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Evidence from Single Case Research on Social Skills Interventions for Preschoolers At-Risk for EBD: A Scoping Review and Application of Quality Indicators

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Title: Evidence from Single Case Research on Social Skills Interventions for Preschoolers At-Risk for EBD: A Scoping Review and Application of Quality Indicators
Language: English
Authors: Dong, Xin (ORCID 0000-0002-7380-0872), Sanchez, Lisa, Burke, Mack D., Bowman-Perrott, Lisa
Source: Psychology in the Schools. Jul 2023 60(7):2270-2295.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 26
Publication Date: 2023
Document Type: Journal Articles
Information Analyses
Education Level: Early Childhood Education
Preschool Education
Descriptors: Preschool Children, Antisocial Behavior, Behavior Problems, Intervention, Interpersonal Competence, Social Development, Program Effectiveness, Research, Preschool Education
DOI: 10.1002/pits.22855
ISSN: 0033-3085
1520-6807
Abstract: Research suggests that 10%-20% of preschoolers have emotional and behavioral problems that would place them at-risk for development of emotional and behavioral disorders (EBD). Preschool children who exhibit early onset of antisocial and externalizing problem behaviors require early social-behavioral interventions focused on social skills. A scoping review was conducted that identified 33 single-case research design studies on social skills interventions for preschoolers. Quality indicatiors were used to examine the design quality of the studies included. A total of 19 studies met quality standards with reservation or met standards without reservations. 43 participants in 11 studies conducted by 10 research teams showed evidence to support social skills interventions as effective interventions. The majority of the evaluated studies (97%) reported IOA. These findings contribute to the growing literature base underscoring social skills interventions in early childhood settings.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1379693
Database: ERIC
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  Value: <anid>AN0164066385;pis01jul.23;2023Jun05.08:09;v2.2.500</anid> <title id="AN0164066385-1">Evidence from single case research on social skills interventions for preschoolers at‐risk for EBD: A scoping review and application of quality indicators </title> <p>Research suggests that 10%–20% of preschoolers have emotional and behavioral problems that would place them at‐risk for development of emotional and behavioral disorders (EBD). Preschool children who exhibit early onset of antisocial and externalizing problem behaviors require early social‐behavioral interventions focused on social skills. A scoping review was conducted that identified 33 single‐case research design studies on social skills interventions for preschoolers. Quality indicatiors were used to examine the design quality of the studies included. A total of 19 studies met quality standards with reservation or met standards without reservations. 43 participants in 11 studies conducted by 10 research teams showed evidence to support social skills interventions as effective interventions. The majority of the evaluated studies (97%) reported IOA. These findings contribute to the growing literature base underscoring social skills interventions in early childhood settings.</p> <p>Practitioner Points: Social skills interventions were effective for preschoolers at risk for emotional behavioral disorders in 11 included single case research studies.A total of 19 single case research studies had robust research designs according to What Works Clearinghouse standards.Teachers were effective implementers in 12 included single case research studies.</p> <p>Keywords: preschoolers; quality indicator review; social skills interventions; WWC standards</p> <hd id="AN0164066385-2">INTRODUCTION</hd> <p>There is a substantial number of young children entering preschool with emotional and behavioral problems. The field of special education does not often identify children early on as having an emotional and behavioral disorder (EBD), however, many preschoolers have sufficient emotional and behavioral problems to be considered at‐risk for EBD and would benefit from early behavioral intervention (Forness et al., [<reflink idref="bib11" id="ref1">11</reflink>]; Ghandour et al., [<reflink idref="bib14" id="ref2">14</reflink>]). These children entering preschool with externalizing and antisocial behaviors pose challenges for teachers and staff. Problem behaviors can lead to poor peer relations, which in turn, decrease social learning opportunities that come from positive peer interactions. Up to 50% of preschoolers with early‐onset behavior problems will exhibit at least one or more significant behavior disorders when they grow older (Dunlap et al., [<reflink idref="bib10" id="ref3">10</reflink>]; Webster‐Stratton & Taylor, [<reflink idref="bib55" id="ref4">55</reflink>]). Children exhibiting problem behavior patterns in preschool often have transition issues in kindergarten (Nix et al., [<reflink idref="bib40" id="ref5">40</reflink>]). Moreover, persistent problem behaviors in early childhood are associated with a trajectory of antisocial behaviors, conduct problems and later socialization problems, school adjustment issues, and poor educational and vocational outcomes (Brennan et al.,[<reflink idref="bib4" id="ref6">4</reflink>]; Bulotsky‐Shearer et al., [<reflink idref="bib6" id="ref7">6</reflink>]; Heckman, [<reflink idref="bib21" id="ref8">21</reflink>]; Jones et al., [<reflink idref="bib27" id="ref9">27</reflink>]).