1 Graduate School of Childhood Development and Education
The effectiveness of a social skills training using
video modeling for children aged 8-12 years
Research Master Child Development and Education Thesis 2
Melissa Goossens (10002014) Supervisors:
dr. F.J.A. van Steensel dr. L. Jongerden prof. dr. S.M. Bögels July, 2016
2 Abstract
This study investigated the effectiveness of a social skills training using video modeling for children having social skills deficits. Participants of this study were 11 families of which the children aged 8-12 years (63.6% boys; mean age 9.81) followed a 12 weekly social skills training at academic treatment centre UvA minds located in Amsterdam. All children were diagnosed with a DSM-IV-TR disorder: ADHD (63.3%), anxiety disorder (9.1%), behavioral problems (9.1%) or another disorder of childhood not otherwise specified (18.2%). Of the 11 participating families, 10 children (mean age = 9.81), 10 mothers (mean age = 44.30) and 8 fathers (mean age = 44.50) filled in questionnaires before, during and after the training. In addition, every week both the children and their parents rated improvement with regard to their treatment goals as listed before the training. The results of the treatment goals suggest that social skills training can be effective in achieving individual treatment goals. However, no significant improvement was found for parent completed questionnaires measuring child behavior problems or prosocial behavior, but effect sizes were medium, ranging from η2 = 0.010 to 0.162. According to the children’s self-report, prosocial behavior was increased after the training (d = 0.925), but self-esteem did not change (d = 0.364). To study the possible beneficial effects of video-modeling, it is recommended to use a randomized control trial in future studies in which one group receives video modeling and the other group does not. Further, it is recommended to include longer term follow-ups, as it may take some time before learned skills are implemented in daily social interactions.
Key words: social skills training, video modeling, video feedback, child behavior problems, social skills, self-esteem, prosocial behavior, effectiveness.
3 Introduction
According to Segrin (1992; 2000) and Spitzberg and Cupach (1985;1989) having good social skills is the ability to interact with other people in a way that is effective and appropriate, in which appropriateness is seen as behavior that is accepted by others and in line with social norms, values, or expectations (Segrin & Givertz, 2003). Children with social skills deficits have difficulties in creating and maintaining satisfying relationships, taking turns in games or in conversation, making eye-contact, and in understanding what other people feel or think (Elliot, Sheridan, & Gresham, 1989). Social skills deficits are particular prominent in children with autism spectrum disorder (Simonoff et al., 2008) and attention deficit hyperactivity disorder (Nijmeijer et al., 2008; Wehmeier, Schacht, & Barkley, 2010), but also for children with other disorders (e.g., anxiety disorders) social skills deficits have been found (Frankel & Feinberg, 2002; Rao et al., 2007). For children that have a disorder, the social problems can further impair daily functioning, quality of life and well-being over and above the disorder specific symptoms (Gantman, Kapp, Orenski, & Laugeson, 2012; Mikami, Jia, & Jiwon Na, 2014).
Since the end of the seventies, many intervention programs aimed at improving social skills were developed (Combs & Slaby, 1977). An often-used intervention to improve social skills is social skills training (SST). Many studies show that SST for children and young people is effective (Bellini, Peters, Brenner & Hopf, 2007; Erwin, 2007). That is, studies showed promising results in improving social behavior (DeRosier et al., 2011; White, Koenig, & Scahill; 2007;2010) with Cohen’s d effect sizes ranging from .51 to .94. In addition, SST showed some good results in improving self-esteem (Durlak, Weissberg & Pachan, 2010; Fox & Boulton, 2003) and a decrease in both internalizing and externalizing behavior problems (Durlak et al., 2010; Wilhite & Bullock, 2012). The results of SST targeting victimization of bullying are mixed; while some studies (Fox & Boulton, 2003) found no significant
4 differences in terms of victim status (Fox & Boulton, 2003), other studies found significant improvement for victims of bullying, when the programs were intensive and long-lasting (Ttofi & Farrington, 2011).
