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Children’s Behavioral Disorders and Lower Cognitive Development:
A Systematic Review
By
Sonia Donaires
B.S. Peru, 1998
Thesis Submitted in Partial Fulfillment
of the Requirements for the
Master's Degree in Public Health
Concordia University
August, 2016
Abstract
Children’s behavioral disorders and lower cognitive development are problems that impact school performance in elementary schools. The purpose of this systematic review was to identify the internal factors related to issues that arise in schools and the external factors related to problems that happen in an interrelationship between parents, siblings, relatives and friends at home. The seven studies were included in this review three qualitative and four quantitative. The qualities of the studies were evaluated with the Jadad score and the Critical Appraisal Skills Program (CASP). Results showed that problems at home impact tremendously on the incidence of the behavior of children and poor performance in schools. Parenting programs are a successful strategy to support children emotionally and improve behavior. The collaboration between parents, teachers and children is effective intervention with children at school. Further research is needed on the internal factors to related to the issues.
Introduction
Problem Statement
Child behavioral disorders and low cognitive development are problems that impact academic success in elementary schools. The National Research Council and Institute of Medicine reported 10-15 percent of children globally suffer from emotional and behavioral disorders (Kids Mental Health, 2009). According to the Center for Diseases Control and Prevention (CDC) an estimated 13 to 20 percent of US children ages 3-17 (1 out of 5 children) experience behavioral disorders and mental illnesses. The most common child behavioral disorders identified were: Attention Deficit Hyperactivity Disorder (ADHD) 6.8%, behavioral or conduct problems 3.5%, anxiety 3.0%, depression 2.1%, autism spectrum disorders 1.1% and Tourette syndrome 0.2% (CDC, 2015). Medical treatment expenses related to child mental disorders are estimated at $247 billion annually (CDC, 2015).
Even though diverse programs and interventions in schools have been implemented, the disruptive behavior of children continues to be a burden not only for parents but also for teachers and communities (CDC, 2015). Children’s lower cognitive development has also been linked to disruptive behavior in the classroom (Losinski, et al., 2014). Most of the time, these children have intervention in schools without any support from parents. Behavior disorders and low cognitive development are issues that can be prevented if they are identified and intervention occurs in early stages of a child’s development (Pre-K children).
Purpose Statement
Children’s disruptive behaviors in the classroom are associated with social interaction at home concerning family issues, trauma and sexual abuse (Klansen & Crombag, 2012). Likewise, issues that influence low cognitive development have been linked to children that suffer abuse at schools. Abuse that is a result of bullying, stigmatization, and antisocial behavior that affects the child emotionally and delays cognitive development in schools (Esch, et al., 2014).
The purpose of this systematic review was to investigate ways to improve academic performance in schools through implementations of programs based on children’s particular cases. Schools are the right organization in a community to provide an integrative intervention to families of students with disruptive behavior. The ultimate objective is to provide the right intervention for children at early stages of the development that involve an active parent and teacher collaboration to prevent behavior disorders and lower cognitive development.
Research Questions and Hypotheses
Optimum strategies to prevent and treat children’s behavioral disorders and low cognitive development are needed in elementary schools.
Alternate Hypothesis: There are external and internal factors that contribute to the behavior and lower academic performance of children with behavioral disorders.
This systematic review addressed the following research questions:
1) What are the external and internal factors of behavioral disorders of children that contribute to poor academic achievement in elementary schools?
2) What are the suitable strategies to intervene with students that face behavior disorders?
The systematic review analyzes the effectiveness of different behavioral disorders and low cognitive development interventions to change behavior and increase cognitive development of children in elementary schools.
Potential Significance
Each year five to seven percent of the U.S. children are retained at grade level placed in special education, tiered instruction and intervention in a Response-to-Intervention Model (RTI) categorized as tier 2 and 3 or Rehabilitation Act of 1973 called section 504 in the assumption to help students that are failing academically (Wisconsin Education Association Council WEAC, n.d.). Results show that these measuremes are not effective to intervene students with behavior issues or learning problems (Glickman, 1991). Elementary schools throughout the U.S. have shown poor academic performance because there are several factors that impact student achievement. Those factors are linked to issues with school, home, social relationships, and socio-economic conditions. The potential significance of this systematic review is to make a contribution to the public schools by identifying the external and internal factors that affect children’s behavior and academic performance. Also, to provide possible interventions and recommendations that can further the establishment of better policies and programs in elementary schools.
