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Interventions for Students With Behavioral Disorders: An

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August 2007
Volume 32
Number 4

Beha v i o r a l Di s o rd e r s
Journal of the Council for Children with Behavioral Disorders

Articles
V Strength-Based Versus Traditional Social-
Emotional Reports: Impact on Multidisciplinary
Team Members’ Perceptions
V Sound-Field Amplification to Increase
Compliance to Directions in Students
With ADHD
V Wealthy and Wise? Influence of
Socioeconomic Status on the Community
Adjustment of Previously Incarcerated Youth
V Interventions for Students With Behavioral
Disorders: An International Literature Review

C C
B D
Council for
Children with
Behavioral
Disorders
 Interventions for Students With Behavioral Disorders:
An International Literature Review

Daniel J. Gulchak
Arizona State University

João A. Lopes
University of Minho, Portugal

ABSTRACT: Students with emotional and behavioral disorders (EBD) are found internationally. This
systematic literature review identifies interventions conducted on these students. Although the U.S.
produces abundant studies on effective school-based academic and behavioral interventions, a
search of over 4,000 articles published over 6 years yielded only 11 international studies meeting the
selection criteria. Out of 11 qualified studies, 6 reported therapeutic treatments, 8 targeted elementary
students, 9 were conducted in self-contained classrooms, and 9 were from the U.K. These findings
indicate a paucity of quantitative research determining effectiveness of EBD interventions currently
used in schools worldwide. The results indicate that quantitative studies are not the standard of
evidence-based practice internationally, and diagnostic criteria and terms used to identify students
vary worldwide.

Students with behavior disorders A multitude of terms used worldwide include

are a concern for educators worldwide. students with (a) emotional and behaviour
Researchers from the United Kingdom report difficulties (Renwick, 2005); (b) social,
that “in Scotland, England, and Wales, the emotional, and behaviour difficulties (SEBD;
rise in numbers of pupils (with behavioural Cooper, P., Arnold, R., & Boyd, E., 2001); (c)
difficulties) excluded from school has provoked special education needs (SEN; Cullen-Powell
considerable concern amongst policymakers & Barlow, 2005); (d) behaviour problems
and professionals in education and beyond” (Desbiens & Royer, 2003); and (e) emotional
(Head, Kane, & Cogan, 2003, p. 33). An and psychiatric difficulties (Sage, 2002); as well
Australian council on education recognized as (f) disruptive boys (Charlesbois, Brendgen,
that “behavioural problems were both ongoing Vitaro, Normandeau, & Boudreau, 2003); (g)
and growing and were a major concern students that are seriously emotionally disturbed
nationally” (De Jong, 2005, p. 353); a team of (Topping & Flynn, 2004); and (h) students
Canadian researchers stated that “behaviour that are aggressive who meet the American
disorders represent a major concern in today’s Psychiatric Association DSM-IV criteria for
schools” (Glendron, Royer, Bertrand, & conduct disorder, oppositional defiant disorder,
Potvin, 2004, p. 249); and Chilean researchers or disruptive behavior disorder-not otherwise
reported that “in Latin America there are no specified (DBD-NOS; van Manen, Prins, &
published longitudinal follow-up studies of Emmelkamp, 2004).
prevalence and persistence of emotional and In the United States children are defined as
behavioral problems in school-aged children” having EBD if they exhibit one or more of the
(de la Barra, Toledo, & Rodriguez, 2005, p. following behaviors over an extended period of
228). Yet, most literature reviews on classroom time and to a marked degree: (a) an inability to
interventions for behavior problems and learn that cannot be explained by intellectual,
emotional and behavioral disorders (EBD) sensory, or health factors; (b) an inability to
report only American studies (Lewis, Hudson, build or maintain satisfactory interpersonal
Richter, & Johnson, 2004; Lloyd, Forness, & relationships with peers or teachers; (c)
Kavale, 1998; Stage & Quiroz, 1997). inappropriate behaviors or feelings under
One difficulty teachers and researchers face normal circumstances; (d) a general mood of
identifying effective interventions for students unhappiness or depression; and (e) a tendency
with EBD is defining this population of students. to develop physical symptoms or fears