Although SST has proven its effectiveness, critical notes are that the effect sizes are only small to medium (Quinn, Kavale, Mathur, Rutherford, & Forness, 1999; Wang & Spillane, 2009), and heterogeneity in outcome across studies and individuals is large (Kasari et al., 2011; Lord et al., 2005; Maag, 2006). Further, the treatment ingredients vary across the different SST interventions which may account for differences in effects across studies. One treatment ingredient of SST that has been proven highly effective is video modeling. Video modeling is a teaching strategy in which the child watches a video of someone other than himself demonstrating a specific skill or social situation appropriately. The goal of video modeling is to target a change in the child’s behavior, which will increase his ability to successfully demonstrate a skill or act appropriately in a social situation (Murray & Noland, 2013). Previous research has shown that video modeling is effective for teaching and improving a variety of skills to children and adolescents (with autism spectrum disorders), including social skills (Bellini & Akullian, 2007; Charlop-Christy, Le, & Freeman, 2000; Delano, 2007; Wang, Cui, & Parrila, 2011). Therefore, adding this component to (regular) SST may be beneficial for treatment effectiveness.
This study is a pilot of a social skills training using video modeling for children having social difficulties. The main aim of the study is to examine its effectiveness on a range of outcome measures: social skills, self-esteem, problem behavior, bullying behavior, and individual treatment goals. With respect to the latter, from previous studies it is known that there is a lot of heterogeneity in the groups of children following SST and in the social difficulties they have (Kasari et al., 2011; Lord et al., 2005; Maag, 2006), therefore, a more individualistic method of examining results seems preferable.
5 Method
Participants
Participants of this study were children between 8 till 12 years old having limitations in the social field, such as social anxiety or shyness, difficulties entering into social contact, having few friends or because the child was bullied. The children followed SST at the academic treatment centre UvA minds located in Amsterdam. No explicit in- or exclusion criteria was applied, however the practitioner of UvA minds decided in consultation with the clinical team if the child was eligible for SST based on the clinical information gathered from diagnostic process (e.g., intake, interviews, observations of the child, questionnaires from parents and teachers).
In total, 11 families were included of which 10 (91.7%) mothers, 8 (66.7%) fathers and 10 children (83.3%) filled in the questionnaires. The sample consisted of 7 boys (63.6%) and 4 girls (36.4%), with a mean age of 9.81 years old (SD = 1.08). From the 11 children, 6 (63.3%) children had an ADHD diagnosis. Other DSM-IV-TR diagnoses were: an anxiety disorder (9.1%), behavioral problems (9.1%) or another disorder of childhood not otherwise specified (18.2%). Also, 18.2% of the children had a comorbid disorder, namely one child had both a ADHD diagnosis and another disorder of childhood not otherwise specified, and one child had an ADHD disorder and an anxiety disorder. Child DSM-IV-TR diagnosis was based on evaluations with the child and parents, checking developmental history, observations, and psychological assessments.
All of the children attended primary school, and more than half of the children had a Dutch ethnic background (63.3%) and lived with both of their parents (54.5%). The average IQ-score of the children was 105.89 and ranged from 85 to 126 (N = 9, SD = 13.53). The mothers’ average age was 44 years (SD = 5.50) and the fathers’ average age was 45 years (SD
6 = 5.32). The average social economic status (SES) of the parents was middle to middle-high, see Table 1.
Table 1
Demographic characteristics of children, fathers and mothers Children (N = 11) Fathers (N = 8) Mothers (N = 10) Age (yrs) Mean 9.81 44.50 44.30 Range 8-11 37-51 34-50 Sex Male 7 (63.6) Female 4 (36.4) Ethnicity Dutch 7 (63.3) 6 (75.0) 6 (60.0) Mixed 3 (27.3) Other 1 (9.1) 2 (25.0) 4 (40.0) Education level 1 5.67 6.20
Note. The education level ranges from 1-7. 1 = Primary School; 7 = University Degree.
Procedure
The practitioner of UvA minds decided in consultation with the clinical team if the child was eligible for SST. When this was the case, the family (child and his or her parents) was asked to participate in the study. If the child and parents agreed, the researcher was informed (if parents and children did not agree, the same treatment could still be carried out, however, the family was not participating in the study). From three training groups involving 17 children in total, 11 families (64.7%) participated.
7 Parents and the child had to fill in several questionnaires at four
measurement-moments: (1) during waiting list, (2) prior to the training (pretest), (3) after 6 weeks, and (4) after 12 weeks (immediately after training, posttest). In addition to the four research
measurements, every week both the parents and the child had to rate the progress of the child on the ‘treatment goals’. The individual treatment goals were made during a pre-treatment session with the trainer, child and parents present and were discussed until everyone agreed with these goals. A maximum of five goals could be listed.
