PROMOTING ALTERNATIVE THINKING STRATEGIES (PATHS)

Principal Investigator: Mark Greenberg

Level of Intervention: Universal

Target Population: elementary-aged children

References: Greenberg, et al. (1995); Greenberg & Kusche (1993, 1996, 1997, 1998); Conduct Problems Prevention Research Group (1999b)

Theory (Risk & Protective Factors Targeted):
Based on the ABCD (Affective-Behavioral-Cognitive-Dynamic) model of development, PATHS focuses on the developmental integration of affect, behavior and cognitive understanding, recognizing that a child’s behavior and self-regulation are functions of emotional awareness, affective-cognitive control and social-cognitive understanding. PATHS seeks to provide children with the knowledge and skills necessary for self-control, understanding , expressing and regulating their emotions, and effective social problem-solving. In addition, PATHS also targets improvements in classroom and school ecology.

Description of Intervention:
Originally developed for use with deaf children, PATHS has been adapted through action research for use with regular education and special needs children (learning disabled, language delayed, behaviorally and emotionally impaired, and mildly mentally delayed children). PATHS is implemented by trained teachers with entire classrooms using a 131-lesson curriculum over a period of up to 5 years.

PATHS covers five conceptual domains, including self-control, emotional understanding, positive self-esteem, relationships, and interpersonal problem-solving skills. The curriculum consists of three major units: the Readiness and Self-Control Unit – 12 lessons that focus on readiness skills and developing basic self-control; the Feelings and Relationships Unit – 56 lessons that focus on teaching emotional and interpersonal understanding; and the Interpersonal Cognitive Problem-Solving Unit – 33 lessons that cover 11 formal steps to interpersonal problem solving. PATHS also intersperses lessons on building positive self-esteem and improving peer communications/relations throughout the 3 major units. A supplementary unit contains 30 additional lessons that review and expand on the concepts taught in the 3 major units.

A separate teacher instruction manual is included and parent letters and home activity assignments are used to encourage generalization of the skills to the home environment.

Research Subjects:
PATHS has been evaluated with three trials: (1) a population of 200 regular education first grade children (87 intervention and 113 control; 65 percent white, 21 percent African American); one with 126 special needs children (57 intervention and 69 control); and 57 deaf children (29 intervention and 28 control). .

Research Design:
All three trials utilized randomized, controlled trials (the trials with deaf children used a randomized wait-list control design); For the regular education trials, four schools were randomly assigned to intervention or control conditions. There were no significant differences on pretest measures related to the outcomes of interest.

Outcomes:
Measures included an interview of social problem solving, two tests of non-verbal cognitive abilities, achievement testing, and teacher, parent and child ratings of behavioral problems.

Deaf Children:
At post-test intervention children showed significant improvements on problem solving skills, emotional understanding, Results indicated that the intervention led to significant improvement in students’ social problem-solving skills, emotional recognition skills, and teacher and parent-rated social competence. There was no effect in this normative sample on teacher or parent-rated psychopathology. One and two year post-test results following the first intervention group indicated maintenance of effects. Results on the wait-list control group indicated replication of effects in a second sample.

Regular Education Children:
At post-test, intervention group children had significantly improved social problem solving skills and emotional understanding and were significantly less likely to provide aggressive solutions and more likely to provide prosocial solutions to interpersonal conflicts. Intervention group children also showed significant improvement on the two cognitive ability tests.

At 1-year followup, significant effects were again found on measures of emotional understanding and interpersonal problem solving skills. Significant differences were also found on a task of social planning and on the non-verbal subtest of Coding on the WISC-R. There were no differences on teacher or self-reports of problem behavior at this time point.

At 2-year followup, significant differences on teacher rating of the CBCL subscales of externalizing behavior problems and of total adaptive functioning. In addition, intervention students self-reported a significantly lower rate of conduct problems.

Special Needs Children:
At post-test, intervention group children had significantly improved social problem solving skills and emotional understanding and were significantly less likely to provide aggressive solutions and more likely to provide prosocial solutions to interpersonal conflicts. Teachers reported improvements in social competence and internalizing behavior problems (depression/anxiety). Students reported decreases in symptoms of depression.

At 1-year followup, significant effects were again found on measures of emotional understanding and interpersonal problem solving skills. Significant differences were also found on a task of social planning and on the non-verbal subtest of Coding on the WISC-R. Teachers again reported differences on internalizing problems and students reported decreases in depressive symptoms.

At 2-year followup, significant differences on teacher rating of the CBCL subscales of both internalzing and externalizing behavior problems. In addition, intervention students self-reported a significantly lower rate of depression and conduct problems.

Multisite Replication:
A more limited, grade 1 only version of the PATHS Curriculum has been examined within the larger Fast Track Multi-Site Program. This study involved a randomized trial in which schools within sites (Seattle, Nashville, Durham, rural Pennsylvania) were randomized in sets of intervention and control status. Grade 1 intervention involved approximately 400 classrooms (198 intervention and 180 control classrooms) and involved assessment of over 5000 children. Classroom teachers delivered a 57-lesson version of PATHS. Findings comparing classroom level data (HLM analysis with classroom as the unit of analysis) indicated lower peer report of aggression and hyperactive-disruptive behavior (using peer sociometric assessment) and higher quality of classroom atmosphere (as by independent observers). There was also a trend for improvement in teacher ratings of disruptive and aggressive behavior. Within the intervention classrooms, the quality of implementation predicted significant variation in both teacher and peer assessments of classroom functioning.

Strengths & Limitations:
PATHS is a school-based intervention that targets the development of social and emotional competence in order to build protective factors and decrease risk for behavior problems and social maladaptation. It also seeks to improve the quality of the classroom ecology. Because of its multiple replications and strong experimental designs, the studies of PATHS have indicated that it has robust effects across different populations (regular and special needs children) and in both urban and rural locations. A particularly strong point of the recent FAST Track replication is the large sample size and the use of the classroom as the unit of analysis; such analysis are more conservative as they take into account the interdependency among scores within classrooms. In addition, across trials effects have been shown by multiple reporters (teachers, children, peers). Two of the trials have carefully measured implementation (dosage, and fidelity of delivery by teachers) and some results have related quality of implementation to outcome demonstrating a dose-response relationship.

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