Exploring the teacher-student relationship in teacher education: A
Exploring the Impact of Teacher-Child Interaction Training ...
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Exploring the Impact of Teacher-Child Interaction Training on Challenging Behaviors and Social Competencies for Developmentally Delayed Children Amanda Moen, 1 Elaine K. Martin, M. A., 1 Christopher Campbell, Ph. D., 2 Tiffany West, M. A., 1 Jaycie Vanderbeek, B. A., 1 Katrina Poppert, B. A., 1 and Mary Fran Flood, Ph. D. 1 University of Nebraska – Lincoln 1 University of Oklahoma Health Science Center 2 Empirical literature indicates that children with developmental delays tend to be less socially competent (Matson & Fodstad, 2010), and children with low social competence and developmental delays are more likely to have conduct problems than their more socially competent peers (McIntyre, 2008). Without appropriate intervention, delays in social competence are predictive of negative peer relationships, negative school experiences, mental health issues, drug abuse, internalizing behaviors, delinquency and antisocial behavior over the lifespan (Bornstein, Hahn, & Hays, 2010; Craig-Unkefer & Kaiser, 2003; Denham, 2006; McIntyre, Blacher, & Baker, 2006). Furthermore, children with developmental delays are three times more likely than their non-delayed peers to score in a clinical range for behavioral problems, be aggressive and have negative peer relationships (Baker, et al., 2003; Denham, 2006). In addition, behavioral problems may become stable, which is also associated with outcomes such as drug abuse, depression, juvenile delinquency, violent behavior, school dropout, and less adaptive school functioning (Miller, Gouley, Seifer, Dickstein, & Shields, 2004; Webster- Stratton & Hammond, 1998). Prior literature has found that early intervention has assisted in successfully transforming children’s behavior. For example, Upshur, Wenz-Gross, and Reed (2009) found that children who experienced a behavioral intervention in preschool exhibited decreases in both aggression and maladaptive classroom behaviors, while also demonstrating gains in adaptive social skills. Children who develop socio-emotional and behavioral problems are an at risk population (Domitrovich, Cortes, & Greenberg, 2007), children with developmental delays who are prone to these issues and therefore are most in need of early intervention. A promising area for early intervention is the teacher-child relationship. Prior research suggests that children who experience more secure/close teacher-child relationships exhibit fewer behavioral problems and are more prosocial toward peers than children who experience more conflicted teacher-child relationships (Hamre & Pianta, 2001, 2005; Helker & Ray, 2009; Palermo, et al., 2007). Teacher-Child Interaction Training (TCIT), a variation of the empirically supported Parent-Child Interaction Therapy (PCIT; McNeil & Hembree-Kigin, 2011), is a teacher training program intended to improve teacher-child relationships as well as increase social skills while decreasing problematic behaviors in the classroom. Interventions that focus on building a strong-teacher child relationship may be especially important with children with delays, as their lessened language abilities, limited social skills and challenging behaviors may strain their relationship with their teacher (Rudasill et al., 2006). TCIT has been found to decrease challenging behaviors and increase social competence (Campbell et al., 2010), although this has not been examined in developmentally delayed children. The purpose of this exploratory study was to examine the impact of TCIT on increasing social competencies and general adaptation, as well as decreasing challenging behaviors in developmentally delayed children in a Head Start setting. It was hypothesized that the prosocial behaviors and general adaptation of all children would increase. Additionally, it was hypothesized that TCIT would decrease challenging behaviors and internalizing behaviors in both typically developing and developmentally delayed children. Furthermore, it was also hypothesized that the impact of the intervention would be greater for developmentally delayed children given that several factors present in TCIT have been identified in interventions specifically for children experiencing delays (Matson & Fodstad, 2010). Participants Participants were 24 children enrolled in 3 Midwestern Head Start Centers across 2 counties. The participating children ranged in age from 3.08 to 5.25 years of age (M = 4.29, SD = .599), and 58.3% of the sample was male. The majority of the children were identified as European American (58.3%), with 29.2% identifying as Latino and 12.5% identifying as African American. Twelve developmentally delayed children were matched on gender, age and center county to twelve typically developing children. The small sample size did not allow for matching children on ethnicity. The five teachers receiving training ranged in age from 25 to 40 years of age (M = 30, SD = 6.21). Four of teachers were female and one was male, with all of identifying as European American. The teaching experience of the teachers ranged from 48 to 156 months (M = 82.8, SD = 44.28). This study was part of a larger evaluation of TCIT in three Head Start Centers. Children who attended one of the participating Head Start centers were eligible for the