The intervention
The social skills training is a cognitive behavioral therapy program based on the training program of Reenders and Spijkers (1996). The training consists of twelve weekly sessions of one and a half hour for the children (each week one session, except for holidays) and three parent meetings. During the training, new social behaviors are taught, dysfunctional beliefs of the children that influence social behavior are identified, the children learn a
cognitive rationale to evaluate their behaviors, and the children evaluate their own
performance using video feedback. Video feedback is a method in which a person objectively views a videotape of him- or herself during a performance (Clark & Wells, 1995), in this training during a social activity.
A new aspect added to this training is the use of video modeling. A difference with video feedback is that video modeling is a method in which the child is watching a video of someone other than him- or herself, performing a specific social skill or routine correctly. When the child sees this skill or routine performed, this will motivate the child to demonstrate the skill or routine successfully by himself (Baker, Lang & O’Reilly, 2009; Murray & Noland, 2013). During each session, one or more short videos (up to two minutes) are shown to the children where after the children discuss the videos and practice similar situations/skills using role-play.
8 Each session has a ‘social theme’ and has the following structure: (1) catch up (2) watching videos of the previous session including video feedback, (3) discuss the home assignment, (4) introduction and discussion of the new theme via video modeling, (5) practice (new) social behavior through role-play, (6) explain the new homework assignment. The themes throughout the training are: (1) introduction, acquaintance, and posture when meeting someone new/introducing yourself, (2) active listening and having a conversation, (3) the four basic feelings and other feelings, (4) the five G’s (occurrence, thoughts, feelings, behavior, and consequence), (5) giving and receiving compliments, (6) asking questions to someone, (7) play together, (8) saying no and getting a ‘no’, (9) receive criticism, (10) how to deal with situations in which another person irritates you, (11) bullying, (12) completion of the training. Instruments
Child behavior problems. To measure child behavior problems the Brief Problem
Monitor-Parent (BPM) for ages 6-18 years was used (BPM, Achenbach, McConaugy, Ivanova, & Rescorla, 2011). The BPM provides information about children’s functioning and responses to interventions, using 19 items. The BPM is a abbreviated version of the Child Behavior
Checklist for Ages 6-18 (CBCL, Achenbach & Rescorla, 2001). The correlations between the CBCL and BPM for the total score (r = 0.95), the internalizing scale (r = 0.86), externalizing scale (r = 0.93), and attention scale (r = 0.97) are high (Piper et al., 2014). Each item is rated on a three-point scale (0-2), with a zero indicating that the item is ‘not true’, and a two
indicating that the item is ‘often true’. An example item is: ‘Acts too young for his/her age’. A total score can be calculated, as well as three subscales, namely internalizing problems,
externalizing problems, and attention problems (Achenbach et al., 2011). In a study using U.S. samples Cronbach's alpha scores of the BPM scales varied between 0.85 and 0.92 (Achenbach & Rescorla, 2001). The internal consistency values for the three scales in the current study range between .81 and .93.
9
Social behavior. Social behavior of the child was measured using the Questionnaire Social
Skills of Youth (VSVJ, Hulstijn et al., 2005). Normally, the VSVJ is filled in by the child itself, but to limit the number of questionnaires that the child had to fill in and to keep the child motivated to participate in this study, a parent version of this questionnaire was made by rewording the items (i.e., ‘I’ was replaced by ‘my child’). The questionnaire includes 31 items that can be answered on a five-point scale ranging from 'not at all' to 'very often'. An example item is: ‘My child hits others when he or she is angry’. Two subscales can be calculated, namely prosocial behavior and socially inappropriate behavior (Hulstijn et al., 2005). Previous studies suggest that the VSVJ is a reliable instrument with Cronbach’s α = .79 or higher for both subscales and a good test-retest reliability. The validity of the child (self-report) version is good (Hulstijn et al., 2005; 2008) and the correlation of the scale prosocial behavior of the VSVJ with the scale prosocial behavior of the Bullying Prevalence
Questionnaire (BPQ) in the current study is r = .45, p < .05, demonstrating a first indication of validity for the currently used parent version. In addition, the internal consistency value in the current study is .91 for the scale prosocial behavior, and .89 for the scale socially
inappropriate behavior.