Behavioral Disorders, 32 (4), 267-281 August 2007 / 267

associated with personal or school problems research-based interventions identified by
(Individuals With Disabilities Education Stage and Quiroz for decreasing disruptive
Improvement Act, IDEA, 2004). EBD in the classroom behavior in the classroom include
United States is diagnosed in approximately (a) group contingency, (b) self-management,
1% of school-age children and accounts (c) differential reinforcement, and (d) token
for 8.2% of all students enrolled in federally economies. Together, these studies, based
funded special education programs (Bradley primarily on a behavioral theoretical model,
& Monfore, 2004). However, according to the provide a concise yet comprehensive overview
National Institute of Mental Health (1990), the of effective classroom interventions for EBD in
prevalence of mental and emotional problems the United States.
in children and adolescents is as high as 22%. As previously stated, researchers from the
Bradley and Monfore cite a U.S. Department of United Kingdom, Canada, Australia, and Chile
Education report showing that 80% of students report increased national concern over students
with EBD were male, 30% of students with with behavior challenges in school. There is
EBD were educated outside of the general clearly a need for international research in
education classroom for the majority of their this area to determine effective, culturally
school day, and 50% of the students with relevant practices for intervention for students
EBD dropped out of school before graduation. with EBD. This literature review provides
They also report that 72% of high school-age a comprehensive analysis of quantitative
students with EBD were suspended or expelled research conducted outside the United States
from school compared to only 22% of students on classroom interventions for students with
without disabilities. This clearly indicates behavior disorders, however defined by the
that the United States has a documented local culture. Specifically we investigated (a)
need for school-based interventions for these empirically researched classroom interventions,
students. Other countries may have similar (b) research methodology, (c) assessment
needs. But since there is a lack of international instruments, (d) terms used to define or
systematic research, it is difficult to make that describe students with behavior disorders and
determination. diagnostic criteria used to identify a student
Having an agreed upon definition of EBD as having a behavior disorder, (e) age and
enables educators to more easily identify gender of students in studies, (f) setting where
effective evidence-based practices for these students received the intervention for their
students. Numerous literature reviews on problem behavior, and (g) countries publishing
effective interventions for students with EBD empirical research literature on this topic in
in the United States are available on topics English language journals.
such as (a) academics (Hodge, Riccomini,
Buford, & Herbst, 2006; Mooney, Epstein,
Reid, & Nelson, 2003; Rivera, Al-Otaiba, Method
& Koorland, 2006; Ryan, Reid, & Epstein,
We established a two-step process a
2004); (b) behavior (Conroy, Dunlap, Clarke,
priori to conduct a comprehensive search
& Alter, 2005; Hieneman, Dunlap, & Kincaid,
for quantitative research on interventions for
2005; Maag, & Swearer, 2005); (c) social
students with behavior disorders in school.
skills training (Beelmann, Pfingsten, & Losel,
Search and selection methodology included
1994; Mathur, Kavale, Quinn, Forness, &
searching library databases using identified
Rutherford, 1998; Singh, Deitz, Epstein, &
keywords and hand searching articles in
Singh, 1991); and (d) general best practices
special needs journals with an international
(Lewis et al., 2004; Lloyd et al., 1998; Stage
focus identified by using the Google search
& Quiroz, 1997). Examples of scientifically
engine on the World Wide Web.
supported intervention practices for EBD from
the Lewis et al. study include (a) using teacher
praise for positive reinforcement; (b) providing Procedures
opportunities for students to respond during
instruction; and (c) using positive behavior
support (PBS) such as functional behavior Search Procedures
assessments (FBA), social skills instruction,
teaching for desired replacement behaviors and The methodology for this study was
self-management, and schoolwide systems of partially based on a literature review reported
positive behavior support (SW-PBS). Additional by Artiles, Trent, and Kuan (1997). After

