Promoting Alternative Thinking Strategies (PATHS)/Preschool PATHS - a comprehensive programme for promoting emotional and social competencies and reducing aggression and behaviour problems

The programme has been evaluated in several cluster randomised controlled trials, two in the UK - one in Northern Ireland (Ross et al., 2011) three in England (Hennessey et al., 2019, 2021; Panayiotou et al., 2020; Humphrey et al., 2015, 2016; Little et al., 2012) – one in Switzerland (Malti et al., 2011, 2012) and one in Sweden (Eninger et al., 2021). There have also been four quasi-experimental studies, one each in Turkey (Seyhan et al., 2017) and the Netherlands (Goossens et al., 2012) and two in the UK (Curtis & Norgate, 2007; Hughes & Cline, 2014).

One UK trial (Little et al., 2012) was conducted with 5397 children aged 4 to 6 years from 29 schools that were randomised to intervention and 27 schools that were randomised to control. Measures were gathered using five scales from the teacher-completed Strengths and Difficulties Questionnaire and nine scales from the PATHS Teacher Rating Survey. Results indicated that while there were some statistically significant improvements in the intervention group compared to the control group at mid-intervention, these improvements disappeared post-test and no statistically significant differences were observed between groups at immediate post-test.

In another UK trial (Humphrey et al., 2015, 2016), 4516 children aged 7 to 9 years from 45 schools, that were randomly allocated to intervention or control, participated. Of the 14 scales, there was a significant positive intervention effect on 1 measure and a significant negative intervention effect on 2 measures. There was a statistically significant increase in teachers' perceptions of change in children's social–emotional competence in the intervention group. A statistically significant effect favouring the control group was found on SDQ peer problems and SDQ emotional symptoms scales.

Hennessey et al. (2019, 2021) and Panayiotou et al. (2020) used the former sample of (45 schools with 5218 school-aged children). Academic performance was measured with a national curriculum assessment for English, Mathematics and Science. The intervention did not show more effectiveness in improving the academic attainment of children compared to the control group. The results concerning loneliness (KIDSCREEN27) revealed a significant positive effect compared to the control group. Psychological wellbeing, peer social support and school connectedness showed a small, but statistically significant improvement after the PATHS intervention at a 2-year follow-up. However, the intervention had no discernible impact on peer social support and school connectedness.

The study from Northern Ireland (Ross et al., 2011) included 1448 students, aged 4 to 10 years, from 12 primary schools that were evenly randomised to intervention or control. Students were from primary 1 and 2, and 5 and 6; some analysis was reported separately for these groups. For primary 1 and 2, there were no significant effects on teacher-reported behaviour. For primary 5 and 6, there were three significant differences between groups, two of which favoured the control group: reflectivity and perseverance. There was a positive intervention effect on negative affect. There were positive intervention effects that were significant on 4 of 11 observed teacher behaviour: positive behaviour management, supporting peer interaction, supporting mutual respect and understanding, and providing feedback on peer interactions 6 of 20 observed measures of child behaviour also indicated a significant programme effect: compliments others, mutual respect and understanding, involvement, taking turns in play, compliance with playground rules and including others (in play).

The Swiss trial (Malti et al., 2011, 2012) included 1675 first-grade students, with an average age of 7 years, from 56 schools. The trial compared PATHS to Triple P, a group parenting programme. Compared to the control group, children receiving PATHS displayed a significant reduction in aggressive behaviour (based on teacher and parent reports, but not child reports) and in ADHD symptoms (based on teacher reports only, not on parent or child reports). There were no effects on nonaggressive externalising behaviour or on social competence based on any measure. At the two-year follow-up, the effect on teacher-reported aggression and ADHD symptoms was statistically significant, but the effect on prosocial behaviour was not.

The Swedish trial (Eninger et al., 2021), comprised a sample of 285 children, aged 4-5 years from 26 schools. Children were randomly assigned to an intervention group (145 children) or a control group (140 children). The intervention resulted in significant improvements after 6 months in working memory, prosocial play and hyperactive behaviours in the intervention group compared to the control group.

One quasi-experimental study in the UK (Curtis & Norgate, 207) included 287 students, aged 5 to 7 years, from 5 intervention and 3 comparison schools. There were significant intervention effects on all 5 subscales of the SDQ. There was a significant improvement on emotional symptoms, conduct problems, hyperactivity, peer problems, and consideration, for intervention schools but not for the comparison schools. It is important to note that the levels of behavioural and emotional problems were already at a lower level in the comparison schools at pre-test.

The Dutch study (Goossens et al. 2012) included 1333 children aged 5 to 11 years from 18 kindergarten and elementary schools, half of which delivered the intervention and the other half served as control. There was a significant effect on only 1 of 27 outcome measures – emotional awareness - immediately after the intervention.

A quasi-experimental (Hughes & Cline, 2014) evaluated of the Preschool version was conducted in the UK with 57 children, aged 3 to 4 years, from 3 different preschools. One school delivered the full version, while one school delivered an adapted (shortened) version and the third school did not deliver PATHS. There was a significant interaction effect: the full PATHS group significantly improved their receptive emotion vocabulary from pre to post test, while the other groups did not. There was no effect on affective perspective taking skills, or parental measure of behaviour (SDQ). There were significant interaction effects on 6/7 scales of the teacher-reported SDQ: children in the full PATHS version improved significantly while the other two groups did not.

The Turkish study (Seyhan et al., 2017) also evaluated the Preschool version and included 565 children aged 4 to 6 years from 41 classrooms in 4 preschools. There were significant intervention effects on teacher-reported children’s social and emotional skills reflecting interpersonal relationships and emotion regulation, and observed quality of classroom environment. The effect on observed behaviours and management techniques of teachers was not significant. In terms of student-teacher relationship, as reported by teachers, there was no effect on conflict or closeness, but there was a significant effect on dependency. Teachers in intervention group reported significantly more dependency in their relationships with children. Children in the intervention group described their relationships as significantly more positively than did children in the comparison group.