Self-esteem. Self-esteem of the child was measured using The Rosenberg self-esteem scale
(RSES, Rosenberg, 1965). The questionnaire measures self-esteem by asking the respondents to reflect on their current feelings by filling in a 10-item questionnaire. The items can be answered on a four-point scale, from strongly agree to strongly disagree. One half of the items are positively worded statements while the other half of the items are negatively worded statements. An example item of a positively worded statement is: ‘I am able to do things as well as most other people’ (Rosenberg, 1965). According to previous studies, the internal consistency of the RSES is high with Cronbach's α = .89 (Everaert, Koster, Schacht, & De Raedt, 2010). The RSES has good validity, and a good test-retest reliability (Keith & Bracken,
10 1996; Blascovich & Tomaka, 1991; Byrne, 1996). The internal consistency value in the current study for the questionnaire is .93.
Victimization of bullying. To measure the level of victimization of bullying, the Bullying
Prevalence Questionnaire (BPQ, Rigby & Slee, 1993) was used. There are two versions of the questionnaire; the total questionnaire which consists of twenty items, and the short version that only includes twelve items. In this study the short version of the BPQ was used. The items are rated on a four-point scale, from never to very often. An example item is: ‘I get called names by others’. Three subscales can be calculated, namely Bully, Victim, and
Prosocial. A higher score on the subscales Bully indicates higher levels of bullying behaviors, a higher score on Victim indicates higher levels of victimization caused by bullying, and a higher score on Prosocial indicates higher levels of prosocial behaviors (Rigby & Slee, 1993). The validity of the questionnaire has not been studied, therefore it is unknown if the
questionnaire has good validity. The internal consistency values in this study range between .82 and .83.
Treatment goals. To assess the children’s and the parents’ goals during SST systematically, an
equivalent approach as Weisz et al. (2011) was used. Before parents and the child attended SST, a pre-session treatment meeting with a clinician was held and were goals were listed. Each family member had to agree on the goal that were put on the list and in total each family could list a maximum of 5 goals. Every week the parents and the child had to fill in a short questionnaire about the treatment goals to see to what extent the goal was achieved, with ‘0 = not at all achieved to 10 = very much achieved’. An example of a treatment goal is: ‘Ask things nicely’,
Statistical analyses
The measurement occasion during waiting list was not used in analysis because of a lot of missing data. Prior to analyses, normality was checked, and univariate and multivariate
11 outliers were explored with boxplots and Mahalanobis D2. To examine differences in child behavior problems and social behavior amongst children 8-12 years after SST across three time points (pretest, 6 weeks after start of the training, and posttest), profile analysis was used. Profile analysis corrects for the dependence of time and for dependence of the scores from the parents. The assumptions of multivariate normality, homogeneity of variance-covariance matrices and linearity were checked and were met. Using profile analysis, three hypothesis were tested, namely parallelism of profiles, equal levels of groups, and flatness across time points. The hypothesis of ‘parallelism of profiles’ tests if the profiles of the group of fathers and mothers are the same or differ, the hypothesis of ‘equal levels of groups’ tests whether the profiles of fathers and mothers have equal levels (on average) across the three measurement-occasions, and the hypothesis of ‘flatness across time points’ tests if the dependent variables (DV’s) have the same average response during the three measurement occasions. For the group of children that filled in the online questionnaires, a paired t-test was used to examine differences in self-esteem and victimization of bullying amongst children 8-12 years after SST, using the pretest and posttest-scores on the RSES-questionnaire and the BPQ. To evaluate the individual treatment goals, scores on the first (before treatment) and last (after treatment) measurement occasion were compared using a paired t-test. Parents and children who did not score the goals at the first and the last measurement occasion were excluded from analyses, namely of 1 father, 1 mother and 1 child. This approach of analyzing the first and last measurement occasion was chosen over imputing missing data, because the parents and the children found it hard to score the goals every week, resulting in much missing data, except for the first and last measurement occasion.
Results
12 A profile analysis was performed to test whether SST reduces child behavior problems for children aged 8-12 years. First, the effect of SST on total child behavior problems was examined. None of the tests were significant, indicating that (1) there was no significant difference between fathers and mothers for reporting about the total child behavior problems,
F(1, 16) = 0.029, p = 0.868, η2 = 0.020, (2) the total child behavior problems did not significantly change over time, λ = 0.922, F(2,15) = 0.633 , p = 0.545, η2 = 0.078, and (3) fathers and mothers showed parallel profiles in reporting in child behavior problems on the different measurement occasions, λ = 0.887, F(2, 15) = 0.960, p = 0.405, η2 = 0.113.
