Game Changer? Findings of a Randomized Controlled Trial to Assess the Impact of the Good Behavior Game on Children's Mental Health and Related Outcomes

Introduction: The Good Behavior Game (GBG) is a universal behavior management intervention in which children are rewarded for following four class rules: (1) we will work quietly; (2) we will be polite to others; (3) we will get out of seats with permission; and (4) we will follow directions. It has an extensive evidence base in relation to improved behavioral outcomes (e.g. reduced disruption; Flower et al, 2014). However, the UK evidence base is extremely sparse, and relatively little is known about its impact on children's mental health (conduct problems, emotional symptoms, psychological wellbeing) and related outcomes (bullying, peer and social support, school connectedness) among either the general or at-risk school population.

Methods: 77 schools were randomly allocated to deliver the GBG for two years (n=38) or continue with their usual practice (n=39). Participants were N=3,084 children aged 6-7 at baseline. Conduct problems and emotional symptoms were assessed using the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). Psychological wellbeing, bullying, peer and social support, and school connectedness were assessed via the Kidscreen-27 survey (Kidscreen Group, 2006). Following Kellam et al (1994), our at-risk subgroup were boys who scored in the borderline or abnormal range of the SDQ conduct problems scale at baseline. Dosage data (total number of minutes played in the GBG) was used as a proxy for intervention compliance.

Results: Analysis is on-going at the time of submission. In brief, intention-to-treat (ITT) and subgroup analyses are being conducted using two-level (school, child) hierarchical-level models with fixed effects and random intercepts in MLWin. Missing data are being addressed via multiple imputation in REALCOM-Impute. Complier average causal effect (CACE) estimation in MPlus will be undertaken to robustly ascertain the effects of moderate (50th percentile) and high (75th percentile) compliance on intervention effects.

Conclusions: Our findings will contribute significantly to the GBG evidence base, and more broadly, the field of school-based prevention, by reporting not just 'what works', but 'for whom' and 'how/why'.