Aggressive/disruptive behavior in the elementary school years is a strong indicator of antisocial behavior, drug abuse and low educational and occupational attainment in adolescence and young adulthood. The Good Behavior Game (GBG) and Promoting Alternative Thinking Strategies (PATHS) represent two of a handful of universal, elementary school, preventive interventions which have been shown in large scale, randomized controlled trials to have an immediate and beneficial impact on aggressive/disruptive behavior. PATHS seeks to accomplish reductions in such behavior via teacher led instruction aimed at facilitating emotion regulation and social problem-solving, whereas the GBG provides teachers with an efficient means of reducing aggressive/disruptive behavior using social learning principles within a game-like context. Importantly, however, the effects of the GBG on aggressive/disruptive behavior proved modest in our 1st and 2nd generation Johns Hopkins University Preventive Intervention Research Center (JHU PIRC) field trials. This has been the case for PATHS as well. We recently completed a 27-school, randomized controlled trial examining whether the combination of these interventions, which we refer to as PATHS to PAX, would yield significantly greater impact on aggressive/disruptive behavior than the GBG alone. Our rationale for expecting greater impact was that the use of the GBG should result in reductions in aggressive/disruptive behavior, which should then facilitate the acquisition of the emotion regulation and social problem-solving skills taught in PATHS. PATHS to PAX did result in a modestly greater reduction in aggressive/disruptive behavior than the GBG alone at 1-year post-test. Yet, the most aggressive/disruptive students still failed to sufficiently benefit from te PATHS to PAX intervention. Accordingly, in this application, we propose to examine whether the addition of the Incredible Years (IY), an evidence-based preventive and treatment intervention aimed at reducing aggressive/disruptive behavior, would yield greater impact on these behaviors than the PATHS to PAX intervention alone. We also propose to examine whether the combination of the PATHS to PAX + IY results in increased frequency of implementation of the PATHS to PAX intervention. We hypothesize that relative to teachers in the PATHS to PAX alone condition, teachers in the PATHS to PAX+IY condition will perceive PATHS to PAX as more efficacious and will therefore be more likely to implement it. Four cohorts of 12 schools each will be recruited with schools randomly assigned to 1 of 3 intervention conditions: 1) Control; 2) PATHS to PAX Alone; or 3) PATHS to PAX+IY. Assessments of student outcomes will be carried out at pre-test and post-test in the fall and spring of the initial school year foreach cohort and at a 6-month and one year follow-up.

Public Health Relevance

In this application, we propose to examine whether the combination of a universal, elementary school-based preventive intervention with an indicated preventive and treatment intervention would yield greater impact on aggressive/coercive and off-task behavior than the universal preventive intervention alone.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Sims, Belinda E
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Johns Hopkins University
Other Health Professions
Schools of Public Health
United States
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