Principal Investigator: Elaine A. Blechman
Level of Intervention: Indicated
Target Population: Elementary-school aged children at-risk for conduct disorder due to high rates of aggressive behavior.
References: Prinz, Blechman, & Dumas (1994)
Theory (Risk & Protective Factors Targeted):
Based on coping-competence model that seeks to change antisocial coping (e.g. aggression) as well as asocial coping (i.e. withdrawal & depressive symptoms) by promoting the development of prosocial skills for coping with affective, social, & achievement challenges. Prosocial coping skills include social-cognitive processes of information exchange, behavior management, and problem solving. However, the problem solving component does not aim to teach specific solutions but rather teaches prosocial skills to help children cope with diverse problems encountered in different social contexts.
In addition, due to lack of social support experienced by many conduct problem children, the content and structure of the Peer Coping Skills program (PCS) is designed to engage the target child in a supportive, positive peer network.
Description of Intervention:
Peer Coping Skills Training
PCS focuses on developing childrens prosocial-coping skills of information exchange, behavior management, & problem solving. Two-member teams administer the program, which consists of 50-minute weekly sessions that are conducted outside the classroom, but in the school building. The median number of sessions was 22. Sessions followed the same organization each time: Rules, Reunion (discuss personal week & problems, rehearse skills), Probes (role plays through which assess coping skills, rehearse & master), Group Activity, & Group Reward (token for rule following). Each child must master a specific set performance goal that accompanies each probe that is introduced but the group does not move to subsequent probe until all members have mastered the probe. Group activities take place at the same time as the probes. Dyads must accomplish probes during 3 types of activities: low challenge, medium challenge, & high challenge.
For children in this condition, teachers maintained a Good-News Note system (described in Blechman, 1985), which is a program designed to improve social behavior in the classroom by providing opportunities for positive reinforcement for on-task behavior in the classroom.
Subjects were screened on the teacher CBCL (Achenbach, 1991), the CES-T (Blechman, Lowell, Dumas, & Printz, 1993), and an abbreviated version of the Walker-McDonnell Social Skills Scale (Walker & McConnell, 1988). Aggressive group membership required a t-score > or = to 65 on CBCL Aggressive subscale. Competent Non-Aggressive group membership required t-score < 60 on CBCL & CES-T > median. In the PCS group there were 48 aggressive and 52 non-aggressive competent subjects. In the control group there were 47 subjects in the aggressive group and 49 subjects in the non-aggressive competent group. At post-test there were 8 fewer children in the PCS condition and 20 fewer children in the no-PCS condition
Twenty-five, 1st through 3rd grade classrooms in 6 schools were screened. Subjects that met criteria for either Aggressive or Non-Aggressive Competent classification were randomly assigned a combination treatment of PCS and a minimal classroom condition or no treatment and minimal classroom condition only. A maximum of 4 aggressive and 4 competent-non-aggressive children were chosen from each classroom.
Measures included teacher reports of aggression and competence, and observations coded with the INTERACT/BLISS system (Dumas, Blechman, & Prinz, 1992) during an information-exchange task The coding resulted in a composite prosocial information exchange score. Intervention effects were examined with analysis of covariance (ANCOVA) using pre-intervention scores as a covariate.
The aggressive students in PCS were rated by teachers as significantly less (p<.02) aggressive (TRF, Achenbach, 1991). Teachers also rated these students as more socially skilled on the CES-T (p<.02) and as exhibiting better communication effectiveness (p<.001) on the Communication Effectiveness Scale for Teachers (Blechman, Lowell, Dumas, & Prinz, 1993) compared to controls. Observations of aggressive participants receiving PCS indicated that they exhibited higher levels of prosocial coping than controls (p<.002).
Follow-up (6 month):
Aggressive students participating in PCS were rated by teachers as significantly less aggressive (p<.01) and improved in effective communication (p<.005) compared to non-PCS controls. Observations were not conducted as part of the follow-up assessment.
Strengths & Limitations:
PCS is a primarily child-focused program that focuses on improving the skill deficits and maladaptive coping style that often accompany disruptive behavior problems. Although parents were mentioned in the classroom intervention their involvement in the intervention is minimal. The evaluation was well-designed (i.e. randomized trial) and provided support for the intervention. Children who participated in PCS exhibited less aggression and significantly more social skills and prosocial coping compared to controls. These changes were evident through multiple sources (i.e. teacher, peers, & observations). Significant findings were maintained 6 months following the intervention. Although the findings were positive, the small sample size limits their generalizability. In addition, the authors did not mention whether the differential attrition between the intervention groups was significant. One positive aspect of this evaluation was that both genders were well represented. The authors noted several steps that were taken to ensure program fidelity. An intervention manual, clear guidelines for program decisions, and structured forms was used by the staff to administer the program and sessions were videotaped so that staff could review them in on-going supervision. Consumer evaluations were obtained from children, teachers, and parents. There has been no independent replication of the program.