However, the effect size (partial eta-squared) for change over time was medium, which may indicate the potential effectiveness of SST on total child behavior problems.
Secondly, the effect of SST on internalizing and externalizing child behavior problems was tested. No significant difference was found between fathers and mothers in reporting about the amount of internalizing, F(1, 16) = 0.164, p = 0.691, η2 = 0.010, or externalizing behavior problems, F(1, 16) = 0.322, p = 0.578, η2 = 0.020. No significant difference between pre and post assessment was found for internalizing child behavior problems, λ = 0.838, F(2, 15) = 1.450, p = .266, η2 = 0.162, or externalizing child behavior problems, λ = 0.888, F(2, 15) = 0.950, p = .409, η2 = 0.112. The group of fathers and mothers demonstrated parallel profiles in reporting internalizing behavior problems, λ = 0.999, F(2, 15) = 0.010, p = .990, η2 = 0.001, and externalizing behavior problems, λ = 0.905, F(2, 15) = 0.786, p = .474, η2 = 0.095, which suggests there were no significant differences between fathers and mothers in reporting about their child behavior problems over time. Although (again) no significant differences were found over time, the medium to large partial eta-squared suggest the potential effectiveness of the training on internalizing and externalizing behavior problems.
Finally, the effect of SST on attention problems of the child was tested. The test of between subject effects shows that there was no significant difference between fathers and
13 mothers in reporting about their child’s attention problems, F(1, 16) = 0.291, p = .597, η2 = 0.018. Also, no significant differences were found between pre and post assessment for attention problems, λ = 0.909, F(2, 15) = 0.748, p = .490, η2 = 0.091, and between the group of fathers and mothers reporting about the attention problems of their child during the
different measurement occasions, λ = 0.987, F(2, 15) = 0.101, p = .904, η2 = 0.013. However, also here the medium partial eta-squared for change over time might suggest possible
effectiveness of the training in reducing attention problems of the child.
Social behavior
A profile analysis was performed to test whether SST improves social behavior of children aged 8-12 years. The test of between subject effects showed that there was no significant difference between the group of fathers and mothers in reporting about their child’s prosocial behavior, F(1, 16) = 0.172, p = .684, η2 = 0.011. Also, there was no significant difference in prosocial behavior after following SST, λ = 0.910, F(2, 15) = 0.740, p = .494, η2 = 0.090, and the group of fathers and mothers showed parallel profiles in reporting about their child’s prosocial behavior over time, λ = 0.949, F(2, 15) = 0.404, p = .675, η2 = 0.051. Although the three tests showed no significant differences, the medium effect sizes may indicate possible effectiveness of the training on prosocial behavior.
Secondly, it was tested if SST was effective in reducing antisocial behavior. The three tests showed that there was no significant difference between the group of fathers and mothers in reporting about their child’s antisocial behavior, F(1, 16) = 0.185, p = .673, η2 = 0.011, the antisocial behavior did not significantly change over time, λ = 0.978, F(2, 15) = 0.169, p = .846, η2 = 0.022, and the group of fathers and mothers had parallel profiles in reporting about their child’s antisocial behavior over time, λ = 0.935, F(2, 15) = 0.522, p = .603, η2 = 0.065. Also, the small effect sizes suggest limited effectiveness of the training on antisocial behavior.
14
Self-esteem
A paired t-test was conducted to test whether SST improved self-esteem as rated by the children. There was no significant difference in the scores on self-esteem before (M = 22.33,
SD = 6.10), and after (M = 20.78, SD = 8.26) the SST; t(8) = 1.092, p = .307, d = 0.364. These
results suggest that SST does not have a significant effect on improving self-esteem.
