Interventions reducing children’s
ag-gressive behavior while improving
peer interaction
A systematic literature review
Zinala Yimamu
One year master thesis 15 credits Supervisor
Interventions in Childhood Anna Karin Andersson
Examinator
SCHOOL OF EDUCATION AND COMMUNICATION (HLK) Jönköping University
Master Thesis 15 credits Interventions in Childhood Spring Semester 2020
ABSTRACT
Author: Zinala Yimamu
Main title Interventions reducing children’s aggressive behavior while improving peer interaction
Subtitle A systematic literature review
Pages: 23 Aggressive behavior of young children has always existed. In kindergarten, teachers and children will encounter the consequences frequently. However, not all teachers have enough experience and knowledge to deal with children’s aggressivebehavior. Children’s aggressive behavior will not only affect the teacher’s curriculum, the relationship between teachers and children, but also the relationship between children. Therefore, the purpose of this systematic review is to provide teachers with interventions that can help young children reduce aggressive behavior while improving peer interaction. ERIC and
PsycINFO were used to search peer-reviewed articles since these two databases have arti-cles related to my topic, and data collecting and analyzing were conducted in March and April 2020. By including five relevant articles and summarizing and analyzing the contents of these five articles, it is concluded that there are two types of interventions in kindergar-tens to reduce children's aggressive behavior while improving their peer interaction. One type includes a method for social story, which is a short, simple story written from a child’s perspective to provide guidance for appropriate social behavior for children with autism. The other intervention type teaches social skills. The advantage of this systematic review is that it is very practical for teachers because four of the five articles have an effect on aggressive behavior and/or peer interaction This paper analyzes relationships of chil-dren's aggressive behavior, and does not include other elements such as chilchil-dren's lan-guage ability. In conclusion, teachers need to choose appropriate interventions, because some interventions cannot achieve the effect of reducing aggressive behavior and increas-ing peer interaction at the same time.
Keywords: Peer relation, Peer interaction, Aggressive behavior, Aggression, Children in early age, Kindergarten, Intervention Postal address Högskolan för lärande och kommunikation (HLK) Street address Gjuterigatan 5 Telephone 036–101000 Fax 036162585
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摘 要 幼儿的攻击行为一直都存在。在幼儿园时，由于教室里有不止一个的幼儿，教师更是 会频繁的遇见这一情况，然而并不是所有的教师都有足够的经验和知识来应对幼儿的 这一行为。幼儿的攻击行为不仅会影响教师的课程，教师与幼儿的关系，还会影响幼 儿之间的关系。因此本文献综述的目的是给教师提供能帮助幼儿降低攻击行为的同时 提高同伴互动的干预计划。ERIC 和 PsycINFO 用于搜索同行评审的文章因包含最多与本 篇论文主题相关的文献，并在 3 月和 4 月进行了数据收集和分析。通过纳入五篇相关 文献并对这五篇文献内容的总结与分析得出教师在幼儿园中有不同的方法来减少儿童 的攻击行为，促进他们的同伴互动。其中，干预分为两大类，一种是包括了社交故事 的干预，另一种是教导学生社交技巧的干预，并且，社交故事的使用频率较高。但 是，教师需要选择合适的干预，因为有些干预不能达到减少攻击性行为的同时增加同 伴互动的效果。本片文献综述的优点是对于教师来说十分实用，而主要的不足点是只 分析了幼儿的攻击行为与幼儿间的关系，并没有分析幼儿的语言能力等能够影响幼儿 攻击行为的要素。
Table of Content
1 Introduction ... 1
1.1 Aggressive behavior ... 1
1.2 Impact of childhood's aggression on the future ... 2
1.3 Peer relationships ... 2
Positive peer social interactions ... 2
1.3.2 The impact of peer relationships in children with aggressive behavior ... 2
1.4 Relationship between teachers and students ... 3
1.5 Reasons for aggressive behavior ... 3
Personal factors... 3
Environment factors ... 4
1.6 Theoretical background ... 4
1.7 Rationale ... 5
1.8 Aim: ... 6
1.9 Research questions: (PIO) ... 6
2 Method ... 6
2.1 Design ... 6
2.2 Procedure ... 6
The search process ... 6
Selection process — Screening of title and abstract ... 7
Selection process -- Screening of full text ... 8
Data analysis ... 10
2.3 Quality of studies ... 10
2.4 Ethical consideration ... 11
3 Result ... 12
3.2 Interventions including the social story method... 13 Process ... 13 Person — Teacher ... 15 Person — Children ... 15 Context ... 15 Time ... 16
3.3 Teaching social skills intervention ... 16
Process: ... 16
Person ... 16
Context ... 17
Time ... 17
3.4 Results of the interventions ... 17
Interventions including the social story method ... 18
Interventions teaching social skills ... 18
4 Discussion ... 19
4.1 Reflections on the result ... 19
4.2 Limitations ... 21
4.3 Future research ... 22
5 Conclusion ... 23
6 Reference ... 24
1
1 Introduction
1.1 Aggressive behavior
Aggressive behavior in early childhood is not formulated by a child itself but a result of hered-itary and environmental factors (Anderson & Bushman, 2002), and it is the observable mani-festation of aggression (Liu et al., 2013). On the other hand, Palacios et al (2016) argue that children’s aggression and bullying may be similar, but they are not equal to one another. Ac-cording to (Olweus, 1994), an individual who “chronically harasses someone else either phys-ically or psychologphys-ically” is bullying, and “A student is being bullied or victimized when he or she is exposed, repeatedly and over time, to negative actions brought upon by other students”. While aggressive behavior is a related symptom of many mental disorders and can be mani-fested throughout the life span (Liu et al., 2013).