</p> <hd id="AN0164066385-3">Social skills interventions</hd> <p>In the area of social skills interventions, problem behaviors are often defined as "competing behaviors that interfere with, or otherwise block, either the acquisition or performance of socially skilled behaviors" (F. M. Gresham et al., [<reflink idref="bib19" id="ref10">19</reflink>], p. 35). The goal of social skills interventions, is therefore to teach those social behaviors and skills that would compete with problem behaviors. F. M. Gresham ([<reflink idref="bib18" id="ref11">18</reflink>]) defined social skills as "behaviors that, within given situations, predict important social outcomes for children" (p. 7). Moreover, there are various theoretical conceptualizations of social skills. F. M. Gresham et al. ([<reflink idref="bib19" id="ref12">19</reflink>]) broadly defined social skills interventions as behavioral, cognitive, or social interventions that are directed at improving social skills or remediating social skills deficits. Depending on the theoretical framework, the social skills intervention components can vary considerably depending on the theoretical orientation and may draw upon social learning theory, behaviorism, cognitive theory and social‐emotional learning theory (Bandura & Walters, [<reflink idref="bib2" id="ref13">2</reflink>]; Kazdin et al., [<reflink idref="bib28" id="ref14">28</reflink>]) or multimodal approaches incorporating multiple types of intervention components (Vaughn et al., [<reflink idref="bib54" id="ref15">54</reflink>]).</p> <hd id="AN0164066385-4">Evidence‐based practice</hd> <p>Efforts are being made in special education to identify the evidence that supports practices being implemented to determine "What Works?". Evidence‐based practices refer to "practices and programs shown by high‐quality research to have meaningful effects on student outcomes" (B. G. Cook & Odom, [<reflink idref="bib7" id="ref16">7</reflink>], p.136). Legislative changes to the Individuals with Disabilities Education Improvement Act (IDEA, [<reflink idref="bib26" id="ref17">26</reflink>]) have impacted the field of special education to place more emphasis on evidence‐based practices, which have pushed researchers to examine which practices are effective for students with special needs and under what conditions as well as on what type of outcomes. A critical part of identifying what works in special education is making sure the evidence that practices are based on use high quality designs. Design and study standards and quality indicators have been established for group and single case designs (Kratochwill, et al., [<reflink idref="bib30" id="ref18">30</reflink>]) even though there is some variability between different associations and researchers (Horner & Kratochwill, [<reflink idref="bib23" id="ref19">23</reflink>]; Horner et al., [<reflink idref="bib22" id="ref20">22</reflink>]; Kratochwill, et al., [<reflink idref="bib30" id="ref21">30</reflink>]). Available guidelines for quality indicator reviews (Horner & Kratochwill, [<reflink idref="bib23" id="ref22">23</reflink>]; Horner et al., [<reflink idref="bib22" id="ref23">22</reflink>]; Kratochwill,  [<reflink idref="bib30" id="ref24">30</reflink>]) proposed typically emphasize the following methodological features: (a) operational descriptions of independent variables, dependent variables, settings and contexts; (b) the replication of treatment effects both within and across studies; (c) the collection and reporting of treatment fidelity; (d) the collection and reporting of interobserver agreement (IOA); and (e) the collection and reporting of social validity.