Victimization of bullying
A paired t-test was conducted to test whether SST had an effect on the level of victimization of bullying according to the children. There was a significant difference in the scores of prosocial behavior before (M = 10.89, SD = 3.55), and after (M = 12.56, SD = 2.13) SST; t(8) = -2.774, p < 0.05, d = 0.925. These results suggest that SST does have an effect on prosocial behavior of children (see Figure 2). Specifically, the results suggest that after following a SST, the amount of prosocial behavior of children is increased. No significant differences were found for the subscales bullying, t(8) = 1.835, p = .104, d = 0.612, and victimization of bullying, t(8) = 1.525, p = .166, d = 0.509. However, the medium effect sizes highlight the potential effectiveness of SST on being bullied or bullying behaviors of children.
10 10,5 11 11,5 12 12,5 13 Prosocial Behavior Before After
15 Figure 1. Mean-scores of prosocial behavior from children aged 8-12 years before and after following SST. Higher scores indicate higher levels of prosocial behavior.
Treatment goals
A paired t-test was conducted to compare the treatment-goals as scored before and after the child followed a SST. The 10 children, 9 mothers and 8 fathers listed a total of 44 treatment goals. Because not all participants scored the goals before and after the training, a total of 40 treatment goals were used in analysis (Nchildren = 9, Nmothers = 8, Nfathers = 7). There was a significant difference in the scores of the children for the treatment goals before (M = 4.09,
SD = 2.11) and after the training (M = 7.24, SD = 2.12); t(39)= -7.14, p < .001, d = -1.13.
Also, significant differences were found for the treatment goals as scored by the mothers, before (M = 4.27, SD = 1.62) and after (M = 7.11, SD = 1.34) the training; t(31) = -9.57, p < .001, d = -1.20, and as scored by the fathers, before (M = 3.99, SD = 2.14) and after (M = 5.88, SD = 1.73) the training; t(27) = -5.20, p < .001, d = -1.00. These results suggests that after SST, the amount of wanted/appropriate behaviors increases according to children, mothers and fathers (see Figure 1). The treatment goals as listed by the children and their parents can be found in the Appendix.
0 1 2 3 4 5 6 7 8
Child Mother Fathers
Before After
16 Figure 2. Mean-scores of treatment goals before and after following a SST as scored by the children and their parents. Higher scores indicate higher levels of wanted behavior.
Discussion
The aim of this pilot study was to evaluate the effectiveness of a SST with video modeling on a range of outcome measures. It was found that after following a SST, children did not
observe a significant difference in self-esteem, but they found themselves behaving more prosocial. Parents however did not observe this difference. Also, they did not report a
significant decrease in child behavior problems. However, it should be noted that the medium to high effect sizes as found in this study may indicate possible effectiveness of SST in increasing prosocial behavior and reducing child behavior problems. Furthermore, it was found that SST is effective in achieving individual treatment goals.
A mixed effect was found for prosocial behavior; while the children did observe a significant increase in prosocial behavior after following the training, their parents did not observe this difference. One explanation may be that although the children feel like they already have learned more prosocial behavior, they have not yet generalized the behavior to other contexts and is therefore not always observable (by their parents). From previous studies (Vugt et al., 2013) it is known that social skills still increase after the training; social skills deficits are not easily changeable, and it needs time and exercise to further generalize the behavior to other contexts. Another explanation may be that there is a lot of heterogeneity in this group of children and in the social difficulties they have; there are children that followed the training because they had internalizing behavior problems and wanted to learn how to stand up for themselves, and there were children that followed the training because they had externalizing behavior problems and wanted to learn to control their behavior. Therefore, it may be less likely to find a significant result for the total group of children. Note in this regard
17 that a large and significant change over time was found for the individual treatment goals (see discussion below). Also, although parent report about the child’s prosocial behavior indicated no significant change over time, the medium to high effect sizes on prosocial and bullying behaviors as scored by the children and parents highlight the potential effectiveness of the training, and it might be that when a larger sample size is used, more significant effects may be found.
In contrast to previous studies that found SST effective for children in reducing child behavior problems (Mandelberg et al., 2014; Quinn et al., 1999), this study found no
significant differences for child behavior problems, as observed by parents. Thus, the study suggests that the SST does not directly affect child behavior problems. One explanation may be that the child behavior problems that parents reported on are not the target for treatment, and thus these problems are not directly affected by the training. Another explanation may be that child behavior problems will decrease at a later time point; for example, from previous studies it is known that child behavior problems decrease quite some time after the training (Vugt et al, 2013). Furthermore, it is known that there is a lot of individual variation regarding the effectiveness of the training (Maag, 2006; Nangle et al., 2002) which may (partly) account for the non-significant findings. Alternatively, the sample size of the study may be too small to find any significant results. In accordance, the medium effect sizes for child behavior problems as found in this study, do indicate the potential effectiveness of the training on child behavior problems. This mixed finding underlines the need for further research into the effectiveness of the SST on problem behaviors.
