reported motivation, and parental perception of typical compliance. Standardized Odia-English bilingual scripts were used to ensure linguistic consistency. Intervention fidelity was verified through inter-rater reliability (κ = 0.88) and video-recorded session reviews. Statistical analysis involved one-way analysis of variance with post hoc Tukey tests and effect size estimation. Institutional ethics approval (IEC/IDS/2025/0427) and Clinical Trials Registry-India registration (CTRI/2025/07/067891) were obtained prior to commencement.

Children in the RP group demonstrated significantly higher compliance (M = 85.2%, 95% confidence interval: 78.4-91.9) compared with TSD (M = 70.3%) and PR (M = 65.8%) (F(2,27) = 6.78, P = 0.004, η² = 0.33). RP participants also completed the task faster (180 ± 25 s) and reported higher enjoyment levels (80%). No dropouts or adverse events were observed.

RP significantly improved compliance and engagement among preschoolers compared with conventional behavioral methods. Its playful, autonomy-supportive nature makes RP a simple, low-cost, and culturally adaptable strategy for pediatric behavior management and early childhood education, particularly in resource-limited contexts.