Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S., Wang, W., Toyinbo, P., et al. (2008). Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes. Drug and Alcohol Dependence, 95(Suppl. 1), S5-S28. 
Mackenzie, A. C., Lurye, I., & Kellam, S. G. (2008). History and evolution of the Good Behavior Game. Supplementary materials for the article "Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes."
Petras, H., Kellam, S. G., Brown, C. H., Muthen, B. O., Ialongo, N. S., & Poduska, J. M. (2008). Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms. Drug and Alcohol Dependence, 95(Suppl. 1), S45-S59.
Supplementary Materials Brown, C. H., Wang, W., Kellam, S. G., Muthen, B. O., Petras, H., Toyinbo, P., et al. (2008). Methods for testing theory and evaluating impact in randomized field trials: Intent-to-treat analyses for integrating the perspectives of person, place, and time. Drug and Alcohol Dependence, 95(Suppl. 1), S74-S104.
Kellam, S. G., Ling, X., Merisca, R., Brown, C. H., & Ialongo, N. (1998). The effect of the level of aggression in the first grade classroom on the course and malleability of aggressive behavior into middle school. Development and Psychopathology, 10(2), 165-185.
Kessler, R. C., Wittchen, H. U., Abelson, J. M., McGonagle, K. A., Schwartz, N., Kendler, K. S., et al. (1998). Methodological studies of the Composite International Diagnostic Interview (CIDI) in the U.S. National Comorbidity Survey. International Journal of Methods in Psychiatry Research, 7, 33-55.
Lochman, J. E., & the Conduct Problems Prevention Research Group. (1995). Screening of child behavior problems for prevention programs at school entry. Journal of Consulting and Clinical Psychology, 63(4), 549-559.
Poduska, J. M., Kellam, S. G., Wang, W., Brown, C. H., Ialongo, N. S., & Toyinbo, P. (2008). Impact of the Good Behavior Game, a universal classroom-based behavior intervention, on young adult service use for problems with emotions, behavior, or drugs or alcohol. Drug and Alcohol Dependence, 95(Suppl. 1), S29-S44.
Turner, R. J., & Gil, A. G. (2002). Psychiatric and substance use disorders in South Florida: Racial/ethnic and gender contrasts in a young adult cohort. Archives of General Psychiatry, 59(1), 43-50.
Wittchen, H. U. (1994). Reliability and validity studies of the WHO--Composite International Diagnostic Interview (CIDI): A critical review. Journal of Psychiatric Research, 28(1), 57-84.
Outcomes
| Outcome 1: Drug abuse/dependence disorders |
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Description of Measures
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Drug abuse/dependence disorders (DSM-IV criteria) were measured by the University of Michigan version of the Composite International Diagnostic Interview (UM-CIDI). The standard CIDI, administered by a layperson, is a structured psychiatric interview designed to minimize clinical judgment when eliciting diagnostic information and recording responses. The original, standard CIDI used diagnostic criteria consistent with both DSM-III-R and International Statistical Classification of Diseases and Related Health Problems, 9th Revision (ICD-9), coding systems and included a substance abuse module to address alcohol, tobacco, and other drug use/abuse. The UM-CIDI, a shortened, 90-minute version of the standard CIDI, addresses fewer clinical diagnoses, includes commitment and motivation probes, and places diagnostic probe questions at the beginning of the interview. The version of the UM-CIDI used in the study is consistent with DSM-IV and ICD-10 criteria for certain clinical diagnoses. The instrument measured the occurrence of lifetime, past-year, and past-month drug abuse/dependence disorders.
