58 Chapter 2 to a passive condition (Axford et al., 2020; David & Fodor, 2023; Kuosmanen et al., 2017; Schakel et al., 2020; Shum et al., 2019). The studies of Wu et al. (2022), Yu et al. (2023) and Yunus et al. (2020) compared (a) casual game(s) to a passive condition. Three studies compared an applied (David et al., 2019b; Maden et al., 2022) or casual game (Cioffi & Lubetzky, 2023), to both an active and passive condition and these studies therefore contributed two effect sizes to the plot. Figure A.15 (Appendix) shows that the five effect sizes comparing the applied game to an active condition ranged from 0.01 to 0.45, with David et al. (2019b) and Perry et al. (2017) showing significant effects favouring the applied game. When adjusting for clustering, however, the effect size found in Perry et al. (2017) became nonsignificant. Kato et al. (2008) showed a significant effect size of –0.36 favouring the casual game over the applied game. The seven effect sizes comparing an applied game to a passive condition ranged from –0.08 to 0.66, with three studies finding a significant effect in favour of the applied game (David et al., 2019b; David & Fodor, 2023; Kuosmanen et al., 2017). However, when the effect size was adjusted for clustering, the effect size found in Kuosmanen et al. (2017) became nonsignificant. Cioffi and Lubetzky (2023) found a nonsignificant effect size of 0.59 when comparing a casual game to an active condition. The four effect sizes comparing a casual game to a passive condition ranged from –0.05 to 0.36 and were all nonsignificant. General Psychological Difficulties Six studies (described in seven papers) examined general psychological difficulties. Participants’ mean age ranged from 8 to 12 years, and the proportion of male participants varied from 0% to 77.8%. Three studies used a regular RCT design (David et al., 2019b; David & Fodor, 2022, 2023; Mannweiler et al., 2023), one study employed a crossover design (Hammond et al., 2014), and two studies used cluster randomisation (Axford et al., 2020; Valenzuela et al., 2022). See Table A.12 (Appendix) for the characteristics and findings of these studies. Effect sizes were calculated on data from six papers. Outcome measures used to calculate the effect sizes on were self-reported (David et al., 2019b; David & Fodor, 2023; Valenzuela et al., 2022) and teacher-reported total level of psychological difficulties (Axford et al., 2020), and parent-reported social behaviour and emotional/behaviour problems (Hammond et al., 2014; Mannweiler et al., 2023). Data from David and Fodor (2022) was not used as relevant data was already extracted from David et al. (2019b). Regarding the papers included in the plot, one study compared the applied game to an active condition (Mannweiler et al., 2023), two compared an applied game to a passive
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