268 / August 2007 Behavioral Disorders, 32 (4), 267-281

consulting with a university librarian, we published in English substantially constrained
chose several large electronic databases that the scope of generalization of the review
reference journals from subject areas related findings. However, this limitation allows for
to this topic. We decided to cast a wide net future research by teams of bilingual or trilingual
with descriptive terms in order to capture the authors to expand this study. Other articles
broadest range of articles in this topic area. The excluded from the review were studies that
keywords included (a) emotion* or behavior* focused on adults, rehabilitation, or disabilities
or behaviour* or mental-health, (b) disabil* or such as developmental disabilities (mental
disorder* or disturb* or problem or illness*, retardation or intellectual disability), autism,
and (c) intervention* or practice*. The asterisk and attention deficit hyperactivity disorder
(*) indicates acceptable keywords could have (ADHD) as well as case studies, conference
various endings such as disabil-ity or disabil- papers, books, chapters, reports, editorials, and
ities. unpublished theses and dissertations.
An Internet search using the Google search
engine identified additional electronic and Coding Procedures
paper journals focused on behavior disorders,
special education, and special needs which We established several coding categories
may not have been indexed in the previously before conducting the search to compare and
searched databases. Keywords used in the contrast selected articles. Coding categories
search included international, journal, special included author information, country of origin,
education, and special needs. When journals description of the treatment/intervention,
were found, issues were hand searched for summary of results, research design and
articles meeting the criteria described in the assessment tools used for the study, disability
selection procedure section. When publishers label or subject description and any diagnostic
of international books and journals were found, criteria used to define this population for the
their collection was also searched for journals study, subject’s demographic information, and
focusing on the topics outlined previously. educational setting where the intervention
took place. We decided that this information
Selection Procedures provided enough details allowing readers to
assess if the intervention could be replicated
Seven criteria were established to select in their country.
quantitative articles relevant to this review. To
be selected for this review, the articles met all
Reliability Measures
of the following criteria:
1. Published in peer reviewed journals. To check the reliability of the article
2. Focused on students with behavior section procedure, 36% of selected articles
problems outside of the United States. were reassessed using similar procedures used
3. Published between 2000 and 2005 to give by Artiles et al. (1997). We used a statistical
a current representation of intervention table of random numbers to select the articles
implemented throughout the world. from this study. We then used the selection
4. Used quantitative studies using single- procedures outlined in this article to assess if
subject, experimental, quasi-experimental,
the articles met the requirements for inclusion
or mixed research method designs.
in this study. Interrater agreement for article
5. Identified participants as children and
selection was 1.00. Reliability data were not
adolescents in preschool through high
collected on the search procedures.
school identified as having behavior
problems. All regional definitions of
behavior problems were accepted. Results
6. Used intervention treatments (defined as
actions performed to reduce or discourage We searched five electronic databases for
disruptive behavior in school) including international scholarly articles in the fields of
programs, academic or behavioral education, special education, and psychology.
practices, therapies, counseling, or The indexes Academic Search Premier,
pharmacological interventions that target Educational Full Text, Eric (CSA) Illumina,
students with behavior problems. Family and Society Studies Worldwide, and
7. Published in English. PsychINFO databases identified a total of
Limiting the inclusion of articles to those 3,272 articles as candidates for review of which

Behavioral Disorders, 32 (4), 267-281 August 2007 / 269

 TABLE 1
Databases and Search Results From 2000 to 2005

Articles
Database n Selected Relevant Search Field Code

Academic Search Premier 71 0 0.00 Keyword (KW)

Educational Full Text 397 0 0.00 KW

Eric (CSA) Illumina 1152 2 0.17 KW

Family and Society Studies 152 0 0.00 KW not available, used descriptors
Worldwide (DE) “child” and “adolescent”

PsychINFO 840a 2 0.24 KW, peer reviewed, English, human,

quantitative, and birth-to-12-year-olds

PsychINFO 660a 2 0.30 KW, peer reviewed, English, human,

quantitative, and 13-to-17-year-olds

Total Articles 3272 6b 0.18

a
Some overlapping articles. b Four unique articles.

four met selection criteria. Table 1 details the selection procedures. Using interlibrary loan,
search results for the years 2000 to 2005. we received the few articles unavailable online
PsychINFO initially returned 10,606 articles via e-mail.
matching the keywords used in the search After conducting an Internet search for
procedures. Because this database allowed additional international journal titles using the
additional descriptors to be selected narrowing Google search engine and the search procedures
the number of articles presented, the search outlined, 12 journals were identified as having
was conducted twice using the additional potential articles for this review. However,
descriptors “children” and “adolescents.” This during the course of the hand search of the
new search resulted in some overlap of articles journals, we realized that several journals
since children in middle school were often could not be included in this review due to
included under both descriptors. Potential (a) the lack of a full set of journals published
articles were downloaded directly from most consistently between 2000 and 2005, (b) the
databases to be analyzed according to the lack of articles meeting selection criteria, or (c)