</p> <p>Design standards commonly used in the field of special education are those proposed by What Works Clearinghouse (WWC). The WWC standards include guidelines to evaluate research design quality and guidelines to examine whether there is enough evidence of an intervention effect (Kratochwill et al., [<reflink idref="bib30" id="ref25">30</reflink>]). The WWC quality standards include quality indicators for evaluating the research design for single‐case studies and standards for evaluating evidence of an intervention effect. The research design standards were proposed to guide the evaluation of empirical support for evidence‐based practice (Kratochwill, et al., [<reflink idref="bib30" id="ref26">30</reflink>]). WWC standards classify studies into three categories based on research design quality: <emph>Meets Design Standards, Meets Design Standards with Reservation</emph>, or <emph>Does Not Meet Design Standards</emph>. In addition, the WWC standards include specific guidelines on how to use the standards to examine the research designs in review. To meet the design standards, studies must (a) systematically manipulate an independent variable, (b) systematically measure dependent variables over time by more than one observer, (c) include at least three demonstrations of an intervention effect, and (d) include a minimum of five data points per phase.</p> <hd id="AN0164066385-5">Purpose and research questions</hd> <p>The purpose of this article is to describe and provide a "scoping" review of the existing social skills interventions and evaluate the quality of the single‐case studies on early interventions targeting social skills for preschoolers with or at‐risk for emotional and behavioral problems. Scoping reviews are those reviews that seek to map a particular literature base to better understand the literature base in a particular area and identify existing knowledge gaps (Tricco et al., [<reflink idref="bib52" id="ref27">52</reflink>]). Many studies on the effects of social skills interventions have been conducted including single‐case studies. Single‐case research uses small <emph>n</emph> experimental time series designs to examine intervention effects (Ledford & Gast, [<reflink idref="bib32" id="ref28">32</reflink>]). Single‐case studies are often criticized for the small number of participants and limitation in generalization. However single‐case studies build an evidence base using direct and systematic replications. A scoping review and application of quality indicators provides an approach for identifying and summarizing the available evidence from the social skills intervention evidence base. This scoping review focuses on the following research questions:</p> <p></p> <ulist> <item> 1. What is the scope of the evidence base for social skills interventions for preschoolers with or at risk for emotional and behavioral problems?</item> <p></p> <item> 2. What are the characteristics of the participants and interventions features for the single‐case studies on social skills interventions for preschoolers with or at risk for emotional and behavioral problems?</item> <p></p> <item> 3. What is the quality of the evidence base for single‐case studies on social skills interventions for preschoolers with or at risk for emotional and behavioral problems?</item> <p></p> <item> 4. What are the methodological strengths and areas of improvement for the included single case research (SCR) studies?</item> </ulist> <hd id="AN0164066385-6">METHODS</hd> <p></p> <hd id="AN0164066385-7">Article identification</hd> <p></p> <hd id="AN0164066385-8">Literature search strategy</hd> <p>The review covered studies published before 2019. The following databases were searched: (a) ERIC, (b) PsycINFO, and (c) Academic Search Complete. Multiple combinations of the following search terms were used for the social aspects of the studies: interpersonal competence, prosocial behavior, social cognition, emotional development, social and emotional development, social skills, socioemotional, social competence, and social interaction. The following search terms on disability status were used: disab*, handicapped, emotional disturbances, seriously emotional disturbance, emotional behavioral disorder, EBD, emotional disturbance, emotional problems, behavioral problems, and impairment. For Academic Search Complete, the following search terms were applied to limit the participants' age ranges: Preschoolers, 3–5 years, early childhood education, young children, and preschool. For ERIC and PsycINFO, no age limit was included in the search process as these two databases lack a filter for age.</p> <hd id="AN0164066385-9">Inclusion and exclusion criteria</hd> <p>We applied the following criteria to determine articles for inclusion in our study.</p> <p>First, studies had to be published in peer‐reviewed journals: The studies had to be published in peer‐reviewed journals in English. Studies published in languages other than English were excluded.