study. The larger study received IRB approval and all parents signed a consent form allowing their child to participate. Children who had completed the Denver Developmental Screening Test more than 6 months prior to the beginning of TCIT were not selected for the purposes of the current study. Measures Social Competence and Behavior Evaluation (SCBE; LaFreniere & Durnas, 1995) – The SCBE assesses a child’s adaptation to and functioning within a classroom environment, and is intended for use with children between the ages of 30 to 76 months of age (2 ½ to 6 years of age). The evaluation contains 80 items that are divided up into 8 basic scales: Depressive-Joyful, Anxious-Secure, Angry-Tolerant, Isolated-Integrated, Aggressive-Calm, Egotistical- Prosocial, Oppositional-Cooperative and Dependent-Autonomous. These 8 scales can also be abbreviated into 4 summary scales: Social Competence, Externalizing Problems, Internalizing Problems, and General Adaptation. Low scores on a scale reflect negative behaviors and high scores reflect positive behaviors. The SCBE has demonstrated favorable inter-rater reliability (.80 to .89), internal consistency (.72 to .89) and two-week test-retest reliability (.74 to .87). Good convergent, discriminant and criterion validity have also been established (Lobo &Winsler, 2006). Child Behavior Checklist-Teacher Rating From (CBCL-TRF; Achenbach & Rescorla, 2000) – The CBCL-TRF is a teacher report used to assess a child’s social competence and behavioral problems in children 1.5 to 5 years of age. The checklist contains 99 items that break down into Internalizing and Externalizing scales. Additionally, there are each of the following subscales: Emotionally Reactive, Anxious-Depressed, Somatic Complaints, Withdrawn, Attention Problems and Aggressive Behavior. There are also problem scales assessed: Total Problems, Affective Problems, Anxiety Problems, Pervasive Developmental Delays, Attention-Hyperactivity Problems and Oppositional-Defiant Problems. Low scores on a scale reflect positive behaviors and high scores reflect negative behaviors. Test-retest reliability has been demonstrated with correlation coefficients ranging from .77 to .88. Internal consistency has also been established, with correlation coefficients ranging from .89 to .97 (Achenbach & Rescorla, 2000). Denver Developmental Screening Test (DDST; Dick, Bryant & Davies, 1973) – The DDST is designed to screen children between infancy and six years of age for delays in four areas: Personal-Social (getting along with people and caring for personal needs), Fine Motor-Adaptive (eye-hand coordination, manipulation of small objects, and problem solving), Language (hearing, understanding, and using language), and Gross Motor (sitting, walking, jumping, and overall large muscle movement). Children who are classified as typical in their development have a maximum of one Caution and no delays in performing age appropriate tasks. Children who are classified as suspect in their development have two or more Cautions and/or one delay or more. The DDST has demonstrated good test-observer reliability and test-retest reliability, with correlation coefficients ranging from .66 and .93. Concurrent validity has also been established (.86 to .97) (Allard & Pfohl, 1988). Procedures The TCIT intervention consisted of 14 sessions that were administered over a 7-week period, with two sessions occurring each week. The intervention was performed in two phases, a Child-Directed Interaction (CDI) phase followed by a Teacher-Directed Interaction (TDI) phase. Teachers completed a battery of measures at baseline and one month post-treatment. One typically developing child was not included in the CBCL analyses because their post- treatment data was missing. The development classification of the children was based on the results of the DDST completed between 1 month and 6 months prior to treatment by a healthcare professional employed by Head Start (e.g., nurse). Following the standard protocol of the DDST, children were classified as suspect in their development if they had two more cautions and/or one delay or more. A mixed group factorial ANOVA was used to assess whether general adaptation increased. Mean SCBE general adaptation scores did not significantly increase from pre-treatment to post-treatment, and the interaction of general adaptation and developmental group was not significant. This finding indicates that neither group experienced significantly different change from the other. A mixed groups factorial ANOVA was used to assess whether behavioral problems decreased after treatment. According to the SCBE, mean behavioral problems did not significantly decrease from pre-treatment to post-treatment and the interaction of externalizing scores from the SCBE and developmental group was not found to be significant, indicating that neither group yielded significantly different change from the other. There was not a significant decrease in mean externalizing behaviors on the CBCL either, although a significant interaction term was found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that normally developing children displayed a small increase in their externalizing behaviors, while developmentally delayed children exhibited a decrease in their externalizing behaviors. A mixed group factorial ANOVA was used to assess whether oppositional behaviors decreased. Using the SCBE, significantly