The aggressive behavior has two directions, reactive and proactive aggression. Reactive aggres-sion is an angry or frustrated reaction to a real or perceived threat, whereas proactive aggresaggres-sion is with more positive expectations) of the outcome of the aggression (Fite et al., 2009; Anderson & Bushman, 2002; Tuvblad et al., 2009). A child may use aggressive behavior to obtain the other child’s toy; this would be deemed proactive aggression. Child A may use aggressive be-havior react to other children's intentional or unintentional bebe-havior/words which makes A un-comfortable; this is reactive aggression. Regarding these two directions, it also has two aspects of each: ‘relational aggressive’ (Crick, Casas, & Mosher, 1997), such as isolating peers; and physically aggressive, which shows as hitting, pushing, throwing, etc. (McEvoy, Estrem, Ro-driguez & Olson, 2003). Meanwhile, another type of aggressive behavior among children known by various names (such as hostility and anger) has been studied in recent decades, which may be the cause of coronary heart disease and depression (Yamasaki & Nishida, 2009). ulti-mately, girls have a greater tendency to be more relationally aggressive than the opposite sex, by contrast boys are often more physically aggressive than girls. Overall, boys are considered to be more aggressive than girls in both relational and physical aspects(McEvoy et al., 2003). Aggression is a problem in school settings and classes, especially for teachers. A majority of teachers emphasize that relational aggression is one of the key challenges that arises in the classroom environment (Ostrov et al., 2009).
2 1.2 Impact of childhood's aggression on the future
Younger children may be physically aggressive because they are unable to express themselves in other ways, as a result of language and social-cognitive development, children adopt the use verbal aggression, and in turn, social aggression eventually becomes the main approach (Bjoerkqvist, Lagerspetz, & Kaukiainen, 1992). Despite that, children who display a high level of physical aggression in elementary school are most at risk of physical violence during ado-lescence and adulthood. In relation to boys, models that assess the bivariate relationship be-tween physical aggression in childhood and adolescent delinquency indicated that consistently high levels of physical aggression in childhood increase the likelihood of violence and nonvio-lent delinquency. As for girls, in the multiple regression model, no specific type of aggressive behavior in elementary school has a consistent, unique effect on violence or nonviolent crime in adolescence (Broidy et al., 2003). Nevertheless, Swit et al. (2016) suggested that children with a high degree of relational aggression are more likely to use prosocial problem-solving and conflict resolution strategies.
1.3 Peer relationships
Positive peer social interactions
Positive social interaction is an interaction that occurs between peers. This interaction is posi-tive in nature and successful for both participating children. ‘Getting a friend’s attention, shar-ing objects, askshar-ing peers to share objects, providshar-ing a play idea to a peer, sayshar-ing somethshar-ing pleasant to the other person are a few examples of how one would interact positively with peers (Bovey & Strain, 2003).
1.3.2 The impact of peer relationships in children with aggressive behavior
Not only will aggressive behaviour in children result in them being rejected by their fellow peers but will also cause social withdrawal and victimization (Khtri & Kupersmidt, 2003). With that being said, many aggressive children show social cognitive deficits and emotional disorders, and the combination of these two is a risk factor for hostile and compulsive relationships with peers and can lead to continued peer rejection (Bierman et al., 1993). Reactive aggression is associated with peer rejection and victimization. Crick et al. (2006) indicated that the relational aggressive behavior of girls and the physical aggression in boys during the initial evaluation was significantly related to the peer rejection as reported in the future by teachers. In turn, the
3 combination of aggressive, destructive behavior style and severe rejection is particularly harm-ful to children's adaptation. Additionally, studies reveal that peer rejection increased the exter-nalizing problems over the elementary school period (Ladd, 2006). Compared with children who are moderately or temporarily excluded, those who have been rejected for a considerable amount of time are less likely to experience prosocial forms of socialization, consequently the individual risks associated with peer exclusion are more likely to be persistent and harmful (Ettekal & Ladd, 2014).
Nevertheless, Swit et al. (2016) suggested that children with a high degree of relational aggres-sion are more likely to use prosocial problem-solving and conflict resolution strategies. As well as Rose et al. (2004) claimed that when controlling relational aggression between children in the 7th grade and above,, discovering positive concurrent relationships between aggression and perceived popularity became less significant. While controlling overt aggression, a positive connection was identified between relational aggression and perceived popularity.
1.4 Relationship between teachers and students
Supportive interaction between teachers and students is related to the child's sense of intimacy with the teacher and peer community, which is beyond the influence of the child's personal characteristics (Madill et al., 2014). McAuliffe MD et al. (2009) suggested that teachers' per-ception of children and corrective/negative behaviors of children mediate the relationship be-tween aggressive and prosocial child behavior and peer aversion. In addition, teacher-student conflicts that may take place in kindergarten indicate higher level of aggressiveness in the first grade (Runions et al., 2014; Doumen et al., 2011). Expanding on that, Shavega et al. (2019) suggested that the absence of a teacher-student relationship and friction between one another encourages a child’s aggressive behavior. Moreover, with the assistance of teachers who offer emotional support, children who display internalized or externalized behaviors are no longer at risk of establishing less intimate or conflicting relationships with the teacher (Buyse et al., 2008). 1.5 Reasons for aggressive behavior
Personal factors
Aggression is heritable, the differences in the stability of proactive aggression between people are for the most part genetically mediated (Tuvblad et al., 2009), what is more, genetic factors have a greater effect on adults in comparison to children (Rowett al., 1999). Apart from that, a child’s personal belief in aggression and personal perception of the school environment are
4 closely related to the implementation and victimization of relationship aggression (Elsaesseret al., 2013).
A child in his early childhood may have aggressive behavior since his language is not developed well (Ginette et al., 2003) and so does the social skills. Children with attentional difficulties display increased levels of aggressive behavior in childhood, adolescence, and adulthood. Dodge et al. (1997) found that children with reactive aggressive behavior have more attention deficits and impulses than children with active, aggressive behavior and non-aggressive chil-dren.