TABLE 2
Hand Search Results of Journals From 2000 to 2005

Articles
Journal Issues Published n Selected Relevant

British Journal of Special Education 24 167 6 3.6

Emotional and Behavioural Difficulties 20 85 2 2.4

European Journal of Special Needs Education 19 134 0 0.0

International Journal of Special Education 10 103 0 0.0

School Psychology International 25 186 0 0.0

Total Articles – 675 8 1.2

270 / August 2007 Behavioral Disorders, 32 (4), 267-281

 TABLE 3
Excluded Journals From Hand Search Results 2000 to 2005

Articles
Journal Issues Published n Selected Relevant

Asia Pacific Journal of Education 2 16 0 0.0

Child and Adolescent Mental Health 12 77 0 0.0

International Journal of Behavioural Development 18 162 0 0.0

International Journal of Disability, Development, 12 89 0 0.0

and Education

Journal of Research in Special Education Needs 9 56 0 0.0

Journal of Special Education in the Asia-Pacific 1 9 0 0.0

South African Journal of Education Articles not available to researcher

Total Articles – 409 0 0.00

other research and methodological issues. Table treatments (Cooper et al., 2001; Cullen-Powell
2 lists the 5 journals included in this review & Barlow, 2005; O’Connor & Colwell, 2002;
which produced 675 potential articles of which Renwick, 2005; Renwick & Spalding, 2002;
8 met the selection criteria. Some articles that Spalding, 2000); three articles focused on
met this selection criterion had been previously social skills training programs (Charlesbois et
identified in the initial database search. al., 2003; Desbiens & Royer, 2003; Maddern,
Table 3 references the 7 journals excluded Franey, McLaughlin & Cox, 2004); one article
from this review synthesis. They are listed to targeted language and communication skills
illustrate the scope of international scholarly (Sage, 2002); and one article addressed using
journals focusing on special education research direct observation to assess student behavior
published in English. This list of excluded after an inservice training program for teachers
articles may enable further research on this (Swinson & Cording, 2002). Although most
topic if these journals are published regularly programs targeting teachers and parents were
in the future. Out of 3,947 articles identified excluded from this review, the Swinson and
through database and hand searches (not Cording study was included because the
including the 409 articles from Table 3), only intervention’s effectiveness was measured by
11 articles met the selection criteria for this directly observing the behavior of students with
review illustrating eight unique interventions EBD. The eight interventions are summarized
being researched on students with behavior below.
disorders outside the United States. 1. A Quiet Place (Renwick, 2005; Renwick &
Spalding, 2002; Spalding, 2000) provided
Interventions a therapeutic holistic support program.
Treatment included one session of outcome
Eight unique interventions using oriented psychotherapy, massage, and
quantitative methods to assess the effectiveness biofeedback-supported relaxation per week
of treatment were found for children with in a dedicated room designed to promote a
behavior disorders outside the United States sense of peace and relaxation.
from 2000 to 2005. Although the principles 2. Nurture Groups (Cooper et al., 2001;
of applied behavior analysis are often used O’Connor & Colwell, 2002) met in self-
in interventions identified as effective in the contained classrooms. These groups
United States (Lewis et al., 2004; Lloyd et al., applied a therapeutic approach to
1998; Stage & Quiroz, 1997), few international intervention guided by the philosophy of
studies shared this orientation. Six programs attachment theory and Maslow’s hierarchy
used psychotherapy, massage, and holistic of needs which caters to students who have

Behavioral Disorders, 32 (4), 267-281 August 2007 / 271

 difficulty achieving a sense of security and Note that the three articles for A Quiet Place
safety. intervention only reported on two research
3. Self-Discovery Programme (Cullen-Powell studies. The article published by Renwick
& Barlow, 2005) combined various (2005) was a “reconsideration of data” from the
elements to assist development of a sense of study by Renwick and Spalding (2002), which
self-worth by teaching sensory awareness, was a follow-up study to the article published
peer massage (hands), communication, by Spalding (2000). See Table 4 for an overview
and relaxation. Intervention was 45 min of all studies.
per week delivered by a tutor trained in the
field of complementary therapy (including Research Methodology
massage and holistic therapies).
4. PARC Programme (Programme As detailed in the selection procedures, only
d’autocontrôle, de résolution de studies employing quantitative methodology
problèmes et de compétence sociale were included in this review. The most frequently
pour les élèves du primaire ayant des used method to determine the effectiveness
troubles du comportement) delivered a of classroom interventions was quasi-
self-control, problem-solving, and social experimental designs with preintervention and
competency program for primary school postintervention data collection. Some studies
students with behavior problems (Desbiens added control groups which were matched
& Royer, 2003). PARC was adapted and with the intervention group for traits such as
used to teach social skills using prosocial age, gender, and socioeconomic status. Half
peers during two to four 30-to 60-minute of the studies identified in this review were
workshops per week. The program is based 1 to 3 years in length. The other studies were
on a cognitive behavior approach aimed to conducted in 6 to 20 weeks. No single subject
reduce the incidence of disruptive behavior or pure experimental studies were found.
by increasing children’s control over their
own behavior. Assessment Instruments
5. (Un-named) social skills program
(Maddern et al., 2004) promoted Although all studies reported the use of
children’s coopera-tive skills and anger some quantitative methodology, details about
management. It was taught for 90 min the assessment process and instruments used
per week by a team including a clinical in the study were often lacking or difficult to
psychologist, educational psychologist, determine. Therefore, many of the assessments
community psychiatric nurse, and assistant reported might be considered subjective
psychologist. rather than objective measures in the strictest
6. (Un-named) academic and social skills sense. Direct observation of student behavior
training (Charlesbois et al., 2003) delivered was used in a few articles and the majority
reading and self-regulation training for of studies relied on rating scales, behavior
students with parental support. This profiles, and questionnaires completed by
included social skills training for parents classroom teachers or others in the educational
and teachers. environment. As a result, effect sizes for the
7. Communication Opportunity Group interventions could not be reported for the
Scheme (COGS; Sage, 2002) developed selected articles. See Table 5 for the description
formal language and thinking skills to of assessment tools provided in some of the
enhance performance of able and less- articles.
able children using a “tell, show, do, and
coach approach.” It was taught 1 hr per Defining Students
week for 10 weeks or 2-hr per day for 5
days. Worldwide, a variety of terms describe
8. Assertive Discipline (Swinson & Cording, students with behavior disorders. This was
2002) provided inservice training for problematic for a literature review of this
teachers consisting of three 2-hr sessions scope. Terms found to describe students in
over 3 weeks. Results were measured this study include (a) emotional and behaviour
through direct observation of student difficulties, (b) social, emotional, and
behavior. behaviour difficulties, (c) special education