fewer oppositional behaviors and more cooperative behaviors were found for all children, and the interaction of opposition-cooperation scores and developmental group was not significant, indicating that the groups did not show differential change. There was not a significant decrease in mean oppositional behaviors on the CBCL, although a significant interaction term was found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that typically developing children displayed a small increase in their oppositional-defiant behaviors, while developmentally delayed children exhibited a decrease in their oppositional-defiant behaviors. A mixed group factorial ANOVA was used to determine whether aggressive behaviors on the CBCL decreased. Mean aggressive behaviors did not significantly decrease, and the impact on developmentally delayed children was not greater, as the interaction between developmental group and aggressive behaviors was not significant. A mixed group factorial ANOVA was used to assess whether there was a significant decrease in all children’s attention- hyperactivity problems on the CBCL. Mean attention-hyperactivity scores at post-treatment were significantly lower that pre-treatment scores for all children. The interaction of developmental group and attention-hyperactivity behaviors was not significant meaning that developmentally delayed children did not show significantly greater progress than their typically developing peers. A mixed group factorial ANOVA design was used to assess whether internalizing behavior increased for both groups of children. Mean internalizing scores from the SCBE significantly increased from pre-treatment to post-treatment for all children. The interaction of internalizing scores and developmental status was not significant, suggesting that neither group regressed more than the other. Results from the CBCL analyses found no significant difference in mean internalizing behaviors for either group of children, although a significant effect was not found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that typically developing children displayed a small increase in their internalizing behaviors, while developmentally delayed children exhibited a decrease in their internalizing behaviors. A mixed group factorial ANOVA was used to assess whether children’s pervasive developmental delays on the CBCL improved and a significant impact was found, such that all children had significantly lower mean pervasive developmental delay scores after the intervention. The interaction term was not significant, indicating that TCIT did not have a significantly greater impact on the pervasive developmental delays of the developmentally delayed children. A mixed group factorial ANOVA was used to examine if the children experienced decreases in their total behavioral problems. There was not a significant decrease in mean total problems although a significant interaction of total problems and developmental group was found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that typically developing children displayed a small increase in their total problems, while developmentally delayed children exhibited a decrease in their total problems. The prediction that TCIT would lead to significant increases in social competence for both groups of children was fully supported by the analysis. Social competence scores for all children significantly increased from their pre-treatment levels. Increases in social competence are important, as previous literature has noted that greater social competence is related to having fewer behavioral problems (Izard, et al., 2008). This finding supports prior research that has found that a closer teacher-child relationship not only decreases problem behaviors, but also increases social competence (Churchill, 2003; Hamre & Pianta, 2001, 2005; Palermo, et al., 2007). The increases in social competencies that have been identified in this study is important, due to the fact that poor social skills are predictive of negative school and peer experiences, delinquency, drug abuse and behavioral problems across the lifespan (Craig-Unkefer & Kaiser, 2003; Denham, 2006; McIntyre, Blacher, & Baker, 2006). In addition, it was hypothesized that during the course of TCIT developmentally delayed children would make greater gains in their general adaptation, but this finding was not supported by the analysis. While the finding was not significant, the developmentally delayed children did show a trend toward greater strides in general adaptation. It was also hypothesized that developmentally delayed children would show greater increases in social competence than their typically developing counterparts, but the analysis did not support this hypothesis. While both groups demonstrated progress in their social competence, neither group experienced a change that was significantly different from the other group. While TCIT contains certain characteristics of interventions used to decrease problem behavior and increase social competence in developmentally delayed children, such as the use of both one- to-one and small group therapy, as well as repetition of experiences (Matson & Fodstad, 2010), there were some components that were not included that may have made a greater impact on the developmentally delayed group. For instance, to be more successful, the intervention would most likely need to be more time-intensive for