</p> <p>Second, the studies had to include preschoolers or young children aged 3 to 5‐year‐old identified as having emotional and behavioral problems or at risk for emotional and behavioral disorders as participants. The conceptual understanding noted in the review by C. R. Cook et al. ([<reflink idref="bib8" id="ref29">8</reflink>]) is adopted in the current review; the term "emotional and behavioral disorders" is used to refer to the full spectrum of students with social, emotional, and behavioral problems regardless of whether they receive special education. Preschoolers are often not formally identified as having EBD, so the current review focuses on children at‐risk due to the emotional and/or behavioral problems exibited. At‐risk children included both preschoolers who are identified as being at risk by any reliable screening tool or children nominated by teachers as demonstrating challenging behaviors, including chronic problem behaviors, aggressive behaviors, oppositional‐defiant behaviors, frequent tantrums, and noncompliance and rule infractions. Preschoolers who are identified as having attention deficit/hyperactivity disorder (ADHD) or show clear signs of externalizing behavior patterns are also considered at risk. Studies were excluded if they only include participants with autism or other developmental disabilities.</p> <p>Third, a single‐case research design had to be used. Single‐case research includes reversal design, multiple baseline design, multiple probe design, alternating treatment design, and changing criteria design. Studies were excluded if the designs were not single‐case research designs (e.g., studies using group designs, systematic literature reviews, editorials, commentaries, practitioner guides, or descriptive studies).</p> <p>Fourth, interventions had to target children's social behaviors. Studies were excluded if their research focused on parenting training or interventions to improve parent–child relationships and interactions. Studies were excluded if they did not have manipulation over interventions (e.g., descriptive studies, reviews, or book chapters).</p> <p></p> <ulist> <item> 1) Implementers: The intervention implementers had to be professionals (e.g., preschool teacher or teaching assistant), social instructors, or researchers.</item> <p></p> <item> 2) Settings: The interventions had to be conducted in Head Start programs, private or public preschool programs, daycare programs, or early childhood classrooms with children with special needs. Studies were excluded if they were conducted in clinic settings or psychiatric hospitals.</item> <p></p> <item> 3) Dependent variables: The studies had to be examined the effects of social skills interventions on one or more social, emotional, or behavioral outcome(s).</item> </ulist> <hd id="AN0164066385-10">Extended search</hd> <p>Three strategies were used to identify more potential articles. (<reflink idref="bib1" id="ref30">1</reflink>) References of the articles that met the inclusion criteria were reviewed to identify other articles that meet the criteria. (<reflink idref="bib2" id="ref31">2</reflink>) The past 5 years of publications of the peer‐reviewed journals from which the included articles were identified were searched. (<reflink idref="bib3" id="ref32">3</reflink>) The Google Scholar engine was used to search for newly published articles that cite the articles that met the inclusion criteria.</p> <hd id="AN0164066385-11">Final pool</hd> <p>A total of 3246 articles were identified with the search strategies employed by this review. After a screening of the titles and abstracts, 3011 articles were excluded because they did not meet the inclusion criteria. A total of 235 articles were included for the full text screening. After the full text screening of the 235 articles, the 26 articles that met the inclusion criteria were included in the review. Because five more articles were included after the ancestry search, a total of 31 articles were included in the quality indicator review (see Figure 1).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/PIS/01jul23/pits22855-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="pits22855-fig-0001.jpg" title="1 Results of the literature search and inclusion screening for the systematic review." /> </p> <p></p> <hd id="AN0164066385-13">Coding</hd> <p>The included articles were reviewed, and critical information including descriptive information and features of methodological design was extracted and coded. Descriptive information included participant and setting. Each study was coded for (a) participant characteristics, (b) methodological features, (c) intervention features, and (d) dependent variables.</p> <hd id="AN0164066385-14">Participant characteristics</hd> <p>Participants were coded on (a) gender, (b) ethnicity, (c) disability status, and (d) educational setting. Gender was dichotomized as male and female. Ethnicity was coded as Caucasian, African American, Hispanic, Asian, Mixed, and not reported. The educational settings of participants were coded as inclusive preschool, Head Start program, special education classroom, community daycare or preschool, and kindergarten. Each participant who received the intervention in the included studies was counted as a case. For some articles, there were more than one dependent variable reported, only one dependent variable was chosen as the main dependent variable. The main dependent variable needed to have line graph reported. The dependent variables more closely related to social behavioral skills (e.g., follow teacher's direction, social interaction with peers) were chosen over the academic skills (e.g., correct response to teachers' questions).