Guan et al. (2005) found that children with modest health conditions are not prone to aggressive behavior, while children with diseases (such as asthma) are more prone to aggressive behavior. It may be that children with chronic diseases often feel frightened, irritable, and anxious due to physical symptoms, which is prone to aggressive behavior. Alternatively, parents being over-protective and accommodating because they are worried about their children’s illness may pro-mote their bad behavior (Guan et al., 2005).
Environment factors
In the school environment, Elsaesser et al. (2013) stated that no school-level environment indi-cator is related to relational aggressive behavior. On the other hand, in-home environment, Lar-zelere (1986) indicates that there is a positive correlation between physical punishment in fam-ily and child aggression. Olson et al. (2011) stated that during the transition from preschool to school, early physical punishment was associated with increased aggressiveness towards peers. Children's aggression was highly heritable, but aggressive friends contributed the most to chil-dren with weak aggression genes. Not to mention chilchil-dren who are genetically at risk for ag-gression, having aggressive friends is a significant environmental risk factor for children) (van Lier et al., 2007). In addition, first-grade boys that live in poverty can be linked to having a higher level of aggression which increases their vulnerability to conflict within the classroom. Boys and girls in poor community schools, regardless of their level of aggressive behavior in first grade, are at risk of being highly aggressive in middle school. (Kellam et al., 1998). Tuvblad & Baker (2011) suggested that not all individuals are affected to the same degree by experience and exposure, and genetic susceptibility may vary depending on the environment. 1.6 Theoretical background
5 Bronfenbrenner (1979) stated the environment around a child to be regarded as ‘a set of nested structures, each inside the next.’ The Bioecological framework consists of different systems, and factors in each system are affecting a person’s development directly or indirectly.
Based on the Bioecological framework, a PPCT model was developed (Bronfenbrenner, 1999). The model is based on four main concepts: Process, Person, Context, and Time. It refers to the dynamic interaction among Process-Person-Context-Time. The process is the interaction be-tween the individual and the environment, and Bronfenbrenner believed that the proximal pro-cess is the main mechanism of development; Person applies to the person and the biological characteristics of the person, for example, age, gender, etc.; Context and Time are same with the Bioecological framework, which consists of 5 different systems (Bronfenbrenner & Morris, 2006). For as long as a person living in the world, there must be different interactions between the person and environment, and these interactions can affect a child’s development either pos-itively or negatively. In this systematic literature review the PPCT model is used to structure the result section and to analyze the included articles in order to frame aggressive behavior within the development of children.
1.7 Rationale
Aggression that arises within childcare settings negatively impacts children, as well as the at-mosphere and ability to achieve goals in the classroom. Peer relationship are vital for children’s development. There is a limited number of articles on how children with aggressive behavior can interact betterwith peers. As previously mentioned, children who showed high levels of physical aggression in elementary school are more likely to experience physical violence when they get older (Broidy et al., 2003). Moreover, children with aggressive behavior run the risk of being rejected by peers (Khtri & Kupersmidt, 2003), and peer rejection increases externaliz-ing problems at the elementary school level (Ladd, 2006). Conflicts between teachers and stu-dents in kindergarten often shows in high aggressiveness of children in the first year of primary school (Runions et al., 2014; Doumen et al., 2011). This paper focus on a preschool context, whereupon stakeholders are preschool teachers and parents. And subsequently, ‘preschool chil-dren’ refers to children aged between two and five years. Preschool teachers encounter numer-ous children every day. Knowing how to prevent and how to handle aggressive behavior will not only improve the preschool environment, but also better support children to reduce their aggressive behavior and improve peer interaction.
6 1.8 Aim:
For optimal development of children, this paper aims to describe interventions for teachers to enhance participation in peer-interaction for children with aggressive behavior.
1.9 Research questions:
What types of interventions in a preschool setting are aimed at promoting peer interaction of children with aggressive behavior while reducing their aggressive behavior?
2 Method
2.1 Design
This study is a systematic literature review with a mixed method. A systematic literature review is research on researches, and it can be conducted on all types of primary research.The system-atic review method is precise and aims to minimize deviations to increase the reliability of conclusions. The purpose of a systematic review is to provide a comprehensive summary of all available basic research on a research question (Clarke, 2011). "Mixed method" is a research approach by which researchers can collect and analyze quantitative and qualitative data (Bow-ers, 2013). The mixed-method design implemented in this study is appropriate for answering research questions that neither quantitative nor qualitative methods can answer individually (Shorten & Smith, 2017).
2.2 Procedure
The search process
A keyword search was performed for this systematic literature review in two databases to find the most relevant articles for the aim of the study. ERIC is a database that provides education literature and resources; PsycINFO is a database providing literature in relation to psychology. The search was done in March 2020. The search terms were different because of the emphasis on different databases. Articles collected in databases ERIC and PsycINFO were imported to Zotero, a free, easy-to-use, online tool to help people collect, organize, cite and share research. Furthermore, Zotero is a software that automatically traces research on the web.
The search terms in ERIC were: (DE "Interpersonal Competence" OR DE "Interpersonal Rela-tionship") AND (interventions or strategies or best practices) AND (child aggression or aggres-sive behaviors) AND (preschool or kindergarten or early childhood education). The limiters
7 were applied based on peer-reviewed, published date: 20000101-20191231, language: English. A limited number of articles was found (44) and a second search was conducted with expanded search terms search terms. The words used for the second time were: (interventions or strategies or best practices) AND (child aggression or aggressive behaviors) AND (preschool or kinder-garten or early childhood education) AND (peer relation*) NOT (family or parent* or mother or father); the same limiters as in the first search were applied. The number of articles found was fourty.
In PsycINFO the words used to search were “(noft(child* aggress*)) AND noft(preschool* or kindergarten*) AND (MAINSUBJECT.EXACT("Social Interaction") OR MAINSUB-JECT.EXACT("Peer Relations")) AND noft(intervention* or strateg*) NOT noft(parent* or mother* or father*)”. Besides thesaurus was used for ‘interaction’ to capture a variety of similar terms, and several filters were applied for locating relevant articles based on published date: 2000-2020, age group: 2-5, language: English and peer-reviewed. A total of 40 articles were found.