children identified as having delays in order to have a greater impact. For programs that do not have the time or resources for a more time-intensive therapy, this analysis has demonstrated that TCIT may be a viable option. The hypothesis that the treatment would significantly decrease problem behaviors for typically developing children and their delayed counterparts was not supported. It was found that the problem behaviors of neither group significantly decreased from pre-treatment to post- treatment on both the CBCL and SCBE. The behavioral effects may not have manifested during the intervention, but may have been detected during follow-up at a later time, allowing the increases in social competence and a closer teacher-child relationship to decrease problem behaviors more gradually. However, a significant decrease in children’s oppositional behaviors was found through analysis of the basic scale on the SCBE. Analysis of the CBCL measure of attention-hyperactivity problems found that all children experienced significant decreases in their inattention and hyperactivity. These findings suggest that some behavioral changes did occur. The hypothesis that TCIT would significantly decrease internalizing behaviors in both groups of children was not supported. Both groups of children showed increases in their internalizing behavior, according to the SCBE, and the treatment did not work differentially well for the developmentally delayed children. Despite the increases found in internalizing behaviors with the SCBE, it is important to note that none of the children moved out of the average range of internalizing behaviors into the clinical range. It could be that teachers learned more about internalizing behaviors during TCIT, and that, combined with their closer relationship with the child, may have led them to see more internalizing behaviors at post-treatment. The nature of TCIT may not lend itself to decreasing internalizing behaviors significantly because of its focus on decreasing externalizing behaviors. One of the most salient findings of this study was that pervasive developmental problems significantly decreased for both groups of children. Developmentally delayed children exhibited a larger decrease in their pervasive developmental problems, although it was not significantly larger. This finding certainly provides evidence that TCIT may potentially decrease developmental problems in all children, and not just decrease behavioral problems and increase social competence. Table 1. Mean CBCL Scale Scores at Pre- and Post-Treatment Table 2. Mean SCBE Scale Scores at Pre- and Post-Treatment A mixed group factorial ANOVA was used to assess whether social competence scores on the SCBE increased. Mean SCBE social competence scores significantly improved from pre-treatment to post-treatment for both groups of children. The interaction of social competence and developmental group was not significant, indicating that neither group displayed greater progress than the other. Figure 1. Mean Social Competence Scores at Pre- and Post-Treatment Table 3. Interactions of Scale and Developmental Group
Transcript of Exploring the Impact of Teacher-Child Interaction Training ...
Exploring the Impact of Teacher-Child Interaction Training on Challenging Behaviors and Social Competencies for Developmentally Delayed Children
Amanda Moen,1 Elaine K. Martin, M. A.,1 Christopher Campbell, Ph. D.,2 Tiffany West, M. A.,1 Jaycie Vanderbeek, B. A.,1 Katrina Poppert, B. A.,1 and Mary Fran Flood, Ph. D.1 University of Nebraska – Lincoln1
University of Oklahoma Health Science Center2
Empirical literature indicates that children with developmental delays tend to be less socially competent (Matson & Fodstad, 2010), and children with low social competence and developmental delays are more likely to have conduct problems than their more socially competent peers (McIntyre, 2008). Without appropriate intervention, delays in social competence are predictive of negative peer relationships, negative school experiences, mental health issues, drug abuse, internalizing behaviors, delinquency and antisocial behavior over the lifespan (Bornstein, Hahn, & Hays, 2010; Craig-Unkefer & Kaiser, 2003; Denham, 2006; McIntyre, Blacher, & Baker, 2006). Furthermore, children with developmental delays are three times more likely than their non-delayed peers to score in a clinical range for behavioral problems, be aggressive and have negative peer relationships (Baker, et al., 2003; Denham, 2006). In addition, behavioral problems may become stable, which is also associated with outcomes such as drug abuse, depression, juvenile delinquency, violent behavior, school dropout, and less adaptive school functioning (Miller, Gouley, Seifer, Dickstein, & Shields, 2004; Webster-Stratton & Hammond, 1998).
Prior literature has found that early intervention has assisted in successfully transforming children’s behavior. For example, Upshur, Wenz-Gross, and Reed (2009) found that children who experienced a behavioral intervention in preschool exhibited decreases in both aggression and maladaptive classroom behaviors, while also demonstrating gains in adaptive social skills. Children who develop socio-emotional and behavioral problems are an at risk population (Domitrovich, Cortes, & Greenberg, 2007), children with developmental delays who are prone to these issues and therefore are most in need of early intervention.
