The study started with five distinct, poor to lower-middle class, mainly African American urban areas within which three or four schools were selected of a similar size and type In terms of social class and ethnicity/country or origin. of school roll. Within each area, six schools were randomly assigned to trial the Good Behavior Game. Within each school in the trial, steps were taken All the schools which tested the game or the other intervention trialled in the study had two or three first-grade classrooms. Children were allocated to these sequentially using an alphabetised list. Reallocations catered for the few instances in which this led to an imbalance in terms of the children's nursery school experience or academic or behavioural performance. Children who joined schools during the year were assigned sequentially across classrooms, with the provision that class sizes remained comparable. to ensure that each first-grade classroom included a similar set of children. In each of the six schools, one 'control' class was randomly selected to carry on as normal while the remaining one or two classes (eight altogether with 238 children) implemented the Good Behavior Game. The most stringent test of the game involved comparing children who had been in the eight Good Behavior Game classes with 169 comparable children in the six control classes at the same schools. However, there was a possibility that control classes would be influenced by game classes at the same schools, blurring the divide between the two. So a further check involved comparing Good Behavior Game pupils with those who had received standard education, but in other schools. These consisted of 515 children in nine control classes in seven schools where an alternative intervention was being tested or in 11 classes in six schools where no formal intervention was being tested.
Children in the first set of eight classes were exposed to the game for two years, in the first grade and then again when whole classes moved up to the second grade. During this second year, a new intake of first-grade children in the same classes started to be taught using the game by the same set of trained teachers, replicating the study – with one difference: because they had already been skilled up, teachers were no longer trained, mentored, or monitored to the same degree.
Around 20% of children not exposed to the game had met criteria for diagnoses of
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
• Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home (eg, repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household).
• Recurrent substance use in situations in which it is physically hazardous (eg, driving an automobile or operating a machine when impaired by substance use).
• Recurrent substance-related legal problems (eg, arrests for substance-related disorderly conduct).
• Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (eg, arguments with spouse about consequences of intoxication, physical fights). or dependence A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
• Tolerance, as defined by either of the following:
a need for markedly increased amounts of the substance to achieve Intoxication or desired effect;
markedly diminished effect with continued use of the same amount of the substance.
• Withdrawal, as manifested by either of the following:
the characteristic withdrawal syndrome for the substance;
the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
• The substance is often taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control substance use.
• A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
• Important social, occupational, or recreational activities are given up or reduced because of substance use.
• The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. at some time in their lives; among children from Good Behavior Game classes, the figure was just 12%. This significant difference was entirely accounted for by the boys. When exposure to the game influenced their development, just 19% qualified for these diagnoses; among comparable boys in the same schools, but in non-game classes, the figure doubled to 38%. Narrowing in on the 1 in 8 boys rated at age six as the most highly aggressive/disruptive, the effect was even greater. Without the game, 83% were diagnosed, with it, 29%. More sophisticated analyses taking in to account initial risk profile and clustering in classes confirmed that in the same schools, boys not exposed to the game were nearly three times more likely to have met criteria for drug abuse or dependence. While impacts were greatest among the higher risk pupils, consistently the game reduced the likelihood of later developing abuse and dependence across the risk spectrum. Results were similar A reduction in drug abuse/dependence disorders from 32% among boys not exposed to the game to 19% among those in the same schools in Good Behavior Game classes. for the second set of children starting school the following year, except that effects were greatest not among the most aggressive or disruptive pupils, but among those at the opposite end of this risk dimension.
Results for alcohol abuse or dependence For criteria see drug abuse or dependence. were similar, but less substantial and not always statistically significant. Exposed to the game, 13% of children later qualified for these diagnoses; in the same schools but without the game, the figure was 20%. More sophisticated analyses confirmed that there was a statistically significant 50% reduction in the likelihood of later drinking problems. The effect was seen among both girls and (to a somewhat greater extent) boys and across the initial risk spectrum. However, there were no such effects among the second set of children starting school the following year.
Impacts on regular smoking More than 10 cigarettes a day at the time of the interview. were similar to those on drug problems: a significant reduction among young men previously exposed to the game (6% versus around 20% in non-game classes), at its greatest among those initially rated as more aggressive or disruptive, but no effects among girls. In the second set of children, 30–40% fewer boys and girls went on to smoke regularly after being exposed to the game, but these differences, though substantial and consistent, were not statistically significant.