To assess the moderating effects of aggressive, disruptive behavior in the 1st grade on drug abuse/dependence disorders in young adulthood, the Authority Acceptance subscale of the Teacher Observation of Classroom Adaptation--Revised (TOCA-R) instrument was used to measure baseline aggressive, disruptive behaviors for each 1st-grade child during the initial 6 weeks of the school year. The TOCA-R is a 2-hour, structured interview administered by trained interviewers to teachers who rate each student's in-classroom behavior across three subscales: Authority Acceptance, Social Contact, and Cognitive Concentration. The Authority Acceptance subscale, which measures aggressive, disruptive behavior, consists of 10 items: breaks rules, breaks things, fights, harms others, harms property, lies, stubborn, teases classmates, takes others' property, and yells at others. The teacher rates each item on a 6-point Likert-type scale that ranges from 1 (almost never) to 6 (almost always).
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Key Findings
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A 2-year field trial randomly assigned 19 primary schools with 41 1st-grade classrooms to 1 of 3 conditions: GBG added to the standard 1st- and 2nd-grade curricula, a reading instruction program known as Mastery Learning added to the standard curricula, or the standard curricula (external control). Within each GBG- or Mastery Learning-designated school, all 1st-grade classrooms/teachers were also randomly assigned to either the active intervention or the standard curriculum (internal control). The TOCA-R was administered at baseline, and the UM-CIDI was administered at follow-up, 14 years after the intervention (at ages 19-21 years). For participants in Mastery Learning classrooms, only baseline data were collected. Findings from this study included the following:
- The percentage of participants at the 14-year follow-up with a drug abuse/dependence disorder was lower among those assigned to GBG classrooms (12%) than internal control classrooms (21%; p = .04) and all control classrooms/schools (19%; p = .03), unadjusted for baseline aggressive, disruptive behavior or for classroom in 1st grade.
- The percentage of male participants at the 14-year follow-up with a drug abuse/dependence disorder was lower among those assigned to GBG classrooms (19%) than internal control classrooms (38%; p = .01) and all control classrooms/schools (30%; p = .05), unadjusted for baseline aggressive, disruptive behavior or for classroom in 1st grade.
- Among the more aggressive, disruptive males in 1st grade (12% with a score of >3.5 on the TOCA-R Authority Acceptance subscale), the percentage at the 14-year follow-up with a drug abuse/dependence disorder was lower among those assigned to GBG classrooms (29%) than internal control classrooms (83%; p = .02) and all control classrooms/schools (68%; p = .02), unadjusted for baseline aggressive, disruptive behavior or for classroom in 1st grade.
- At the 14-year follow-up, compared with males assigned to GBG classrooms, males assigned to internal control classrooms were about 2.7 times more likely to have a drug abuse/dependence disorder (log odds ratio = 0.999; p = .035) and about 3.4 times more likely to have a drug abuse/dependence disorder after controlling for baseline depression symptoms (log odds ratio = -1.216; p = .008). These group differences were associated with small and medium effect sizes (odds ratio = 2.72 and 3.37), respectively.
- At the 14-year follow-up, males assigned to GBG classrooms had lower rates of drug abuse/dependence disorders than males assigned to all control classrooms/schools (p = .035) after controlling for baseline aggressive, disruptive behavior.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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| Outcome 2: Alcohol abuse/dependence disorders |
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Description of Measures
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Alcohol abuse/dependence disorders (DSM-IV criteria) were measured by the UM-CIDI. The standard CIDI, administered by a layperson, is a structured psychiatric interview designed to minimize clinical judgment when eliciting diagnostic information and recording responses. The original, standard CIDI used diagnostic criteria consistent with both DSM-III-R and ICD-9 coding systems and included a substance abuse module to address alcohol, tobacco, and other drug use/abuse. The UM-CIDI, a shortened, 90-minute version of the standard CIDI, addresses fewer clinical diagnoses, includes commitment and motivation probes, and places diagnostic probe questions at the beginning of the interview. The version of the UM-CIDI used in the study is consistent with DSM-IV and ICD-10 criteria for certain clinical diagnoses. The instrument measured the occurrence of lifetime, past-year, and past-month alcohol abuse/dependence disorders.