A promising area for early intervention is the teacher-child relationship. Prior research suggests that children who experience more secure/close teacher-child relationships exhibit fewer behavioral problems and are more prosocial toward peers than children who experience more conflicted teacher-child relationships (Hamre & Pianta, 2001, 2005; Helker & Ray, 2009; Palermo, et al., 2007). Teacher-Child Interaction Training (TCIT), a variation of the empirically supported Parent-Child Interaction Therapy (PCIT; McNeil & Hembree-Kigin, 2011), is a teacher training program intended to improve teacher-child relationships as well as increase social skills while decreasing problematic behaviors in the classroom.
Interventions that focus on building a strong-teacher child relationship may be especially important with children with delays, as their lessened language abilities, limited social skills and challenging behaviors may strain their relationship with their teacher (Rudasill et al., 2006). TCIT has been found to decrease challenging behaviors and increase social competence (Campbell et al., 2010), although this has not been examined in developmentally delayed children.
The purpose of this exploratory study was to examine the impact of TCIT on increasing social competencies and general adaptation, as well as decreasing challenging behaviors in developmentally delayed children in a Head Start setting. It was hypothesized that the prosocial behaviors and general adaptation of all children would increase. Additionally, it was hypothesized that TCIT would decrease challenging behaviors and internalizing behaviors in both typically developing and developmentally delayed children. Furthermore, it was also hypothesized that the impact of the intervention would be greater for developmentally delayed children given that several factors present in TCIT have been identified in interventions specifically for children experiencing delays (Matson & Fodstad, 2010).
Participants Participants were 24 children enrolled in 3 Midwestern Head Start Centers across 2 counties. The participating children ranged in age from 3.08 to
5.25 years of age (M = 4.29, SD = .599), and 58.3% of the sample was male. The majority of the children were identified as European American (58.3%), with 29.2% identifying as Latino and 12.5% identifying as African American. Twelve developmentally delayed children were matched on gender, age and center county to twelve typically developing children. The small sample size did not allow for matching children on ethnicity. The five teachers receiving training ranged in age from 25 to 40 years of age (M = 30, SD = 6.21). Four of teachers were female and one was male, with all of identifying as European American. The teaching experience of the teachers ranged from 48 to 156 months (M = 82.8, SD = 44.28).
This study was part of a larger evaluation of TCIT in three Head Start Centers. Children who attended one of the participating Head Start centers were eligible for the study. The larger study received IRB approval and all parents signed a consent form allowing their child to participate. Children who had completed the Denver Developmental Screening Test more than 6 months prior to the beginning of TCIT were not selected for the purposes of the current study.
Measures Social Competence and Behavior Evaluation (SCBE; LaFreniere & Durnas, 1995) – The SCBE assesses a child’s adaptation to and functioning within
a classroom environment, and is intended for use with children between the ages of 30 to 76 months of age (2 ½ to 6 years of age). The evaluation contains 80 items that are divided up into 8 basic scales: Depressive-Joyful, Anxious-Secure, Angry-Tolerant, Isolated-Integrated, Aggressive-Calm, Egotistical-Prosocial, Oppositional-Cooperative and Dependent-Autonomous. These 8 scales can also be abbreviated into 4 summary scales: Social Competence, Externalizing Problems, Internalizing Problems, and General Adaptation. Low scores on a scale reflect negative behaviors and high scores reflect positive behaviors. The SCBE has demonstrated favorable inter-rater reliability (.80 to .89), internal consistency (.72 to .89) and two-week test-retest reliability (.74 to .87). Good convergent, discriminant and criterion validity have also been established (Lobo &Winsler, 2006).
Child Behavior Checklist-Teacher Rating From (CBCL-TRF; Achenbach & Rescorla, 2000) – The CBCL-TRF is a teacher report used to assess a child’s social competence and behavioral problems in children 1.5 to 5 years of age. The checklist contains 99 items that break down into Internalizing and Externalizing scales. Additionally, there are each of the following subscales: Emotionally Reactive, Anxious-Depressed, Somatic Complaints, Withdrawn, Attention Problems and Aggressive Behavior. There are also problem scales assessed: Total Problems, Affective Problems, Anxiety Problems, Pervasive Developmental Delays, Attention-Hyperactivity Problems and Oppositional-Defiant Problems. Low scores on a scale reflect positive behaviors and high scores reflect negative behaviors. Test-retest reliability has been demonstrated with correlation coefficients ranging from .77 to .88. Internal consistency has also been established, with correlation coefficients ranging from .89 to .97 (Achenbach & Rescorla, 2000).