The children did not observe a significant difference in self-esteem. An explanation could be that the children are not yet comfortable with the learned behaviors, and have not experienced enough success in social situations outside the training. It could be that children not yet feel competent after the training, but when they have generalized the learned behaviors
18 more, and experienced more success in social situations, their self-esteem will increase at a later time point. Alternatively, having better social skills may not directly be related to self-esteem, but may have a more indirect effect. For example, if social skills are improved, children may be better able to make friends and maintain friendships which may eventually change their self-esteem. Also, self-esteem is a relatively stable construct (Orth & Robins, 2014), and may be difficult to change.
Finally, this study showed that SST can be effective in achieving treatment goals as formulated by parents and children before the start of training, and the results demonstrated high effect sizes. These findings are in contrast with the other (mostly non-significant)
findings discussed above. This difference can be explained by the diversity in treatment goals; the reasons of the children to participate in SST are widespread and may correspond less to the constructs as measured by the questionnaires. Therefore, it seems beneficial to not only evaluate the effectiveness of the training by using standardized questionnaires, but also by using individual treatment goals.
As in every study, this study has some limitations. First, most parents of this sample have a middle-high until high socio-economic status and the results of this study therefore could be less generalizable to the general population. Second, no follow-up measurement was used in this study, which is necessary to determine if SST is effective in reducing child behavior problems and whether it increases self-esteem and social skills in the longer term. Third, research about the validity of one questionnaire as used in this study is missing and therefore it is unknown whether the questionnaires has good validity. Finally, heterogeneity in the group of children was observed with respect to their diagnosis. While this is beneficial for the generalization of findings to clinical practice in general, it hampers conclusions for which children this training is specifically effective. Although previous studies showed that SST with video modeling is effective for children with autism spectrum disorders (Bellini &
19 Akullian, 2007; Charlop-Christy, Le, & Freeman, 2000; Delano, 2007; Wang, Cui, & Parrila, 2010), research about SST for children having other disorders is limited, and therefore needs more study.
Further research into the effectiveness of SST is recommended to get an overview of which elements of the training are more or less effective in targeting specific behaviors. Also, it is necessary to investigate the role of video-modeling more; while previous studies suggest that video modeling can be effective, this is not specifically examined in this study. To examine the possible beneficial effects of video-modeling, it is recommended for future studies to use a randomized control trial in which one group receives video modeling and the other group does not.
This study was a pilot of SST using video modeling, and can be seen as a first step in testing the effectiveness of SST using a treatment manual for a group of children with a variety of problems. Although the results of this study are mixed, SST does have the potential to be an effective treatment, as indicated by the significant results on prosocial behavior and the effect sizes on bullying behavior. In addition, this study adds to previous research by highlighting the potential to evaluate interventions with the help of individual treatment goals. However, there is a great need for further research into the effectiveness of SST, and its suitability for the different types of children as well as to examine the effectiveness of the different treatment components. More specific, it is recommended to use a randomized control trial to study the potential effect of adding video-modeling.
20 Literature
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26 Appendix
Graphs Treatment Goals
Child 1
Figure 1. Goal 1: Aware of own behaviour. Higher scores indicate higher levels of awareness.
Figure 2. Goal 2: Aware of how own behaviour influences others. Higher scores indicate higher levels of awareness.
Figure 3. Goal 3: Ask things nicely. Higher scores indicate higher levels of asking nice for the things the child wants.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
27 Figure 4. Goal 4: React appropriately when things do not go as planned. Higher scores
indicate higher levels of reacting appropriately.
Figure 5. Goal 5: Do not show agressive behavior. Higher scores indicate lower levels of agressive behavior.
Child 2
Figure 6. Goal 1: Have self-esteem. Higher scores indicate higher levels of self-esteem. 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
28 Figure 7. Goal 2: Start a conversation. Higher scores indicate starting a conversation more often.
Figure 8. Goal 3: Feel confident. Higher scores indicate higher levels of feeling confident.
