School-based programs can curb aggressive behaviors in students, according to a new systematic review.

Moreover, troubled youth can be helped throughout their student years. “The improvements can be achieved in both primary and secondary school age groups,” says the report.

According to the authors, the most effective programs are those that help students learn key social skills such as listening, thinking about the feelings of others, working cooperatively and being assertive in constructive ways.

“The majority of aggressive children are choosing to use that behavior because they don’t have the skills to achieve what they wish to achieve any other way,” said lead author Julie Mytton, M.D., a public health physician at the University of the West of England.

With violence increasing among young students and numerous highly publicized school shootings in the United States, interest in a science-based approach to violence prevention has been on the rise for more than a decade. Yet, the 2001 U.S. Surgeon General’s report on youth violence says, “While hundreds of prevention programs are being used in schools and communities throughout the country, little is known about the effects of most of them.”

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Mytton and colleagues identified 56 randomized controlled trials evaluating programs designed to reduce aggressive behavior in at-risk students. Most took place in the United States and compared a school program to either no program at all or an alternative activity.

Of these, 34 studies involving nearly 3,000 students measured changes in aggressive behavior after the school program. Nine studies involving about 1,700 participants looked at whether there was any change in school actions such as detention, suspension or court contacts.

The intensity of the interventions varied widely, from a single two-hour discussion group to more than 53 hours of intervention spread over two years. Some programs included extracurricular components such as parent training or community interventions.

“These programs are capable of producing moderate beneficial effects,” concludes the study. The authors estimate that for every 100 nonparticipating students who continued their aggressive behavior, only 52 to 59 youths who participated in the programs did so.

The benefits were similar in both elementary and secondary school programs and when programs were delivered to mixed-sex or boys-only groups. In seven studies that followed up after one year, the improvements remained apparent.

The authors point out that none of the studies collected data on violent injuries in schools. “We cannot be certain of the extent to which an improvement in behavior translates to an actual injury reduction,” they wrote.

In addition, more research is needed to determine if the benefits persist beyond 12 months and if they justify the costs of implementing such programs.

“Most school systems are still going to suspension, a longer suspension and then an expulsion” when students exhibit unacceptable behavior, said Phil Leaf, Ph.D., director of the Johns Hopkins Center for the Prevention of Youth Violence.

“There’s not any evidence that sending a child home for three days because of aggression in the school is a positive intervention.” Leaf said. Furthermore, he added, routinely referring individual students to private therapists can be a very expensive strategy.

Instead, communities should consider proven, in-school programs that will help as many children as possible to act appropriately and thus to learn and achieve, he said. “That’s really the bottom line for parents and it’s certainly the bottom line for school systems.”

Mytton agrees, saying the review authors hope schools will “implement programs that aim to improve social and relationship skills, because we can now be confident that these types of programs are likely to be helpful.”

By Laura Kennedy, Contributing Writer

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