272 / August 2007 Behavioral Disorders, 32 (4), 267-281

 TABLE 4
Quantitative Research on Classroom Interventions for Students With Behavior Disorders Outside the United States From 2000 to 2005

Author Disability Label Subjects

(Country) Intervention Results Research Design Assessment (Diagnostic Criteria) (Age/Grade Level) Setting
Charlesbois, P., Reading, self-regula- The number of Quasi-experimental a. Peer Evaluation Disruptive students 58 Boys General education
Brendgen, M., Vitaro, tion, and social skills attended sessions using pretest/ Inventory (PEI) classroom
F., Normandeau, S., & training for students positively related posttest design during b. Academic (Above 70th percentile (K-3)
Boudreau, J. F. (2003) to postintervention a 3-year longitudinal Standards Assessment on PBQ)
(Canada) performance. study.

Cooper, P., Arnold, R., Nurture Groups A statistically Quasi-experimental Boxall Profile Social, emotional, and 342 pupils Nurture Group self-
& Boyd, E. (2001) significant improve- with matched control behavioural difficulties contained classroom
(United Kingdom) ment in SDQ and group using pretest/ (84% 4-to 7-year-
Boxall Profile scores posttest design during (Levels assessed using olds, 16% 7-to

Behavioral Disorders, 32 (4), 267-281

as rated by the a 2-year longitudinal SDQ) 10-year-olds)
teacher. study.

Cullen-Powell, L., & Self-Discovery An improved social Quasi-experimental a. SDQ Special education 16 boys, 2 girls Self-contained class-
Barlow, J. (2005) Programme competence with with matched control b. Observations of needs, behavioural room
(United Kingdom) teachers, increase in group using pretest/ children’s ability and learning difficul- (6-to 8-year-olds)
contributions during posttest design during to give and receive ties, and at risk of
class, increase in a 1-year study. handshakes, body being excluded from
eye contact during language and eye school
intervention group, contact, participation
and improvements in and enjoyment, and (Behavioural profiles
prosocial behaviour attention to task consisting of nine
and hyperactivity questions were com-
scores on the SDQ. pleted by teacher)

Desbiens, N., & Royer, PARC Programme No significant dif- Quasi-experimental a. Sociometric status Behavioural problems 33 boys, 21 girls General education
E. (2003) ference between with matched control and peer acceptance classroom
(Canada) treatment and control group using pretest/ b. Social reputation (Screening adapted (Grade 3)
groups. The effect posttest design during among peers from SSBD)
size for program par- a 10-week study. c. Social affiliations
ticipants was between within the class
47% and 58%. d. Self-administered
PCSC
e. Teacher assessment
scale for academic
and social adaptation continues

August 2007 / 273

 TABLE 4 (Continued)
Quantitative Research on Classroom Interventions for Students With Behavior Disorders Outside the United States From 2000 to 2005
Author Disability Label Subjects
(Country) Intervention Results Research Design Assessment (Diagnostic Criteria) (Age/Grade Level) Setting
Maddern, L., Franey, J., Social Skills A statistically Mixed methods with a a. Culture-Free Self- Severe emotional and 8 boys Self-contained class-
McLaughlin, V., & Cox, Programme significant reduction pretest/posttest design Esteem Inventories behaviour problems room

274 / August 2007

S. (2004) in children’s anxiety during a 20-week b. Spence Children’s (Year 5 and Year 6)
(United Kingdom) scores, teacher obser- study. Anxiety Scale (Stage 3 of code of
vation of anger man- c. Social Competence practice for special
agement problems, with Peers Question- educational needs)
and several variables naire
on the CTRS. d. Observation
Checklist (anger
management)
e. CTRS

O’Connor, T., & Col- Nurture Groups Statistically significant Quasi-experimental DDP Emotional and 46 boys, 22 girls Nurture Group, self-
well, J. (2002) changes between using pretest/posttest behavioural difficulties contained classroom
(United Kingdom) entry and exit from design during a 2-year (Mean age was 5.25
intervention with longitudinal study. years old)
some significant
scores after 2 years
in mainstreamed
reintegration.