Figure 9. Goal 4: Ignore bullying of others. Higher scores indicate ignoring the bullying of others more often.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
29 Figure 10. Goal 5: Be myself when meeting new people. Higher scores indicate higher levels of being myself when meeting new people.
Child 3
Figure 11. Goal 1: Have confidence. Higher scores indicate higher levels of confidence.
Figure 12. Goal 2: Do things indepently. Higher scores indicate higher levels of independence.
Figure 13. Goal 3: Dare to ask questions. Higher scores indicate more often dare asking questions. 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
30 Figure 14. Goal 4: Stand up for own opinion. Higher scores indicate higher levels of standing up for own opinion.
Child 4
Figure 15. Goal 1: Accept a ‘no’. Higher scores indicate more often accepting a ‘no’.
Figure 16. Goal 2: Able to deal with injustice. Higher scores indicate higher levels of able to deal with injustice.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
31 Figure 17. Goal 3: Independently think about possible solutions for difficult (social)
situations. Higher scores indicate higher levels of thinking about possible solutions.
Figure 18. Goal 4: Active listening to others. Higher scores indicate higher levels of active listening to others.
Child 5
Figure 19. Goal 1: More control over anger. Higher scores indicate higher levels of control over anger. 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
32 Figure 20. Goal 2: Keep calm when irritated. Higher scores indicate higher levels calmness when feeling irritated.
Figure 21. Goal 3: Know what to do when other children are having a fight. Higher scores indicate higher levels of knowledge about what to do when others are having a fight.
Figure 22. Goal 4: Know how to respond when others do things I do not like. Higher scores indicate higher levels of knowing how to respond when other do things the child does not like.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
33 Figure 23. Goal 5: Have less conflicts with others. Higher scores indicate lower levels of having conlifcts with others.
Child 6
Figure 24. Goal 1: Have self-esteem. Higher scores indicate higher levels of self-esteem.
Figure 25. Goal 2: Able to deal with injustice. Higher scores indicate higher levels of able to deal with injustice.
Figure 26. Goal 3: Cope with being bullied by others. Higher scores indicate higher levels of coping with being bullied by others.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
34 Figure 27. Goal 4: Not easily angered. Higher scores indicate lower levels of getting angry. Child 7
Figure 28. Goal 1: Have self-esteem. Higher scores indicate higher levels of self-esteem.
Figure 29. Goal 2: Dare to ask questions. Higher scores indicate more often dare asking questions. 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11 Child Mother 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11 Child Mother 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11 Child Mother
35 Figure 30. Goal 3: Cope with anger. Higher scores indicate higher levels of coping with anger.
Figure 31. Goal 4: Make contact with peers. Higher scores indicate higher levels of making contact with peers.
Child 8
Figure 32. Goal 1: Have self-esteem. Higher scores indicate higher levels of self-esteem.
Figure 33. Goal 2: Take initiative in making contact. Higher scores indicate higher levels of taking initiative in making contact.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11 Child Mother 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
36 Figure 34. Goal 3: Cope with being bullied by others. Higher scores indicate higher levels of coping with being bullied by others.
Figure 35. Goal 4: Share things with others. Higher scores indicate higher levels of sharing things with others.
Child 9
Figure 36. Goal 1: Make contact with peers. Higher scores indicate higher levels of making contact with peers.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
37 Figure 37. Goal 2: React appropriately when things do not go as planned. Higher scores indicate higher levels of reacting appropriately.
Figure 38. Goal 3: Share things with others. Higher scores indicate higher levels of sharing things with others.
Figure 39. Goal 4: Make contact. Higher scores indicate higher levels of making eye-contact. 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
38 Figure 40. Goal 5: Maintain and finish an activity. Higher scores indicate higher levels of maintaining and finishing activities.
Child 10
Figure 41. Goal 1: Have self-esteem. Higher scores indicate higher levels of self-esteem.
Figure 42. Goal 2: Take initiative in making contact. Higher scores indicate higher levels of taking initiative in making contact.
Figure 43. Goal 3: Make contact. Higher scores indicate higher levels of making eye-contact. 0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
Child Father Mother
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
39 Figure 44. Goal 4: Stand up for own opinion. Higher scores indicate higher levels of standing up for own opinion.
0 2 4 6 8 10 0 1 2 3 4 5 6 7 8 9 10 11