To assess the moderating effects of aggressive, disruptive behavior in the 1st grade on alcohol abuse/dependence disorders in young adulthood, the Authority Acceptance subscale of the TOCA-R was used to measure baseline aggressive, disruptive behaviors for each 1st-grade child during the initial 6 weeks of the school year. The TOCA-R is a 2-hour, structured interview administered by trained interviewers to teachers who rate each student's in-classroom behavior across three subscales: Authority Acceptance, Social Contact, and Cognitive Concentration. The Authority Acceptance subscale, which measures aggressive, disruptive behavior, consists of 10 items: breaks rules, breaks things, fights, harms others, harms property, lies, stubborn, teases classmates, takes others' property, and yells at others. The teacher rates each item on a 6-point Likert-type scale that ranges from 1 (almost never) to 6 (almost always).
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Key Findings
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A 2-year field trial randomly assigned 19 primary schools with 41 1st-grade classrooms to 1 of 3 conditions: GBG added to the standard 1st- and 2nd-grade curricula, a reading instruction program known as Mastery Learning added to the standard curricula, or the standard curricula (external control). Within each GBG- or Mastery Learning-designated school, all 1st-grade classrooms/teachers were also randomly assigned to either the active intervention or the standard curriculum (internal control). The TOCA-R was administered at baseline, and the UM-CIDI was administered at follow-up, 14 years after the intervention (at ages 19-21 years). For participants in Mastery Learning classrooms, only baseline data were collected. Findings from this study included the following:
- The percentage of participants at the 14-year follow-up with a lifetime alcohol abuse/dependence disorder was lower for those assigned to GBG classrooms than all control classrooms/schools (13% vs. 29%; p = .03), unadjusted for baseline aggressive, disruptive behavior.
- At the 14-year follow-up, participants assigned to GBG classrooms had lower rates of lifetime alcohol abuse/dependence disorders than those assigned to internal control classrooms (p < .05). Compared with participants assigned to GBG classrooms, those assigned to internal control classrooms were about twice as likely to have an alcohol abuse/dependence disorder (p = .045). This group difference was associated with a small effect size (odds ratio = 2.01).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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| Outcome 3: Regular cigarette smoking |
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Description of Measures
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Regular cigarette smoking, defined as smoking more than 10 cigarettes per day, was measured by the UM-CIDI. The standard CIDI, administered by a layperson, is a structured psychiatric interview designed to minimize clinical judgment when eliciting diagnostic information and recording responses. The original, standard CIDI used diagnostic criteria consistent with both DSM-III-R and ICD-9 coding systems and included a substance abuse module to address alcohol, tobacco, and other drug use/abuse. The UM-CIDI, a shortened, 90-minute version of the standard CIDI, addresses fewer clinical diagnoses, includes commitment and motivation probes, and places diagnostic probe questions at the beginning of the interview. The version of the UM-CIDI used in the study is consistent with DSM-IV and ICD-10 criteria for certain clinical diagnoses.
To assess the moderating effects of aggressive, disruptive behavior in the 1st grade on regular cigarette smoking in young adulthood, the Authority Acceptance subscale of the TOCA-R was used to measure baseline aggressive, disruptive behaviors for each 1st-grade child during the initial 6 weeks of the school year. The TOCA-R is a 2-hour, structured interview administered by trained interviewers to teachers who rate each student's in-classroom behavior across three subscales: Authority Acceptance, Social Contact, and Cognitive Concentration. The Authority Acceptance subscale, which measures aggressive, disruptive behavior, consists of 10 items: breaks rules, breaks things, fights, harms others, harms property, lies, stubborn, teases classmates, takes others' property, and yells at others. The teacher rates each item on a 6-point Likert-type scale that ranges from 1 (almost never) to 6 (almost always).