</p> <hd id="AN0164066385-15">Methodological features</hd> <p>Research methodology was coded based on research design. Research design was coded as reversal design, multiple baseline design, multiple probe design, alternating treatment design, and combined design.</p> <hd id="AN0164066385-16">Intervention features</hd> <p>Intervention features include (a) implementer, (b) sociodramatic play, (c) skills instruction, (d) intervention tier, (e) dependent variable, (f) generalization, and (g) maintenance. Implementer was coded as <emph>trained teacher or teaching assistant</emph>, <emph>researcher or social skills instructor trained by researcher</emph>, <emph>collaboration between researcher and teacher</emph>, and <emph>peers (similar age children who received training and delivered intervention to the target children)</emph>; sociodramatic play was coded dichotomously as <emph>included</emph> or <emph>not</emph>; skills instruction was coded dichotomously as <emph>included</emph> or <emph>not</emph>; intervention tier was coded as <emph>Tier‐1</emph>, <emph>Tier‐2</emph>, or <emph>Tier‐3</emph>; dependent variable was coded as described in the study; generalization was coded as <emph>included</emph> or <emph>not</emph>; and maintenance was coded as <emph>included</emph> or <emph>not</emph>.</p> <hd id="AN0164066385-17">Quality of evidence evaluation</hd> <p>WWC design standards were applied to evaluate the quality of the study designs of all 33 studies included in the 31 articles that met the inclusion criteria. When three or more than three cases met the standards with or without reservation, the study was rated as <emph>Meets the Standard with Reservation</emph> or <emph>Meets the Standards Without Reservation</emph>. When less than three cases met the standards without reservation, the study was classified as <emph>Does Not Meet Design Standards</emph>. In the current review, the quality indicator evaluation was conducted in three sections: (<reflink idref="bib1" id="ref33">1</reflink>) WWC design standards, (<reflink idref="bib2" id="ref34">2</reflink>) WWC evidence evaluation, and (<reflink idref="bib3" id="ref35">3</reflink>) treatment fidelity of the intervention implementation. The treatment fidelity was evaluated separately from the WWC design standards in the current review. Although treatment fidelity evaluation was not included in WWC design standards, it is commonly acknowledged the report of treatment fidelity was critical for ensuring the interventions were implemented as they were intended to be (Maggin et al., [<reflink idref="bib38" id="ref36">38</reflink>]).</p> <hd id="AN0164066385-18">Coding for WWC design standards</hd> <p>The WWC design standards focus on research designs and methodological features. The following aspects were examined according to WWC design standards: (a) systematic manipulation of the independent variable, (b) inter‐observer agreement, (c) experiment control, and (d) qualification for an attempt to demonstrate an effect. Each of these aspects were classified as <emph>Meets this Standard</emph>, <emph>Meets this Standard with Reservation</emph>, or <emph>Does not Meet this Standard</emph>.</p> <hd id="AN0164066385-19">Systematic manipulation of the independent variable</hd> <p>The independent variable must be systematically manipulated. For studies included in the current review, the researcher must have determined when and how the social skill interventions were implemented. If the intervention was described clearly enough to render the study replicable, the study was coded as <emph>Meets this Standards</emph>. If the intervention was not described thoroughly or not delivered as the researcher intended, the study was coded as <emph>Does not Meet this Standard</emph>.</p> <hd id="AN0164066385-20">Interobserver agreement</hd> <p>Each dependent variable had to be measured repeatedly by more than one observer. Data on agreement between two observers needed to be collected and reported for at least 20% of the data points in each condition, setting or phase and at least 20% of the data points overall. Furthermore, IOA must meet the minimum thresholds of agreement indices: 80% for percentage agreement or 60% for Cohen's <emph>κ</emph>.</p> <p>This standard was examined in three parts: (a) collection and report of IOA for at least 20% of data overall; (b) inclusion of IOA for at least 20% of data across each condition, setting or phase; and (c) meeting of minimum thresholds of agreement indices. If a study met the criteria of all three parts, the study was rated as <emph>Meets this Standard</emph>. If a study reported IOA for at least 20% of data overall and met minimum thresholds of agreement indices but did not indicate if IOA was collected across each condition, setting or phase, the study was rated as <emph>Meets this Standard with Reservation</emph>. If the IOA of a study was below the minimum thresholds of agreement indices, the study was rated as <emph>Does not Meets this Standard</emph>.