A Randomized Controlled Trial of a Standardized Behavior Management Intervention for Students With Externalizing Behavior

Abstract

This study reports the results from a Swedish randomized controlled trial of a standardized behavior management intervention. The intervention targeted students with externalizing behavior in a regular education setting. First-and secondgrade students (N = 100) from 38 schools were randomly assigned to either the intervention or an active comparison group. Observer, teacher, and peer ratings were collected at pretest, posttest (6 months later), and follow-up (14 months after pretest). Significant intervention effects were found on student externalizing behavior and teacher behavior management at both posttest and follow-up. The intervention effect on student externalizing behavior was mediated by change in teacher behavior. Moderating effects of demographic and classroom variables were explored, as well as the social validity of the intervention. The results are discussed in relation to cost-effectiveness and feasibility of behavioral interventions in typical school settings. has recently received his doctoral degree from Uppsala University, Sweden. He is a licensed clinical psychologist and currently employed at the National Board of Health and Welfare. His interests include evidence-based practices in general and childhood interventions in particular.

Behavioral Management for Children and Adolescents: Assessing the Evidence

“…Researchers also noted that studies in this body of literature generally have small samples, lack RCTs, use single-subject or within-group research designs, do not always use standardized behavioral management protocols, and are limited in their ability to report whether school personnel were implementing the interventions with fidelity (37,(41)(42)(43). However, in this review we included three studies of tertiary-level school-based interventions using RCTs (35)(36)(37).…”

“…Researchers also noted that studies in this body of literature generally have small samples, lack RCTs, use single-subject or within-group research designs, do not always use standardized behavioral management protocols, and are limited in their ability to report whether school personnel were implementing the interventions with fidelity (37,(41)(42)(43). However, in this review we included three studies of tertiary-level school-based interventions using RCTs (35)(36)(37). Researchers indicated various limitations of the design (which varied across studies), including the lack of fidelity measures of team implementation of the intervention, attrition over time, limited measurement of interrater reliability of observational data, lack of validated assessment measurement, and lack of statistical analyses to account for school-level differences.…”

“…However, these results should be interpreted with caution, because the studies evaluated in these reviews had methodological limitations (for example, singleparticipant research designs and small samples). Two RCTs with elementary school students found effects in reducing externalizing behavior, compared with control groups, at the end of the intervention (36) and at the follow-up 14 months after the pretest (37), as indicated by self-reported scores on standardized instruments and observer ratings of student behavior. Compared with students in control groups, students in the intervention group also evidenced higher ratings of self-reported social skills; improvements were also seen in time engaged in academic activities, as measured by independent observational assessment (36).…”

“…Researchers have noted that most studies evaluating the effectiveness of tertiary-level school-based interventions have included students with significant disabilities in selfcontained classrooms, which limits the generalizability of the evidence to general education students in typical classroom settings (37,41). Researchers also noted that studies in this body of literature generally have small samples, lack RCTs, use single-subject or within-group research designs, do not always use standardized behavioral management protocols, and are limited in their ability to report whether school personnel were implementing the interventions with fidelity (37,(41)(42)(43).…”

“…Twelve RCTs that had been published after the previous reviews had been conducted were also identified. Their topics were family-centered behavioral interventions (31)(32)(33)(34), school-based behavioral interventions (35)(36)(37), and integrated behavioral interventions (23,24,(38)(39)(40). Tables 2 and 3 summarize the reviews and the RCTs, respectively.…”