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Key Findings
|
A 2-year field trial randomly assigned 19 primary schools with 41 1st-grade classrooms to 1 of 3 conditions: GBG added to the standard 1st- and 2nd-grade curricula, a reading instruction program known as Mastery Learning added to the standard curricula, or the standard curricula (external control). Within each GBG- or Mastery Learning-designated school, all 1st-grade classrooms/teachers were also randomly assigned to either the active intervention or the standard curriculum (internal control). The TOCA-R was administered at baseline, and the UM-CIDI was administered at follow-up, 14 years after the intervention (at ages 19-21 years). For participants in Mastery Learning classrooms, only baseline data were collected. Findings from this study included the following:
- At the 14-year follow-up, the percentage of regular cigarette smokers was lower among those assigned to GBG than all control classrooms/schools (6% vs. 14%; p = .002), unadjusted for baseline aggressive, disruptive behavior.
- At the 14-year follow-up, the percentage of males who were regular cigarette smokers was lower among those assigned to GBG classrooms (6%) than internal control classrooms (19%; p = .03) and all control classrooms/schools (20%; p = .004), unadjusted for baseline aggressive, disruptive behavior.
- Among the more aggressive, disruptive males in 1st grade (12% with a score of >3.5 on the TOCA-R Authority Acceptance subscale), none assigned to GBG classrooms were regular cigarette smokers at the 14-year follow-up compared with 40% of those assigned to internal control classrooms (p = .008) and 25% of those assigned to all control classrooms/schools (p = .03), unadjusted for classroom in 1st grade.
- At the 14-year follow-up, males assigned to GBG classrooms were less likely to report regular smoking than those assigned to internal control classrooms (p = .03), unadjusted for baseline aggressive, disruptive behavior and classroom in 1st grade; this relationship was more pronounced among males with higher levels of baseline aggressive, disruptive behavior (p = .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.1
(0.0-4.0 scale)
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| Outcome 4: Antisocial personality disorder |
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Description of Measures
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ASPD (DSM-IV criteria) was measured by the UM-CIDI. The standard CIDI, administered by a layperson, is a structured psychiatric interview designed to minimize clinical judgment when eliciting diagnostic information and recording responses. The original, standard CIDI used diagnostic criteria consistent with both DSM-III-R and ICD-9 coding systems and included a substance abuse module to address alcohol, tobacco, and other drug use/abuse. The UM-CIDI, a shortened, 90-minute version of the standard CIDI, addresses fewer clinical diagnoses, includes commitment and motivation probes, and places diagnostic probe questions at the beginning of the interview. The version of the UM-CIDI used in the study is consistent with DSM-IV and ICD-10 criteria for certain clinical diagnoses. The instrument measured the occurrence of lifetime, past-year, and past-month ASPD.
To assess the moderating effects of childhood aggressive, disruptive behavior patterns on ASPD in young adulthood, the Authority Acceptance subscale of the TOCA-R was used to measure aggressive, disruptive behaviors for each 1st-grade child during the initial 6 weeks of the school year and each year thereafter through 7th grade. The TOCA-R is a 2-hour, structured interview administered by trained interviewers to teachers who rate each student's in-classroom behavior across three subscales: Authority Acceptance, Social Contact, and Cognitive Concentration. The Authority Acceptance subscale, which measures aggressive, disruptive behavior, consists of 10 items: breaks rules, breaks things, fights, harms others, harms property, lies, stubborn, teases classmates, takes others' property, and yells at others. The teacher rates each item on a 6-point Likert-type scale that ranges from 1 (almost never) to 6 (almost always). Three patterns of Authority Acceptance subscale scores for aggressive, disruptive behavior in grades 1-7 were derived:
- The persistent high pattern of scores started at 4.0 in 1st grade, increased in 3rd or 4th grade, and decreased through 7th grade to just below 3.0.
- The escalating medium pattern of scores started above 2.0 in 1st grade and increased gradually through 7th grade but remained below 3.0.
- The stable low pattern of scores started at about 1.5 in 1st grade and remained at or slightly above 1.5 through 7th grade.