As for duplicated articles, in ERIC, nine articles were repeated in two searches. The first ERIC search, compared to PsycINFO, revealed one duplicated article. In the second search in ERIC, six articles coincided with PsycINFO.
Selection process — Screening of title and abstract
Inclusion and exclusion criteria were used as a checklist for screening titles, abstracts and full text screening. See table 1 to attach the full vision of the criteria. A protocol was used to record information found when screening the title and abstract, and different criteria have been coded with different numbers (see Appendix). Furthermore, the protocol was utilised to compare in-clusion and exin-clusion criteria, thereby determining which articles to keep. In the title and ab-stract screening, a total of 93 articles were excluded because they did not meet the inclusion criteria or one of the exclusion criteria, or not met both inclusion and exclusion criteria. A ma-jority of the excluded articles did not match the age criteria since only one database had the age filter, articles from ERIC needed to be checked for age. Articles focusing on ‘younger children’ without specifying age were excluded. The many articles focused on the family environment and parental support were also excluded.
8 Table 1.
Inclusion & Exclusion criteria.
Selection process -- Screening of full text
Twenty-four articles were read in full-text following the title and abstract screening process. At this stage, nineteen articles were excluded for numerous reasons. One of the articles was ex-cluded because the definition of prosocial behavior had no relation to peer interaction (Girard et al., 2011). Furthermore, a majority of articles were excluded due to the children’s age and the context. There were five articles included in this systematic literature review. The search procedure is showed in the Flowchart below (see Figure 1).
Inclusion Exclusion
Age 2-6 orchildren in preschool Children under 2 years old and above 6 years old
Method Quantitative Qualitative
The systematic review, in-terview, qualitative
Population Teacher/ children (no matter whether children were diag-nosis or not).
Family members
Publish year 2000-2020 <2000
Settings In the preschool/kindergarten school setting
Family, community, hospi-tal
Language English Other languages
Outcome The decrease in aggressive behavior and increase posi-tive peer interactions
Internalization outcomes
Intervention/strategy Enhance social skills and
re-duce aggressive behavior
9 Figure 1 Flowchart of the search procedure
First search Second search
Excluded: N=93 1. Age 2. Setting 3. Population 4. Systematic re-view PsycINFO N=40 Data analysis N=5 6 duplicates N=84 (1 duplicates) N=124
Title and abstract screening
N=117
Full text screening N=24 Excluded: N=19 1. Age 2. Setting 3. ‘prosocial’ inad-equately defined ERIC N=40 ERIC N=44
10
Data analysis
Firstly, general information such as study design in the studies and intervention programs were described in order to understand the procedures and qualities of the studies. Secondly, the aim and outcome were examined to answer the research questions by different articles. Thirdly, the theoretical framework was applied to analyze the general information and the in-terventions each article contained. All studies focused on two topics, children’s aggressive be-havior and peer interaction. Despite using contrasting terms to represent peer interaction, the definition for both was similar.
2.3 Quality of studies
DifferentCritical Appraisal Skills Programmes (CASP) were used to explore the data to as-sess the quality of articles (CASP checklists for quantitative, qualitative research see Appen-dix). Each checklist has a perfect score of ten, and different checklists have a different total number of questions. After all the questions were completed, they were converted into a 100-point system for comparison. Articles scores above 80 were considered high quality, follow-ing from that, scores above 60 were considered moderate, with scores below 60 befollow-ing re-garded as low quality (evaluation results see Table 2).
Table 2
Overview of articles’ quality
Author & year Quality
(100/level)
1. Hune & Nelson,
2002
69 (medium)
2. Kamps, Tankersley & Eliis,
2000
87.5 (high) 3. Benish & Bralett,
2011 77 (medium) 4. Mihic et al., 2016 5. Ornaghi et al., 2017 75 (medium) 82 (high)
11 2.4 Ethical consideration
The articles included in this systematic literature review have been peer reviewed. Researchers are expected to acquire the voluntary consent of participants and guarantee their anonymity. All researchers should prevent or disclose or manage ethical dilemmas caused by any actual or perceived conflict of interest (AERA 2011) .
When using the research findings of other researchers, their concepts and experimental data theories are to be respected. The original author’s research must not be plagiarised or modified, on top of that, ensuring that sources are indicated. In addition to this, systematic reviewers should carefully examine how their personal, professional or financial interests influence the review results in a specific direction (Suri, 2020). In contrast to the main researchers, the re-viewers of the system fail to collect in-depth personal, sensitive or confidential information from participants. Systematic reviews use publicly accessible documents as evidence and rarely require institutional ethics approval prior to starting a system review. Like major researchers, systematic reviewers should reflect on the various ethical challenges related to potential con-flicts of interest and representation issues (Suri, 2020). When carrying out this report, the data results from the included articles were not altered and the contents from other articles were paraphrased in order to avoid plagiarism.
12
3 Result
Five articles met the selection criteria to answer the research question, that is interventions teachers use to achieve dual goals of reducing aggressive behavior while promoting peer inter-action of children with aggressive behavior. The result section follows the PPCT-model (Bron-fenbrenner, 1999) to structure the content.
3.1 Description of the interventions
The five articles all provided interventions for the teacher to use in a school context to reduce children’s aggressive behavior and enhance peer-interaction. Table 3 gives a brief introduction to each article. Two articles used ‘prosocial’ or ‘social skills’, but the definition and the context showed that these terms were about peer-interaction (1, 4). The intervention provided in two of the articles was conducted in the form of small groups (1, 5). There were two papers in the same program, the “Head Start program” (1, 2). Besides, Table 4 gives an overview of interventions’ characteristics.