Denver Developmental Screening Test (DDST; Dick, Bryant & Davies, 1973) – The DDST is designed to screen children between infancy and six years of age for delays in four areas: Personal-Social (getting along with people and caring for personal needs), Fine Motor-Adaptive (eye-hand coordination, manipulation of small objects, and problem solving), Language (hearing, understanding, and using language), and Gross Motor (sitting, walking, jumping, and overall large muscle movement). Children who are classified as typical in their development have a maximum of one Caution and no delays in performing age appropriate tasks. Children who are classified as suspect in their development have two or more Cautions and/or one delay or more. The DDST has demonstrated good test-observer reliability and test-retest reliability, with correlation coefficients ranging from .66 and .93. Concurrent validity has also been established (.86 to .97) (Allard & Pfohl, 1988).
Procedures The TCIT intervention consisted of 14 sessions that were administered over a 7-week period, with two sessions occurring each week. The intervention
was performed in two phases, a Child-Directed Interaction (CDI) phase followed by a Teacher-Directed Interaction (TDI) phase. Teachers completed a battery of measures at baseline and one month post-treatment. One typically developing child was not included in the CBCL analyses because their post-treatment data was missing.
The development classification of the children was based on the results of the DDST completed between 1 month and 6 months prior to treatment by a healthcare professional employed by Head Start (e.g., nurse). Following the standard protocol of the DDST, children were classified as suspect in their development if they had two more cautions and/or one delay or more.
A mixed group factorial ANOVA was used to assess whether general adaptation increased. Mean SCBE general adaptation scores did not significantly increase from pre-treatment to post-treatment, and the interaction of general adaptation and developmental group was not significant. This finding indicates that neither group experienced significantly different change from the other.
A mixed groups factorial ANOVA was used to assess whether behavioral problems decreased after treatment. According to the SCBE, mean behavioral problems did not significantly decrease from pre-treatment to post-treatment and the interaction of externalizing scores from the SCBE and developmental group was not found to be significant, indicating that neither group yielded significantly different change from the other. There was not a significant decrease in mean externalizing behaviors on the CBCL either, although a significant interaction term was found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that normally developing children displayed a small increase in their externalizing behaviors, while developmentally delayed children exhibited a decrease in their externalizing behaviors.
A mixed group factorial ANOVA was used to assess whether oppositional behaviors decreased. Using the SCBE, significantly fewer oppositional behaviors and more cooperative behaviors were found for all children, and the interaction of opposition-cooperation scores and developmental group was not significant, indicating that the groups did not show differential change. There was not a significant decrease in mean oppositional behaviors on the CBCL, although a significant interaction term was found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that typically developing children displayed a small increase in their oppositional-defiant behaviors, while developmentally delayed children exhibited a decrease in their oppositional-defiant behaviors.
A mixed group factorial ANOVA was used to determine whether aggressive behaviors on the CBCL decreased. Mean aggressive behaviors did not significantly decrease, and the impact on developmentally delayed children was not greater, as the interaction between developmental group and aggressive behaviors was not significant. A mixed group factorial ANOVA was used to assess whether there was a significant decrease in all children’s attention-hyperactivity problems on the CBCL. Mean attention-hyperactivity scores at post-treatment were significantly lower that pre-treatment scores for all children. The interaction of developmental group and attention-hyperactivity behaviors was not significant meaning that developmentally delayed children did not show significantly greater progress than their typically developing peers.
A mixed group factorial ANOVA design was used to assess whether internalizing behavior increased for both groups of children. Mean internalizing scores from the SCBE significantly increased from pre-treatment to post-treatment for all children. The interaction of internalizing scores and developmental status was not significant, suggesting that neither group regressed more than the other. Results from the CBCL analyses found no significant difference in mean internalizing behaviors for either group of children, although a significant effect was not found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that typically developing children displayed a small increase in their internalizing behaviors, while developmentally delayed children exhibited a decrease in their internalizing behaviors.
A mixed group factorial ANOVA was used to assess whether children’s pervasive developmental delays on the CBCL improved and a significant impact was found, such that all children had significantly lower mean pervasive developmental delay scores after the intervention. The interaction term was not significant, indicating that TCIT did not have a significantly greater impact on the pervasive developmental delays of the developmentally delayed children.