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Key Findings
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A 2-year field trial randomly assigned 19 primary schools with 41 1st-grade classrooms to 1 of 3 conditions: GBG added to the standard 1st- and 2nd-grade curricula, a reading instruction program known as Mastery Learning added to the standard curricula, or the standard curricula (external control). Within each GBG- or Mastery Learning-designated school, all 1st-grade classrooms/teachers were also randomly assigned to either the active intervention or the standard curriculum (internal control). The TOCA-R was administered at baseline and each year through grade 7, and the UM-CIDI was administered at follow-up, 14 years after the intervention (at ages 19-21 years). For participants in Mastery Learning classrooms, only baseline data were collected. Findings from this study included the following:
- At the 14-year follow-up, the percentage of participants with ASPD was lower among those assigned to GBG classrooms than all control classrooms/schools (17% vs. 25%; p = .03), unadjusted for baseline aggressive, disruptive behavior.
- Among the more aggressive, disruptive males in 1st grade (12% with scores of >3.5 on the TOCA-R Authority Acceptance subscale), the percentage with ASPD at the 14-year follow-up was lower among those assigned to GBG classrooms than internal control classrooms (38% vs. 70%; p = .05), unadjusted for baseline depression symptoms or baseline aggressive, disruptive behavior.
- At the 14-year follow-up, males assigned to GBG classrooms had a lower prevalence of ASPD than those assigned to internal control classrooms; this relationship was more pronounced among males with higher levels of baseline aggressive, disruptive behavior (p = .028).
- Among males with a persistent high pattern of aggressive, disruptive behavior in grades 1-7, 40% of those assigned to GBG classrooms had ASPD at the 14-year follow-up compared with 100% of those assigned to internal control classrooms (p < .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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| Outcome 5: Violent and criminal behavior |
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Description of Measures
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Violent and criminal behavior was measured using juvenile court and adult incarceration records. Juvenile court records for violent crimes (e.g., assault, rape) were obtained from local records in Baltimore City. Records of adult incarceration were accessed through the Uniform Crime Reports system, which tracks data on felony offenses (e.g., murder, nonnegligent manslaughter, forcible rape, robbery, aggravated assault, burglary, larceny-theft, motor vehicle theft).
Antisocial personality disorder (DSM-IV criteria) was measured by the UM-CIDI. The standard CIDI, administered by a layperson, is a structured psychiatric interview designed to minimize clinical judgment when eliciting diagnostic information and recording responses. The original, standard CIDI used diagnostic criteria consistent with both DSM-III-R and ICD-9 coding systems and included a substance abuse module to address alcohol, tobacco, and other drug use/abuse. The UM-CIDI, a shortened, 90-minute version of the standard CIDI, addresses fewer clinical diagnoses, includes commitment and motivation probes, and places diagnostic probe questions at the beginning of the interview. The version of the UM-CIDI used in the study is consistent with DSM-IV and ICD-10 criteria for certain clinical diagnoses. The instrument measured the occurrence of lifetime, past-year, and past-month ASPD.
To assess the moderating effects of childhood aggressive, disruptive behavior patterns on violent and criminal behavior in young adulthood, the Authority Acceptance subscale of the TOCA-R was used to measure aggressive, disruptive behaviors for each 1st-grade child during the initial 6 weeks of the school year and each year thereafter through 7th grade. The TOCA-R is a 2-hour, structured interview administered by trained interviewers to teachers who rate each student's in-classroom behavior across three subscales: Authority Acceptance, Social Contact, and Cognitive Concentration. The Authority Acceptance subscale, which measures aggressive, disruptive behavior, consists of 10 items: breaks rules, breaks things, fights, harms others, harms property, lies, stubborn, teases classmates, takes others' property, and yells at others. The teacher rates each item on a 6-point Likert-type scale that ranges from 1 (almost never) to 6 (almost always). Three patterns of Authority Acceptance subscale scores for aggressive, disruptive behavior in grades 1-7 were derived:
- The persistent high pattern of scores started at 4.0 in 1st grade, increased in 3rd or 4th grade, and decreased through 7th grade to just below 3.0.