Table 3
Overview of articles
Author & year Country Intervention Using
stories Interven-tion on peer Pre/Post-test
1. Hune & Nelson,
2002 United States Problem-solving strategies √ x √
2. Kamps, Tankers-ley &
Eliis, 2000
United States Social skills inter-vention
x √ x
3. Benish & Bralett, 2011
United States Social story inter-vention √ x √ 4. Mihic et al., 2016 5. Ornaghi et al., 2017 Croatia Italy Preschool Path curriculum Emotional knowledge inter-vention x √ x x √ √
13 Table 4
Overview of characteristics of the interventions
Note: En dash symbol (–) indicates that it is not mentioned whether the intervention was daily.
3.2 Interventions including the social story method Process
All five interventions were implemented by teachers to young children. Three papers (1, 3, 5) used social stories as the primary intervention method. A social story is a short, simple story written from a child’s perspective which can provide guidance for appropriate social behavior (Gray, 2004). Two interventions (1, 3) aimed at improving children’s ability to identify prob-lems in various situations and learn how to solve these issues. The intervention in article 5 helped children recognize their emotions and distinguish between other people’s emotions.
Article Teacher trained
Children
Duration Daily Teacher
nomi-nated/rated Other rat-ing Number
1. Hune & Nelson, 2002 No Yes—having be-havior risk Yes—Crite-ria con-ducted by the research-ers 9 Twenty days √ 2. Kamps, Tankersley & Eliis, 2000 No Yes—having be-havior risk No 49 Two years – 3. Benish & Bralette, 2011 Yes No Yes—TRC & BASC-2 3 One month √ 4. Mihic et al., 2016 Yes No No 53 Five months x 5. Ornaghi et al., 2017 Yes No No 95 Two months x
14 To help children make a distinction between different emotions, the idea of two interventions was roughly the same (1, 5): firstly, the social story was discussed and then the story was re-flected upon. The difference between them lies in the different ways of reflection. In article 1, when the story had been told, the teacher provided pictures with emotional problems, which lead the children to think about the problems in the pictures. The children were then encouraged to combine the previous stories to think about problem solving solutions and steps and exchange views and feelings with peers about to problem-solving solutions and steps. In article 5, the reflection stage was also led by the teacher, who asked the classmates questions about the con-nection between the story and real-life, thereby inspiring students' emotions, reflection and di-alogue. Another difference was that the intervention of article 1 was conducted in the form of small groups. In the program in article 3, the story was written for three children with different problems, helping them learn how to solve the problem in a similar environment. However, after the children had read the story, no reflection session followed.
The stories had various conflicts to help children distinguish between different conflicts in real life in article 1. The teacher first introduced the social interaction problem, then proceeded to tell the story. The children then considered the protagonists ability to problem solve. The final step was to show other images to assist with strategy practice, children needed to identify the problem and then select a solution to the problem in the picture, following a four-step strategy taught by the teacher.
The neutral stories in article 3 were written according to Gray’s guidelines (Gray, 2004) and were based on interviews with teachers and observations of adults. A specific story for each child reflecting the target behavior and interests of the children was then presented. The re-searchers observed the participants’ behaviors to identify the baseline for each participant and during the observation, two kinds of stories were made up for each student. Throughout the intervention phase, social story and neutral story orders were alternate, one week each. Every time a story was told, researchers observed the targeted children for 30 minutes.
In article 5, a book including social stories, was adapted depending on a child’s age and emo-tional vocabulary. Along with stories containing animal characters, specially designed for this research. First, the social story was created and told with a research aim and thereafter adapted to suit the age of the participants. Secondly, the teacher encouraged the treatment group to discuss their emotions with one another, students were asked questions about the emotional
15 problems involved in the story and how they could relate, in an effort to help them enhance their understanding of emotions. For example, “How did the little rabbit feel in this story?”.
Person — Teacher
Teachers were trained (3,5) and the training included examples of social stories, rationale for use, and implementation guidance. Guidelines concerning the intervention program were pro-vided to teachers. Teachers in the intervention of article 3 were trained during a regular staff meeting to use social stories and teachers were specifically trained by the research staff in article 5.
Person — Children
Regarding participating children, a combination of various requirements was used to select par-ticipants (1, 3). There were parpar-ticipants in article 1 nominated by the teacher as having behavior risks, in addition, children needed to meet the criteria set up by researchers such as language skills. Following this, the children needed to be scored on the primary scale for aggression and exceed the standard level of aggressive behavior, which is 0.2 aggressive acts every ten minutes. The author mentioned that this level is lower than children with conductive or disruptive diag-noses. In article 3, children needed to be scored by the Teacher Rating Scale (TRC) and Behav-ior Assessment for Children-2 (BASC-2) to be selected in the program. Participants were re-cruited at eight local preschools in article 5.
As for the number of participants, the two articles’ participants were with a limited number. There was a total of nine children, seven males and the mean age was 4.50 years old in article 1. In article 3 there were three children two males, and the mean age was four years old in article 3. 95 children (54 male) with an average age of 2.50 years participated in article 5. After the interventions, every child had multiple levels and different aspects of progress.
Context
There were two interventions (1, 3) implemented in the United States and one in Italy (5). In addition, there were two articles (3, 5) that were carried out in an early childhood education place, the intervention in article 5 was conducted in a preschool and the other in a preschool center (3). The intervention program of article 1 was located on the campus of a local public school, two classrooms in the same building were for the treatment group. Also, two class-rooms for the non-treatment group were geographically close to the treatment classclass-rooms. The
16 instructional sessions were conducted in small groups. And all the observations were con-ducted in the students’ preschool classes.
According to the intervention of article 3, during the baseline phase, each child had his or her own place to be observed to know their normal state. Lisa was observed when she just arrived at school. Kyle was observed during free play time, and as for John, observations were con-ducted in a small group instruction throughout a regularly scheduled period. During the inter-vention phase, the social stories were read away from distractions but near to other students.
Time
The duration of these interventions varied from two weeks to two years. Intervention in article 3 had two weeks for the baseline phase to understand the normal state of children and two weeks for the intervention phase. Two of the interventions were conducted daily (1, 3). It was a daily 10-minute session in article 1, and 15-minute sessions at 42 occasions in article 5. In the inter-ventions of two articles, the intervention lasted about 10-15 minutes (1, 5).