Renwick, F. (2005) A Quiet Place A statistically Reconsideration of Observation of Emotional and behav- 52 children Self-contained class
(United Kingdom) significant improve- data from Renwick classroom behaviour ioural difficulties in a mainstreamed
ment after a 6-week, and Spalding (2002). using five bipolar (Young children) school
6-month, and 1 year categories:
follow-up observa- a. Attention
tion. b. Self-awareness/self-
esteem
c. Impulse control
d. Interpersonal skills
e. Socialization

continues

Behavioral Disorders, 32 (4), 267-281

 TABLE 4 (Continued)
Quantitative Research on Classroom Interventions for Students With Behavior Disorders Outside the United States From 2000 to 2005

Author Disability Label Subjects

(Country) Intervention Results Research Design Assessment (Diagnostic Criteria) (Age/Grade Level) Setting
Renwick, F., & Spalding, A Quiet Place A statistically signifi- Quasi-experimental Observation in three Emotional and 54 children Self-contained class
B. (2002) cant increase in posi- design using a treat- settings: behavioural difficulties in a mainstreamed
(United Kingdom) tive behaviours and a ment and matched a. Teacher-led (Year 1 to Year 6) school
decrease in negative control group during a activity (Boxall Profile)
behaviours. 6-week study. b. Independent
activity
c. Unstructured situ-
ation

Sage, R. (2002) A Communication A significant and Quasi-experimental Target speaking and Emotional and psychi- 24 students Mainstreamed school

Behavioral Disorders, 32 (4), 267-281

(United Kingdom) Opportunity Group positive difference study using a pretest/ writing competencies atric difficulties
Scheme between students posttest design with a in five activities (Primary and second-
receiving interven- treatment and control a. Appearance on the ary grades)
tion compared to the group along with special needs register
control group. parent and student b. Inappropriate
interviews during a behaviour in school
10-week study. and limited social
interaction
c. Reports from teach-
ers indicating com-
munication needs

Spalding B. (2000) A Quiet Place Not statistically sig- Quasi-experimental a. Boxall Develop- Emotional and behav- 22 children Self-contained class
(United Kingdom) nificant. Children who study using a pretest/ mental Strands ioural difficulties in a mainstreamed
experienced most posttest design with a b. DDP (Age and grade school
gains had emotional treatment and control (Boxall Developmental unspecified)
needs linked to low group along with Strands and DDP)
self-esteem, anger parent and teacher
management, or interviews during a
transitioning to a new 6-week study.
school after exclusion/
suspension.
continues

August 2007 / 275

 TABLE 4 (Continued)
Quantitative Research on Classroom Interventions for Students With Behavior Disorders Outside the United States From 2000 to 2005
Author Disability Label Subjects
(Country) Intervention Results Research Design Assessment (Diagnostic Criteria) (Age/Grade Level) Setting
Swinson, J., & Cording, Assertive Discipline A statistically Pretest/posttest obser- Observation of Emotional and behav- Eight classes of 6–12 Separate school
M. (2002) significant increase vations of student and student’s on/off task ioural difficulties students

276 / August 2007

(United Kingdom) in student’s on-task teacher behaviours behaviour using the
behaviour and Pupil Behaviour (7-to 16-year-olds)
decrease in disruptive Schedule.
incidents following a
statistically significant
increase in teacher
praise statements and
decrease in use of
negative statements.

Note. CTRS = Conners’ Teacher Rating Scale and Conners’ Parent Rating Scale; DDP = Diagnostic Developmental Profile; PBQ = Preschool Behaviour Questionnaire; PCSC = Perceived Competence Scale for
Children; PEI = Peer Evaluation Inventory; SDQ = Strengths and Difficulties Questionnaire; SSBD = Systematic Screening for Behaviour Disorders.

Behavioral Disorders, 32 (4)

 TABLE 5
Descriptions of Assessments

Assessment Description Provided in Article

Boxall Profile A detailed normative, diagnostic instrument completed by the Nurture

Group teacher which can be used to measure a child’s level of emotional
and behavioural functioning and highlight specific targets for intervention
within a child’s individual functioning. Includes a rating questionnaire.

Diagnostic Developmental A 34-item questionnaire used to identify student needs, plan intervention,
Profile, (DDP) and chart student progress.