A mixed group factorial ANOVA was used to examine if the children experienced decreases in their total behavioral problems. There was not a significant decrease in mean total problems although a significant interaction of total problems and developmental group was found. While neither group displayed differences significantly different than zero, there was a difference in directionality, such that typically developing children displayed a small increase in their total problems, while developmentally delayed children exhibited a decrease in their total problems.
The prediction that TCIT would lead to significant increases in social competence for both groups of children was fully supported by the analysis. Social competence scores for all children significantly increased from their pre-treatment levels. Increases in social competence are important, as previous literature has noted that greater social competence is related to having fewer behavioral problems (Izard, et al., 2008). This finding supports prior research that has found that a closer teacher-child relationship not only decreases problem behaviors, but also increases social competence (Churchill, 2003; Hamre & Pianta, 2001, 2005; Palermo, et al., 2007). The increases in social competencies that have been identified in this study is important, due to the fact that poor social skills are predictive of negative school and peer experiences, delinquency, drug abuse and behavioral problems across the lifespan (Craig-Unkefer & Kaiser, 2003; Denham, 2006; McIntyre, Blacher, & Baker, 2006). In addition, it was hypothesized that during the course of TCIT developmentally delayed children would make greater gains in their general adaptation, but this finding was not supported by the analysis. While the finding was not significant, the developmentally delayed children did show a trend toward greater strides in general adaptation.
It was also hypothesized that developmentally delayed children would show greater increases in social competence than their typically developing counterparts, but the analysis did not support this hypothesis. While both groups demonstrated progress in their social competence, neither group experienced a change that was significantly different from the other group. While TCIT contains certain characteristics of interventions used to decrease problem behavior and increase social competence in developmentally delayed children, such as the use of both one-to-one and small group therapy, as well as repetition of experiences (Matson & Fodstad, 2010), there were some components that were not included that may have made a greater impact on the developmentally delayed group. For instance, to be more successful, the intervention would most likely need to be more time-intensive for children identified as having delays in order to have a greater impact. For programs that do not have the time or resources for a more time-intensive therapy, this analysis has demonstrated that TCIT may be a viable option.
The hypothesis that the treatment would significantly decrease problem behaviors for typically developing children and their delayed counterparts was not supported. It was found that the problem behaviors of neither group significantly decreased from pre-treatment to post-treatment on both the CBCL and SCBE. The behavioral effects may not have manifested during the intervention, but may have been detected during follow-up at a later time, allowing the increases in social competence and a closer teacher-child relationship to decrease problem behaviors more gradually. However, a significant decrease in children’s oppositional behaviors was found through analysis of the basic scale on the SCBE. Analysis of the CBCL measure of attention-hyperactivity problems found that all children experienced significant decreases in their inattention and hyperactivity. These findings suggest that some behavioral changes did occur.
The hypothesis that TCIT would significantly decrease internalizing behaviors in both groups of children was not supported. Both groups of children showed increases in their internalizing behavior, according to the SCBE, and the treatment did not work differentially well for the developmentally delayed children. Despite the increases found in internalizing behaviors with the SCBE, it is important to note that none of the children moved out of the average range of internalizing behaviors into the clinical range. It could be that teachers learned more about internalizing behaviors during TCIT, and that, combined with their closer relationship with the child, may have led them to see more internalizing behaviors at post-treatment. The nature of TCIT may not lend itself to decreasing internalizing behaviors significantly because of its focus on decreasing externalizing behaviors.
One of the most salient findings of this study was that pervasive developmental problems significantly decreased for both groups of children. Developmentally delayed children exhibited a larger decrease in their pervasive developmental problems, although it was not significantly larger. This finding certainly provides evidence that TCIT may potentially decrease developmental problems in all children, and not just decrease behavioral problems and increase social competence.
Table 1. Mean CBCL Scale Scores at Pre- and Post-Treatment
Table 2. Mean SCBE Scale Scores at Pre- and Post-Treatment
A mixed group factorial ANOVA was used to assess whether social competence scores on the SCBE increased. Mean SCBE social competence scores significantly improved from pre-treatment to post-treatment for both groups of children. The interaction of social competence and developmental group was not significant, indicating that neither group displayed greater progress than the other.
Figure 1. Mean Social Competence Scores at Pre- and Post-Treatment
Table 3. Interactions of Scale and Developmental Group