</p> <hd id="AN0164066385-21">Experiment control</hd> <p>Experiment control was evaluated based on the number of attempts to demonstrate an effect. This standard required that the study included at least three attempts to demonstrate an intervention effect at three different time points. Furthermore, an attempt to demonstrate an intervention effect had to occur between adjacent phase contrasts. Designs meeting this standard included but were not limited to ABAB design, multiple baseline designs with at least three conditions, multiple probe designs with at least three conditions, alternating treatment designs with two treatments compared with each other or at least three treatments compared to a baseline, and changing criteria designs with at least three different criteria.</p> <hd id="AN0164066385-22">Qualification for an attempt to demonstrate an effect</hd> <p>A phase was qualified as an attempt to demonstrate an effect when there was a certain number of data points within a phase. To meet this standard, a phase must have at least five data points. To meet this standard with reservation, a phase must have at least three data points.</p> <hd id="AN0164066385-23">Overall design quality rating</hd> <p>To receive an overall rating as <emph>Meets Design Standards</emph>, a study must be rated as <emph>Meets this Standard</emph> on all the criteria described above. To receive an overall rating as <emph>Meets Design Standards with Reservation</emph>, a study must be rated as <emph>Meets this Standard with Reservation</emph> or <emph>Meets this Standard without Reservation</emph> on the criteria described above. If a study is rated as <emph>Does not Meet the Standard</emph> on any of the criteria, the study is rated as <emph>Does not Meet Design Standards</emph>.</p> <hd id="AN0164066385-24">WWC evidence evaluation</hd> <p>An evaluation of evidence of an effect was conducted for all the studies that <emph>Meets the Design Standards</emph> or <emph>Meets the Design Standards with Reservation</emph>. The evidence evaluation mainly relied on visual analysis to assess (a) the consistency of level, trend, and variability in each phase; (b) factors that determine the existence of an intervention effect, including the immediacy of effect, proportion of overlap, consistency of data across phases, and projected patterns of outcome variables, and (c) anomalies within the data, such as a sudden change in level or trend of the data. To ensure a reliable evaluation, each graph was assessed according to the coding procedures from the coding manual in Kratochwill and Stoiber ([<reflink idref="bib31" id="ref37">31</reflink>]). Based on these visual analyses, each study was classified as having <emph>strong evidence</emph> (three demonstrations, no noneffects), <emph>moderate evidence</emph> (three demonstrations, one noneffect), or <emph>no evidence</emph> (less than three demonstrations).</p> <hd id="AN0164066385-25">Treatment fidelity</hd> <p>The adapted quality rubric set by Maggin et al. ([<reflink idref="bib38" id="ref38">38</reflink>]) was modified for this study to include a standard on treatment fidelity. Treatment fidelity was not part of the overall evaluation of the WWC design standards but given the critical role of treatment fidelity in the research literature, it was reported in this review as an extra indicator of quality. To receive a rating of <emph>Meets the Standard without Reservation</emph>, a study must collect and report treatment fidelity data for at least 20% of all conditions across different phases, with percentages of accurate implementation at or above 80%. If a study collected treatment fidelity for less than 20% of all conditions or did not report the percentage, the study was rated as <emph>Meets the Standard with Reservation</emph>. If no measure of treatment fidelity was reported, the study <emph>Does not Meet the Design Standard</emph>. Specifically speaking, some studies, that were rated as <emph>Meet the Standards without Reservation</emph> or <emph>Meet the Standards with Reservation</emph> according to WWC design standards, did not report treatment fidelity appropriately, so they were rated <emph>as Does not Meet the Design Standards</emph>.</p> <hd id="AN0164066385-26">Inter‐rater agreement (IRA)</hd> <p>A doctoral student independently conducted IRA for the quality indicator review and evidence evaluation for 21% of the included studies. IRA was calculated using the number of agreements divided by the total number of agreements and disagreements, then multiplied by 100. The IRA was 94%. The two raters consulted each other to resolve any disagreements.