Peer Evaluation Inventory The likeability and aggressiveness-disturbance scale of the PEI was used.
(PEI) Students were given a roster of all classmates and were asked to write the
names of three classmates for each of the two categories: (1) peers whom
they liked the most, who seemed to always understand what was going
on, and who helped others (likeability); and (2) peers who started fights,
disrupted the classroom the most, laughed at others, told lies, cheated,
made up stories,
and said they could beat up other kids (aggressiveness-disturbance).
Perceived Competence Scale
for Children, (PCSC) A self-administered questionnaire with 28 items assessing four fields of
competence: academic, social, sports, and self-esteem.
Strengths and Difficulties
Questionnaire, (SDQ) A 25-item behaviour screening questionnaire measuring five sub-scales:
hyperactivity, conduct problems, emotional symptoms, peer problems, and
prosocial behaviour. It produced results consistent with more established
behaviour rating scales such as Achenbach’s “Child Behaviour Checklist”
and Rutter’s “Child Behavioural Rating Scale.”

needs, (d) behaviour problems, (e) emotional the age or grade level of students in the study.
and psychiatric difficulties, (f) disruptive Five of the studies specified the gender of the
boys, (g) seriously emotionally disturbed, students, of which the majority of subjects
and (h) aggressive behaviour. The variety of were boys.
terms used to describe students with behavior
problems confirms Lopes’ (2005) notion that Setting
“when no scientific classification system is
available, everyone uses their own system. A vast majority of interventions took place
Communication becomes difficult between in self-contained schools, classrooms, or
professionals, since no one can be sure segregated environments. Only three studies
that the category he/she is talking about is reported conducting intervention in general
understandable to others” (p. 346). education classrooms or mainstreamed
Diagnostic criteria for assigning labels or
schools.
providing an intervention for problem behavior
was equally as varied as terms used to define
students. The scope of solutions found in this Country of Origin
review included questionnaires, behavior
According to this literature review, the
screening instruments, behavior profiles, and
countries producing quantitative studies
teacher reports of inappropriate behavior.
of interventions for students with behavior
disorders are England (n = 9) and Canada (n
Student Age and Gender
= 2). Other countries identified in this study
Eight of the 11 studies were conducted for publishing scholarly articles on this topic
with elementary-age children, one study but did not meet the selection criteria for this
specifically targeted high school students, review include Australia, Chile, China, Cyprus,
one study targeted primary and secondary- Finland, Germany, Greece, Ireland, India,
age students, and one study did not specify Japan, Netherlands, and Scotland.

Behavioral Disorders, 32 (4), 267-281 August 2007 / 277

Discussion schools requiring direct action and intervention
on the part of educators may be a common
The purpose of this literature review is problem in the United States, this may not be
to identify interventions being researched the case in other cultural settings. For example,
outside of the United States for students with although Portuguese schools are concerned
behavior disorders. Despite searching over about classroom disruption, this concern is at
4,000 articles published over 6 years, only 11 a different level than that experienced in the
studies met the criteria set forth at the outset United States which is perceived by some as a
of this review. The fact that 6 of those studies more aggressive society (Lopes, 2001).
reported on therapeutic treatments contrasts Although the majority of research on
sharply with the majority of studies published behavioral interventions is performed in
in the United States on intervention for students the United States, it is important that all
with EBD, which focus primarily on academic
researchers and practitioners be open to various
and behavioral interventions (Mooney et al.,
interventions and research not practiced in
2003; Stage & Quiroz, 1997).
their respective countries. For example, the
The keywords specified in the methods
United States should remain receptive to
section produced a very small percentage of
successful interventions not yet practiced in
relevant articles, but numerous articles had
related areas of interest worth noting. Recurring this country. At the same time, due to cultural
topics included bullying; teacher, parent, and differences and schooling practices around the
student perceptions and attitudes; parent world, effective interventions implemented
training interventions; and comments and in one country may not work for students in
analysis on the inclusion movement primarily another.
in Europe. In addition, there were numerous It may be argued that although choice of
articles describing programs, longitudinal methodology and instrument selection for
studies, policies, practices, self-reports, a study reflects the emphasis placed on the
opinion papers, and qualitative narratives about scientific process in a given nation, it also
students with behavior disorders. Articles on reflects the standard accepted for indicating
students with ADHD, intellectual disabilities, a successful intervention. For example,
and severe disabilities were also found using in Portugal, quantitative measurement is
the keywords for this study. Numerous articles not commonly used since it is believed
discussed the influence of parenting styles as a to discriminate (Lopes, 2001). Differing
negative factor in children’s behavior problems. emphases such as measurement in the United
Overall, the abundance of articles on the topic States versus using qualitative indexes outside
of behavioral problems clearly illustrates that the United States may explain the very small
despite the scarcity of quantitative studies number of quantitative studies found for this
published worldwide, other nations view international review. Because of cultural
the topic of behavior problems in schools as differences, it would be unfair to judge or
critical. compare standards set in various nations or to
A general theme that emerged from this state that one nation’s standard is better than
review is the emphasis some countries place
another. However, this review does indicate
on interventions that use holistic treatments
that there are differences in intervention
and therapeutic nurturing environments. This
research for children with behavior disorders
emphasis differs from the current American
conducted throughout the international
emphasis on changing behavior through
community. Overall, there is great variability
principles of applied behavior analysis,
functional behavior assessments, and a in how the selected studies were conducted
three-tiered positive behavior support plan. and reported. In the United States, replication
This difference in interventions shows that is a hallmark of scientific research. Yet very
scientific focus tends to reflect the culture few of the international studies cited in this
from which it emerges. It is possible that review describe the subjects and intervention
behavior modification is popular in the United procedure in enough detail to replicate the
States due to a practical culture which differs study. In addition to the difficulties in research
from reflexive or internalized cultures of other that this causes, its secondary effect is that
countries found in Europe or the Confucian educators cannot implement this research
cultures of some Asian countries (Lopes, 2001). unless more detailed information is reported
In addition, although behavior problems in in future studies.