3.3 Teaching social skills intervention Process:
There were two interventions that taught participants emotional or social skills such as sharing, social words and problem-solving (2, 4). In article 2, the observation phase was used to under-stand the children’s normal state about their peer interaction. Afterward, affection activities (games and songs) and social skills lessons (sharing and agreement) were provided to students in the intervention phase and then followed up with group activities to strengthen the content they learned. In addition to the intervention implemented by teachers on young children, there was also a peer tutoring activity about positive peer interaction that followed it. For the inter-vention in article 4, the teachers educated the class about social skills such as social words and sharing. This was elaborately arranged to help children improve prosocial behaviors in order to help them use these behaviors in inappropriate situations and express their feelings or purposes in a better way.
Person
Teachers as one part of the interventions are essential. Only the intervention in article 4 trained teachers before the intervention began. There were participants identified by teachers as having behavioral risks to participate in both the experimental group and the control group in article 2. However, article 4 did not mention how they recruited participants. The number of participants
17 in article 2 was 49 children (27 male) with an average age of 4.96 years; and three hundred and 53 children (approximately 55% male) in article 4. Moreover, some participants have previous experience of the related intervention or social skills in the intervention of article 2. All the participants displayed behavioral risks. After the interventions, all the children showed different levels of progress.
Context
Article 2 was located in the United States while the intervention in article 4 was conducted in Croatia. The intervention program in article 2 was implemented in groups. Although these places differ from each other, they are still within the microsystem of the Bioecological frame-work.
Time
The observation phase occurred in both articles (2, 4) to know the normal state of the children. Before the interventions in article 2 started, researchers observed the children for 1.5-2 hours in article 2, and in article 4, children were observed for around 30 minutes.
The duration of these interventions varied from two weeks to two years. In article 2, the inter-vention lasted for two years in comparison to the duration of 5 months for the interinter-vention in article 4. It was a 10-15-minute session, followed by 10-minute group activities in the interven-tion in article 2. Affecinterven-tion activities were conducted 2-4 times a week and social skill lessons occurred 1-3 times a week. The intervention in article 4 was expected to perform 30-minute lessons (n=37), about two per week, during fall, winter, and early spring. Only in article 4 was a Likert scale used by teachers to rate children’s behavior on a weekly basis.
3.4 Results of the interventions
The outcomes for each intervention were disparate (see table 5). Most interventions promoted children’s peer interaction (2, 3, 4, 5), and three interventions were helpful for aggressive be-havior (2, 3, 4).
18 Table 5
Result of interventions
Note: Half pair symbol (⍻) indicates that the intervention was partly successful. Interventions including the social story method
Non-significant effects in article 1 revealed that the acquisition of problem-solving strategies affect the types of alternative solutions children provide for social interaction conflicts in sim-ulations. The result of article 3 showed that most participants’ aggressive behavior reduced whilst reading social stories but there was no overall improvement. In article 5, only peer inter-action was promoted, and no training effects emerged in regard to reactive and proactive ag-gressive behavior. Article 3 and 5 measured the effects two weeks after the intervention pro-gram. In the test two weeks after the intervention, peer interaction was higher than the baseline but somewhat lower than the intervention phase. Table 3.3 shows an overview of the results of three interventions.
Interventions teaching social skills
Both article 2 and 4 found a decrease in aggressive behavior and revealed an increase in peer interaction. The result of the intervention in article 4 demonstrated that the aggressive behavior referred to was relational behavior while the intervention in article 2 did not specify what kind of aggressive behavior had improved. Article 4 measured the maintained effects two weeks after the intervention, whereas article 2 did not measure such effects.
Article Aggressive behavior Peer relationship
1. Hune & Nelson,
2002 X X
2. Kamps, Tankersley & Eliis, 2000
√ (Physical) √
3. Benish & Bralette,
2011 ⍻ √
4. Ornaghi et al., 2017
√ (Relational) √
19
4
Discussion
Preschool teachers have to face a multitude of children daily, the probability of meeting children with aggressive behavior brings difficulties to teachers’ daily work. If the child’s aggressive behavior is not intervened, it may cause complications with his/her physical health, self-esteem, depression, and lead to peer rejection (Bigham, n.d.). In order for the better development of children, but also for teachers’ work, this systematic literature review provided two kinds of interventions. One type included social stories, which are short stories about emotions or social skills written for children. And the other taught children social skills through games, songs, lessons, etc. In the PPCT model, proximal processes are gradual and complex interactions be-tween a person and his or her environment, which “occur on a fairly regular basis over extended periods of time” (Bronfenbrenner, 1995). Different interventions required different durations, but the timely effects of most articles were significant.
4.1 Reflections on the result
This systematic review gathered a variety of interventions with advantages and disadvantages for teachers to get an overview of different interventions to reduce aggressive behavior while promoting positive peer interaction. Interventions with social stories could be implemented with the aim to promote peer interaction while interventions teach children social skills and can achieve the dual goal of promoting peer interaction and decreasing aggressive behavior at the same time.
Social skills intervention has been developed and implemented in a series of people. The be-havior of intervened children interferes with a positive relationship with others, which is a par-ticularly good target for social skills intervention (Zaragoza et al., 1991). It was mentioned in the introduction section that children with aggressive behavior are rejected and not accepted more often than their peers without aggressive behavior. Therefore, the focus of many social skill interventions is to increase the acceptance of participants' peers. However, the reasons why social skill interventions work, because of the diversity of interventions (such as direct guidance, peer counseling, reinforcement) and outcome measures, make it difficult to have a definite statement. Although teachers’ social effectiveness is highly rated, a more in-depth analysis of social effectiveness may reveal more about the practicality and feasibility of such social skill interventions. (McDaniel et al., 2017).