The study reported several other measures of the psychological and social health of the former pupils. Though more (72% versus 64% in same-school, non-game classes) Good Behavior Game pupils successfully completed their education, High school graduation. a gap that was greater among the boys, the difference only became statistically significant among the small sub-set of initially highly aggressive and disruptive boys. Without the game to deflect their development, just a fifth graduated; with it, three quarters. In the second set of pupils, impacts were smaller and non-significant, though again boys tended to benefit from the game. Similarly, Good Behavior Game pupils were less likely to have met criteria for antisocial personality disorder A pervasive pattern of disregard for, and violation of, the rights of others which begins in childhood or early adolescence and continues into adulthood, characterised by deceit, manipulation, lawbreaking, impulsivity, irritability, aggression and irresponsibility. and this effect was substantial among the sub-set of children who according to teachers' ratings seemed set on this path from an early age; without the game, 80% had displayed these undesirable traits; with the game, just 38%. However, these and most other comparisons did not satisfy conventional criteria for statistical significance. Though less evident, results were similar among the second set of pupils. Generalised anxiety disorder Chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it. Sufferers can't seem to shake their concerns. Their worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flushes. was rare and its incidence was not significantly affected by experience of the game. Though more common, in most comparisons neither was the incidence of major depressive disorder. Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life. However, in both cases there were signs of beneficial impacts among boys.
Importantly the study featured multiple checks Game classes were compared with other classes in the same schools, classes in similar schools in the same areas, and the study was replicated across two intakes of children. on the reality of the impacts of the game. But as the authors point out, all this hinged on the same set of classes and teachers in six Baltimore schools. Outcomes from those schools suggest the game would be less effective in cultures with less aggressive and disruptive 6–8-year-old boys. The game may also be particularly important when teachers lack classroom management abilities. Though not tested in respect of substance use, in respect of aggression the game works partly by giving teachers who would otherwise be unable control young boys' aggression, the tools to prevent this influencing the development of susceptible children. Without the game, aggressive and disruptive classes boost the development of aggressive and disruptive individuals in to troublesome teenagers. Moderating classroom climate through the game weakens the boost effect, meaning these same unpromising children are less likely to turn out to be troublesome teenagers.
Findings were consistent with the theory that while early social adjustment is strongly predictive of later adjustment, these causal chains are not immutable. The vicious circles of early maladjustment, provoking reactions such as rejection and migration towards similarly problematic friends, leading to further maladjustment, can be interrupted at a time (the first years of compulsory schooling) when there is still considerable malleability and potential for improvement, particularly among higher risk boys. As well as the game itself, selecting teams which forestall the formation of mutually reinforcing deviant peer groups may itself be beneficial, deliberately mixing the genders and more with less problematic children. An improved climate for education (gained with less need to exclude disruptive pupils) leading to a greater sense of achievement may also play its part in fostering healthy development.
Results from the second set of pupils hint that impacts might be less if the game were routinely implemented in schools rather than as part of a high-profile experiment with recent expert training and continuing supervision. The literature is not short of examples of prevention programmes which seemed promising in the first flush of enthusiasm, but failed during attempted replications. This concern is tempered by the many other studies of the Good Behavior Game in various implementations and settings, but mainly among children of primary school age. These have consistently reported improved classroom behaviour which promises, as in the featured study, to culminate in lasting developmental gains. None except the Baltimore studies seems to have tested whether this actually happens.
In essence the game is simple, involving dividing the class into teams, setting criteria for winning, and rewarding winning teams. Simplicity, and potential for universal application at little cost but with major benefits, has led it to be proposed as 'behavioural vaccine' which schools should be required to implement and administrations to resource and monitor. Though not apparent from the featured report, another common element is that the behaviours rewarded or proscribed by the game are developed by the children themselves in response to the teacher's questions about what would, for the children, make the classroom a good place to learn, more enjoyable, pleasant, etc. It is at least in part the children's own vision of a good class which they then realise through their influence on each other.
The fact that the game harnesses pupil peer pressure carries with it risks of this being applied in ways which harm and/or exclude non-conforming pupils. Well behaved team members may also think it unfair if they lose out due to less well behaved teammates. There is the alternative risk that these pupils will gain a rebel kudos from disregarding the rules set out during the game. Such complications have been remarked on and ways found As documented in the cited review, some students have been removed, either temporarily or permanently, from the game. Teachers have also simply not count a persistent offender's points against a team. Another option is to form a separate team with those offenders so as not to penalise other team members to work round them, but the need for these suggests that skilled and sensitive teaching is required to make the most of the game and avoid potential pitfalls.
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