Literature Review
Theoretical Foundation
The appropriate theories to address child behavior change are the Social Cognitive Theory (SCT) and the Ecological Approach. The SCT was developed from the social learning theories (SLT) of Totter (1954) and Bandura (1977). This theory is a combination of stimulus-response (SR) and cognitive approaches to human behavior. The central point of the SCT refers to a reciprocal interaction of individuals with a set of learning experiences, an environment that examines the external and social context, and behavior that responds to stimulus to reach goals. The SCT works at the interpersonal level and states that a social environment influences individuals (McKenzie, 2013). The primary focus of this research with the SCT is on the component “reinforcement” as an integral part of learning. According to this theory, there are three ways to reinforce positive behavior: directly, vicariously and through self-reinforcement (McKenzie, 2013). These three constructs are crucial to intervene with elementary school aged children to maintain behavior change and further cognitive development. Figure 1 represents the SCT model.
· Direct Reinforcing is a group that provides verbal feedback every time the participant does good work. Based on child intervention the supportive group is identified as teachers, school administrators, and other people involved in the progress of cognitive development.
· Vicarious reinforcement consists in the observation of participants (child) of someone being reinforced for behaving appropriately.
· Self-reinforcement is when a participant keeps a record of their behavior and if there is progress, they reward themselves (McKenzie, 2013).
Figure 1: Social Cognitive Theory. Source: Pro-Social Media Effects. (2012).
The Ecological Approach is a model that emphasizes: “the linkages and relationships among multiple factors (or determinants) affecting health” (Institute of Medicine, 2003). The target research population is children. Thus, the Ecological Approach has the purpose of involving all the components of the community in benefiting children. This model does not focus on individual problems rather it emphasizes the social and physical environment that involves behavioral disorders. The way that it works ranges from a micro to macro level.
· Individual – children
· Interpersonal - family and friend
· Organizational - Involving organizations and social institutions
· Community - the relationship between organizers
· Public Policy - national state and local laws (McKenzie, 2013).
The participation of the community will ensure the maintenance of programs and training to intervene with child behavior disorders and academic success with children in elementary schools. Figure 2 represents the Ecologic Approach model.
Figure 2: Bronfenbrenner's Ecological Model. Source: The Psychology Notes HQ. (2016).
The two theories utilized by this review are characterized by essential concepts that are appropriate interventions suitable to respond to the research question. The Ecological Approach is a theory that works at the local, state, and national level, which are essential to the maintenance of the program implemented to ensure the success of the intervention. The SCT works on an interpersonal level and focuses on the relationship between students, parents, teachers, and school administrators. The collaboration of leaders of the community is a crucial part of the project to ensure success and improve behavior change and cognitive development once the external and internal factor are disclosed and risk factors are controlled through training and information to parents, children, and teachers.
Key Concepts and Variables
Children’s behavioral disorders and low cognitive development in elementary schools delay the success of students. According to the U.S. Department of Health and Human Services’ (DHHS) (1999), 20% children and adolescents had a mental disorder from childhood to adolescence. Also, it is estimated that about 10% of people suffer from an emotional disturbance at some point in their life (Brauner & Stephens, 2006). The CDC reported in studies conducted between 2005-2011 that the prevalence of behavior disorders in children ages 3-17 were ADHD 6.8%, behavioral or conduct problems 3.5%, anxiety 3.0%, depression 2.1%, autism spectrum disorders 1.1% and Tourette syndrome 0.2% (CDC, 2015, November 12). Childhood behavior disorders affect not only children, but also, families, and communities. Oliveira, Magalhaes & Salmela (2011) stated that mental health problems are a product of biologic and environmental factors that affect cognitive development in children. Doulames, Lee & Shea (2014) determined that environmental and social interactions are factors that impact behavior in early childhood. The social interaction that a child has with parents, siblings, close relatives, and neighbors at home; as well as teachers, school administrators, paraprofessionals, and tutors at school influence disruptive behavior in the classroom which impacts academic performance (Doulames, Lee & Shea, 2014). The association of child behavior disorders with low cognitive development in elementary schools are affected by external and internal factors that are related to the social interaction of children outside and inside of schools.