20 Social stories are personalized short stories that help children with autism understand social conditions by describing and explaining appropriate behaviors and providing appropriate re-sponse examples (Wright & McCathren, 2012). However, most children love stories because of the dramatic characters, charming places fascinate children as they are transported to the new world. Besides, the stories have countless benefits, for example, it can help children understand cultures, improve concentration, introduce new vocabulary, develop emotional intelligence, im-prove communication, as well as lowering stress and anxiety (Makvana, 2014). Therefore, the social story intervention can be implemented with a high level of acceptance from the child and it could be a fundamental method to combine with other interventions. However, few studies have examined its effectiveness in typically developed preschool children (Benish & Bramlett, 2011).
Allowing children to role-play after the social story and practice the skills learned from the social story in the role-playing environment will give them the opportunity to use the skill and adapt to it before it appears in the daily environment (More, 2012). Children can think of them-selves as characters in the story or use the characters in the story as role models, so they know how to react the next time they encounter a similar storyline. When teachers see children ex-hibiting the expected behavior described in the social story, they should praise the child's be-havior by using specific positive feedback so that they are more likely to repeat the expected behavior (More, 2012). Teachers and parents can use this method to achieve different goals in daily life.
Language ability, as an aspect that both interventions are focused on, is very important. When children have not developed good language ability, they will encounter problems in communi-cating with others. And poor language ability is related to externalized behavior problems with subsequent antisocial consequences (Hill, 2002). Especially after entering kindergarten, there are many more children and teachers may not have time to pay attention to individual children. Parents are therefore important for understanding the child and in collaboration with teachers provide support to meet the child’s needs in time. When the child's needs are not met and he cannot explain his own needs, he may become anxious, which may lead to aggressive behavior. For example, a child wants a toy but cannot explain it clearly, so he reaches out to grab it. On the contrary, higher language expression ability is related to more complex emotional under-standing and larger emotional vocabulary, what is more, enhanced emotional vocabulary has been shown to correlate with aggressive behavior (Bohnert et al., 2003). Thus, the social skill
21 interventions in this study tended to teach young children prosocial words and to identify other’s emotions, and it turned out to be useful. In addition, children will spend more time with peers after entering in preschool. When a child achieves a certain goal by attacking others, other children see this, the "benefits" brought by the behavior will also imitate this behavior and learn the wrong social skills from peers.
The result of this systematic review depicted many different ways for teachers to reduce a child’s aggressive behavior and promote their peer interaction. Teachers can choose interven-tions teaching children social skills, which can simultaneously reduce children’s aggressive be-havior while promoting peer interaction. If the teacher has no intention to achieve this dual goal at the same time, they can choose social story interventions. However, social stories were in-sufficient to reduce aggressive behavior while increasing peer interaction simultaneously. Find-ings from this study show that social stories can be effective to encourage peer interaction, which somewhat contradicts Kokina and Kern (2010), who concluded that social stories are more effective in solving inappropriate behaviors than teaching social skills. This is because social stories provide specific vocabulary words and language expression models.
Adults often believe that children’s aggressive behavior will decrease after intervention. And it is important for teachers to change their views on the severity of children's aggressive behavior, because this may start a virtuous circle in which teachers feel better about children with aggres-sive behavior and provide them with more active support (Zaragoza et al., 1991).
4.2 Limitations
In the included five articles, there are several ways mentioned to select children as participants and efforts have been made to minimize the bias by combining several selection methods. How-ever, there is bias existing in selecting participants in two articles, the remaining three did not mention screening methods, which are weaknesses of these articles. In addition, the number of participants is limited in some of the included articles. Besides, if an intervention with a small number of participants is applied to a large number of participants, its outcome may change. Therefore, teachers need to be cautious about choosing and applying intervention. Moreover, maintained effects of the interventions in the included studies were short term, thus, future re-search should include a follow-up evaluation to evaluate the long-term effects of the interven-tions.
22 There are only five articles in this systematic review which is a significant inadequacy. Using a different aim, with two different research questions, one on how to promote children’s peer interaction, the other on how to decrease children’s aggressive behavior would have changed the search terms and probably have resulted in more articles to extract data from. In regard to the few articles found, it is indicated that relevant research on the combination of aggressive behavior and positive peer interaction is insufficient.
This systematic review was conducted by one person, there may possibly be a bias in the dif-ferent steps of developing the systematic review. Even if the aim is set and there is an extraction protocol, when selecting documents and analyzing the content of the documents, there may be biases due to personal interests, background, and ideas. For example, the focus of this system-atic literature review is only on children’s aggressive behavior and peer interaction, various aspects in the included articles such as language ability affecting the outcome of the interven-tion were not extracted and analyzed. Besides, writing a literature review by one person will lead to a lack of writing efficiency, ideas, and the understanding of the extracted data may be insufficient.
4.3 Future research
Compared with children who did not participate in social intervention, children who partici-pated in social intervention often felt better about themselves, and their teachers and parents felt better about them (Zaragoza et al., 1991). Intervention programs aimed at changing peer perceptions need to develop, implement, and evaluate in future.
In these included articles, there was no other relationship described and analyzed, for example, teacher-parent relationship, teacher-student relationship and parent-child relationship whether one-way or two-way. Parents are the first teachers of children, and the influence of parents on children in the family is also very important. As for the teacher-children relationship, it was found in one study that the internalization and externalization of children's behavior problems were related to the conflict and non-intimate relationship between children and teachers (DeJames, 2001). Therefore, other relationships could be included in future researches. Interventions without using computers or online applications have been widely used and proved to be effective, modern methods such as computers and networks have become indispensable tools for children and adolescents to learn in an entertaining way. Future intervention methods
23 would probably need to be designed in a way that combines traditional methods with computer-intervention when studying aggressive behavior and positive peer interaction.