- The escalating medium pattern of scores started above 2.0 in 1st grade and increased gradually through 7th grade but remained below 3.0.
- The stable low pattern of scores started at about 1.5 in 1st grade and remained at or slightly above 1.5 through 7th grade.
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Key Findings
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A 2-year field trial randomly assigned 19 primary schools with 41 1st-grade classrooms to 1 of 3 conditions: GBG added to the standard 1st- and 2nd-grade curricula, a reading instruction program known as Mastery Learning added to the standard curricula, or the standard curricula (external control). Within each GBG- or Mastery Learning-designated school, all 1st-grade classrooms/teachers were also randomly assigned to either the active intervention or the standard curriculum (internal control). Data were collected with the TOCA-R at baseline and each year through grade 7, and data were collected from juvenile court and adult incarceration records and with the UM-CIDI at follow-up, 14 years after the intervention (at ages 19-21 years). For participants in Mastery Learning classrooms, only baseline data were collected.
Among male participants with a persistent high pattern of aggressive, disruptive behavior in grades 1-7, a smaller percentage of those assigned to GBG than internal control classrooms had both ASPD and a record of violent and criminal behavior at the 14-year follow-up (34% vs. 50%; p < .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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6-12 (Childhood)
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50.1% Male
49.9% Female
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67.2% Black or African American
30.8% White
1.4% American Indian or Alaska Native
0.3% Hispanic or Latino
0.2% Asian
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Drug abuse/dependence disorders
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3.0
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4.0
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2.0
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3.0
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3.0
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4.0
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3.2
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2: Alcohol abuse/dependence disorders
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3.0
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4.0
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2.0
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3.0
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3.0
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4.0
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3.2
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3: Regular cigarette smoking
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3.0
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3.5
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2.0
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3.0
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3.0
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4.0
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3.1
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4: Antisocial personality disorder
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3.0
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4.0
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2.0
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3.3
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3.0
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4.0
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3.2
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5: Violent and criminal behavior
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3.5
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3.5
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2.0
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3.0
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3.0
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4.0
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3.2
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Study Strengths Independent investigators have demonstrated high test-retest reliability and inter-interviewer reliability in general for the UM-CIDI, with high convergent validity across ICD-10 and DSM-IV diagnostic coding systems. Considerable effort was expended to ensure high UM-CIDI inter-interviewer reliability in the study. The cutoff for regular cigarette smoking was based on national, age-adjusted statistics from the Centers for Disease Control and Prevention's Vital and Health Statistics for 2005-2007. GBG 1st- and 2nd-grade teachers for the original cohort received 40 hours of training followed by biweekly monitoring, used a teacher's log/chart of GBG periods played, and received supportive mentoring throughout the school year. There was a relatively low attrition rate (25%) during the 14-year period between the end of the intervention and the follow-up; the minimal differential attrition across the intervention and control groups was handled statistically by a sophisticated multiple imputation approach. Schools matched on size and demographics were randomly assigned to either the intervention or control condition, students entering 1st grade were sequentially assigned to classrooms within each school to achieve matching on kindergarten experience and academic and behavioral performance, and teachers/classrooms within intervention schools were randomly assigned to either the intervention or control condition. Highly sophisticated, state-of-the-art statistical approaches were used to model the data at each level of randomization using an intent-to-treat approach.
Study Weaknesses Study sample test-retest reliability and inter-interviewer reliability statistics on the UM-CIDI were not available, and there was no audiotaping of the 14-year follow-up telephone assessment for subsequent review by supervisors. The researchers did not measure GBG implementation fidelity (i.e., adherence, dosage, quality of delivery, participation responsiveness). The extent to which TOCA-R interviewers were aware of classroom condition was uncertain. The single, point prevalence follow-up study design limited mediational modeling of the data for three of the five outcomes.
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