From the school’s perspective, children suffer a variety of disruptive behaviors while at school. Behavior disorders in children are identified as issues that affect a child’s ability to succeed academically and are linked to early dropouts (Esch, et al, 2014). According to the American Academy of Pediatrics (2004), the most common disruptive behavior disorders that affect cognitive development of children in schools were oppositional defiant disorders (ODD) and conduct disorders (CD). In addition, Bilac, et al. (2014) found an association between classroom issues with aggressiveness and anxiety. In another study by Bilic (2006), some students were affected emotionally or physically as a product of bullying and others were affected by stigmatization and traumatic events occurring in schools. Those students were more dissatisfied with schools. On the other hand, marital conflict, dysfunctional families, and sexual abuse are external factors that were also associated with low academic performance in classroom. Hinnant, et al. (2013) stated that familiar conflicts directly affected children’s attendance, lack of attention, and problem solving. Children’s behavioral disorders are common worldwide; they are exposed to many issues inside and outside of schools that they are unable to control because of the inability to express themselves. In many cases, these are reflected in disruptive conduct that impedes the grasping of and focus on learning.
School interventions to remediate low academic progress in children that are affected by behavioral disorders are typically school-based only interventions without parent involvement. Klansen and Crombag (2012) stated that interventions involving parents could improve the academic performance of children with disruptive behaviors. Studies have shown that some behavior disorders in school can be prevented through counseling and treatment, training parents and teachers on how to manage child behaviors, and treatment through pharmacotherapies (Klanse & Crombag, 2012). Studies related to school-based interventions that involve children, parents, and teachers were not found.
Methods
The search engines used for the initial literature review were: Academic Search Premier, PubMed, and Google Scholar. The terms used to search included Boolean phrases as “Children behavior”, “cognitive development”, “low cognitive development”, children’s behavior issues”, “child development”, “Children behavior issues” AND “cognitive development”, “behavior issues” AND “children impact of behavior issues in classroom”.
This project employed a systematic review to assess how children’s behavior disorders impact cognitive development in elementary schools. The systematic review examined research conducted on the association of external and internal factors that affect children’s behavior and impede cognitive development. Other scientific studies were selected based on issues related to behavioral disorders and school-based interventions. This study also examined behavioral strategies used to intervene with children with conduct problems that result in poor academic progress in the classroom.
Inclusion and exclusion criteria
The systematic review was limited to studies related to the target population (children ages 4-11) and to external and internal factors that impact children’s behavioral disorders. The examination of the literature review was linked to issues correlated with dysfunctional families and socio-economic status issues at schools.
In a effort to find appropriate information to address external and internal factors of disruptive behavior in children, the following inclusion criteria were established: studies that targeted children ages 4 to 11 or Pre-K to 5th grade students, studies with a primarily focus on children’s behavioral and emotional disorders (identified as ADHD, ODD, anxiety disorders, and child depression), Spanish and English languages, and studies conducted from 2000-2016. Exclusion criteria included: poor cognitive development caused by chronic mental illnesses. Therefore, studies related to genetic and biological chronic mental illnesses were excluded. The inclusion and exclusion criteria for this systematic review are depicted in Table 1.
Table 1
Inclusion/Exclusion Criteria
Inclusion Criteria / Exclusion CriteriaStudies published from 2000 – 2016
Population: Target school aged children < 11
Language: English or Spanish
Intervention: School-based programs interventions
Outcome: Poor cognitive development caused by behavioral disorders
Behavior issues: children’s behavioral and emotional disorders such as ADHD, ADD, anxiety disorders, and child depression. / Conducted prior to 2000
Studies on children older than 11
Non English or Spanish publication
Non elementary school related
Chronic mental illnesses
Data analysis plan