5 Conclusion
After determining the aim of this systematic literature review which was to enhance participa-tion in peer-interacparticipa-tion for children with aggressive behavior. The five suitable articles found were screened and extraction protocol was used to extract information from the articles. There were three interventions that used the social story to promote peer interaction: Problem-solving
strategy intervention (1), Social story intervention (3), Emotional knowledge intervention (5).
In addition, there were two interventions teaching children social skills that improved peer in-teraction while reducing children’s aggressive behavior: Social skills intervention (2),
Pre-school Path curriculum (4). A conclusion was reached, which is that teachers could use
inter-ventions with social stories to promote peer interaction and teaching social skills could be used to reduce children’s aggressive behavior and encourage better peer interaction.
24
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29 4. Appendix
Appendix A. Extraction Protocol for the Full-text Screening
General information Author(s)
Year Title
Study location Aim/Purpose(s) Research question(s)
Study design Quantitative
Qualitative Mixed method
Sample selecting Total population
Teacher nominated Scales
Other
Sample Gender
Number
Age(Mean age(SD)/ Range)
Intervention focus in Children
Teacher Peers
Data collection Questionnaire
Teacher rate Observation Other
Form Small groups
Result Outcome Results Discussion Limitation Quality High Medium Low
30 Appendix B. Quality Assessment Tool (1)
Critical Review Form - Qualitative Studies (Version 2.0)
© Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M., 2007 McMaster University
CITATION:
Comments
STUDY PURPOSE:
Was the purpose and/or re-search question stated clearly?
yes no
Outline the purpose of the study and/or research question.
LITERATURE:
Was relevant background liter-ature reviewed?
yes no
Describe the justification of the need for this study. Was it clear and compelling?
How does the study apply to your practice and/or to your research question? Is it worth continuing this review?1
1 When doing critical reviews, there are strategic points in the process at which you may decide the research is not applicable to your practice and question. You may decide then that it is not worthwhile to continue with the review.
31 STUDY DESIGN:
What was the design? phenomenology ethnography grounded theory
participatory action re-search
other
Was the design appropriate for the study question? (i.e., rationale) Explain.
Was a theoretical perspective identified?
yes no
Describe the theoretical or philosophical perspective for this study e.g., researcher’s perspective. Method(s) used: participant observation interviews document review focus groups other
Describe the method(s) used to answer the research question. Are the methods con-gruent with the philosophical underpinnings and purpose?
SAMPLING:
Was the process of purposeful selection described?
yes no
Describe sampling methods used. Was the sampling method appropriate to the study purpose or research question?
32 Was sampling done until
re-dundancy in data was reached?2
yes no
not addressed
Are the participants described in adequate detail? How is the sample applicable to your practice or research question? Is it worth continuing?
Was informed consent ob-tained? yes no not addressed DATA COLLECTION: Descriptive Clarity
Clear & complete description of
site: yes
no participants: yes
no
Role of researcher & relation-ship with participants:
yes no
Identification of assumptions and biases of researcher: yes no
Describe the context of the study. Was it sufficient for understanding of the “whole” picture?
What was missing and how does that influence your understanding of the research?
2 Throughout the form, “no” means the authors explicitly state reasons for not doing it; “not addressed” should be ticked if there is no mention of the issue.
33 Procedural Rigour
Procedural rigor was used in data collection strategies?
yes no
not addressed
Do the researchers provide adequate information about data collection procedures e.g., gaining access to the site, field notes, training data gatherers? Describe any flex-ibility in the design & data collection methods.
DATA ANALYSES:
Analytical Rigour
Data analyses were inductive? yes no not ad-dressed
Findings were consistent with & reflective of data?
yes no
Describe method(s) of data analysis. Were the methods appropriate? What were the findings?
Auditability
Decision trail developed? yes no not ad-dressed
Process of analyzing the data was described adequately?
yes no not ad-dressed
Describe the decisions of the researcher re: transformation of data to codes/themes. Outline the rationale given for development of themes.
Theoretical Connections Did a meaningful picture of the phenomenon under study emerge?
yes no
How were concepts under study clarified & refined, and relationships made clear? De-scribe any conceptual frameworks that emerged.
34 OVERALL RIGOUR
Was there evidence of the four components of trustworthi-ness? Credibility yes no Transferability yes no Dependability yes no Comfirmability yes no
For each of the components of trustworthiness, identify what the researcher used to ensure each.
What meaning and relevance does this study have for your practice or research ques-tion?
CONCLUSIONS & IMPLICA-TIONS
Conclusions were appropriate given the study findings?
yes no
The findings contributed to the-ory development & future OT practice/ research?
yes no
What did the study conclude? What were the implications of the findings for occupa-tional therapy (practice & research)? What were the main limitations in the study?
35 Appendix B. Quality Assessment Tool (1)
Critical Review Form - Quantitative Studies
Law, M., Stewart, D., Pollock, N., Letts, L., Bosch, J., & Westmoreland, M., 1998 McMaster University
CITATION:
Comments
STUDY
PUR-POSE:
Was the purpose stated clearly? Yes
No
Outline the purpose of the study. How does the study apply to occupational therapy and/or your research question?
LITERATURE: Was relevant back-ground literature reviewed?
Yes No
Describe the justification of the need for this study.
DESIGN:
randomized (RCT)
cohort
single case de-sign
before and after case-control cross-sectional case study
Describe the study design. Was the design appropriate for the study ques-tion? (e.g., for knowledge level about this issue, outcomes, ethical issues, etc.)
Specify any biases that may have been operating and the direction of their influence on the results.
36 SAMPLE:
N=
Was the sample described in de-tail?
Yes No
Was sample size justified?
Yes No N/A
Sampling (who; characteristics; how many; how was sampling done?) If more than one group, was there similarity between the groups?
Describe ethics procedures. Was informed consent obtained?
OUTCOMES:
Were the out-come measures reliable?
Yes No
Not addressed
Were the out-come measures valid?
Yes No
Specify the frequency of outcome measures (i.e., pre, post, follow-up)
Outcome areas (e.g., self care, productivity, leisure). List measures used.