278 / August 2007 Behavioral Disorders, 32 (4), 267-281

Limitations of the Review addition, the articles may not be included
in larger databases or there may simply not
Several limitations of this literature review be substantial research being conducted on
must be mentioned. One limitation is the this topic in those regions. In order to aid in
scope of the selection criteria. Focusing international research it would be helpful to
on quantitative studies eliminated a large identify and document intervention practices
portion of international research and reports commonly used for children with behavior
on interventions for students with behavior problems around the world.
disorders. Many published articles from
outside the United States offered narrative
descriptions of programs and practices or Implications for Future Research
attempted to use qualitative methodology.
The results from this international literature
These studies should be considered for follow-
review confirm that there is a paucity of
up research. A second limitation is the selection
research- based interventions for children
of interventions targeting students. Numerous
with behavior disorders outside the United
studies targeting parents and teachers for
States. Only eight programs out of a search
intervention and training were found but
of over 4,000 articles over 6 years were
excluded. A third limitation is the number of
databases and journals searched for this study. identified that provided quantitative evidence
Expanding these searches could potentially of effective interventions with this population
identify additional studies that would meet the of students. This paucity is not simply the
selection criteria for inclusion in this review. result of a restriction of the literature review
This limitation was set due to the availability to the English language. Although language
of time and resources to conduct the research. restrictions are certainly relevant, numerous
Time also affected interrater reliability measures nations that participate in English-language
since only selected articles were reviewed publications such as Australia, Canada,
and not the overall research procedures. A England, and several countries in Latin America
fourth limitation is the design and features express a need for effective interventions
available in the database search engine. Some for their students with behavior disorders.
database indexes provided advanced search Therefore, the lack of international research is
features allowing a researcher to target articles a probable explanation for the small amount
if keywords entered were found in article of documented research. Future research
abstracts, supplied descriptors, full text, or should begin with an assessment of the types
in other parts of the article. A few databases of programs and interventions currently used
provided additional descriptors to narrow the with this population internationally.
search results to articles that were quantitative The United States has produced numerous
or qualitative or included adults, children, studies, reviews, and meta-analyses identifying
or adolescents. Other database indexes did interventions effective for American students.
not offer these features and only allowed a International researchers should consider
limited number of keywords. This variability whether these strategies might be suitable for
in features made consistency in searches replication and testing with students around
difficult. In order for results to be replicable, the globe. Similarly, there is strong potential
all searches were conducted via identical for students in the United States to benefit from
methods and procedures except where noted. greater researcher awareness of interventions
We discovered that researchers must often from other countries. Future research on
seek the lowest common denominator when behavior disorders should be conducted and
planning literature reviews using multiple reported with an emphasis on the scientific
databases. A fifth limitation of this review process. Overall, expectation for treatment
is in its international scope because it only integrity and positive outcomes for students
reviewed one article from South America must be elevated. Students with behavior
and one article from Asia. There were disorders are not endemic to any one nation
no articles reviewed from Africa, Central or period in time. Whatever the country of
America, Eastern Europe, or the Middle East. origin, researchers should invest the time
This may be because articles published from and resources necessary to identify and use
these regions are not in English language effective interventions for students with EBD
journals or journals from these regions may and then share the results with practitioners
not be available to American readers. In around the world.

Behavioral Disorders, 32 (4), 267-281 August 2007 / 279

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Modification, 15, 74–94. We gratefully acknowledge the assistance of Aydin
Spalding, B. (2000). The contribution of ‘Quiet Place’ Bal in delineating search and selection procedures
to early intervention strategies for children for this research study as well as Robert B. Rutherford
with emotional and behavioural difficulties in for helpful comments on earlier versions of this
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of interventions to decrease disruptive classroom
behavior in public education settings. School MANUSCRIPT
Psychology Review, 26, 333–368. Acceptance: 8/14/07

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