</p> <hd id="AN0164066385-27">RESULTS</hd> <p></p> <hd id="AN0164066385-28">Overall</hd> <p>WWC design standards were applied to evaluate the quality of the study designs of all 33 studies included in the 31 studies that met the inclusion criteria. The analysis of different indicators is described below.</p> <hd id="AN0164066385-29">Participants and settings</hd> <p>The included studies were published between 1974 and 2019. The majority of the studies were conducted in the United States (<emph>n</emph> = 28), four were conducted in New Zealand, and one was conducted in Canada. Out of a total of 271 participants across the 33 studies, 122 were target participants with or at risk of emotional and behavioral problems (see Table 1). Eighty‐seven of the target participants were male and 35 of the target participants were female. More than half of the participants did not report information regarding ethnicity (<emph>n</emph> = 80). Among the participants who reported ethnicity information, 24 Caucasian children, 13 African‐American children, three Hispanic children, one Asian child, and one mixed‐racial child were included. The studies included 47 children with developmental delay, 27 children with language delay, 25 children with internalizing behaviors, 14 children diagnosed with EBD, and 10 children with externalizing behaviors. The majority of the children were educated in inclusive classrooms (<emph>n</emph> = 51), followed by Head Start programs (<emph>n</emph> = 21), Special Education preschool classes (<emph>n</emph> = 16), preschool or community daycare (<emph>n</emph> = 15), Kindergarten (<emph>n</emph> = 13), and summer programs (<emph>n</emph> = 6).</p> <p>1 Table Participants and intervention features.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th><italic>N</italic></th><th>%</th></tr></thead><tbody valign="top"><tr><td>Gender</td><td /><td /></tr><tr><td>Male</td><td align="char" char=".">87</td><td align="char" char=".">71.3%</td></tr><tr><td>Female</td><td align="char" char=".">35</td><td align="char" char=".">28.7%</td></tr><tr><td>Race</td><td /><td /></tr><tr><td>Caucasian</td><td align="char" char=".">24</td><td align="char" char=".">19.7%</td></tr><tr><td>African‐American</td><td align="char" char=".">13</td><td align="char" char=".">10.7%</td></tr><tr><td>Hispanic</td><td align="char" char=".">3</td><td align="char" char=".">2.5%</td></tr><tr><td>Asian</td><td align="char" char=".">1</td><td align="char" char=".">0.8%</td></tr><tr><td>Mixed</td><td align="char" char=".">1</td><td align="char" char=".">0.8%</td></tr><tr><td>Not reported</td><td align="char" char=".">80</td><td align="char" char=".">65.6%</td></tr><tr><td>Disability</td><td /><td /></tr><tr><td>Internalizing behaviors</td><td align="char" char=".">25</td><td align="char" char=".">20.5%</td></tr><tr><td>Externalizing behaviors</td><td align="char" char=".">10</td><td align="char" char=".">8.2%</td></tr><tr><td>Developmental delay</td><td align="char" char=".">47</td><td align="char" char=".">38.5%</td></tr><tr><td>Language delay</td><td align="char" char=".">26</td><td align="char" char=".">21.3%</td></tr><tr><td>EBD</td><td align="char" char=".">14</td><td align="char" char=".">11.5%</td></tr><tr><td>Educational setting</td><td /><td /></tr><tr><td>Inclusive preschool</td><td align="char" char=".">51</td><td align="char" char=".">41.8%</td></tr><tr><td>Head start program</td><td align="char" char=".">21</td><td align="char" char=".">17.2%</td></tr><tr><td>Special education class</td><td align="char" char=".">16</td><td align="char" char=".">13.1%</td></tr><tr><td>Preschool or community daycare</td><td align="char" char=".">15</td><td align="char" char=".">12.3%</td></tr><tr><td>Kindergarten</td><td align="char" char=".">13</td><td align="char" char=".">10.7%</td></tr><tr><td>Summer program</td><td align="char" char=".">6</td><td align="char" char=".">4.9%</td></tr><tr><td>Implementer</td><td /><td /></tr><tr><td>Researcher or social skills instructor</td><td align="char" char=".">65</td><td align="char" char=".">53.3%</td></tr><tr><td>Teacher or TA or paraprofessional</td><td align="char" char=".">39</td><td align="char" char=".">32.0%</td></tr><tr><td>Peer</td><td align="char" char=".">4</td><td align="char" char=".">3.3%</td></tr><tr><td>Collaboration</td><td align="char" char=".">14</td><td align="char" char=".">11.5%</td></tr><tr><td>Tier</td><td /><td /></tr><tr><td>Tier‐1</td><td align="char" char=".">18</td><td align="char" char=".">14.8%</td></tr><tr><td>Tier‐2</td><td align="char" char=".">98</td><td align="char" char=".">80.3%</td></tr><tr><td>Tier‐3</td><td align="char" char=".">6</td><td align="char" char=".">4.9%</td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviation: EBD, emotional and behavioral disorders.</p> <hd id="AN0164066385-30">Experimental design</hd> <p>A total of 33 studies included in 31 articles were coded. Multiple baseline design and multiple probe design were the most commonly‐used design (54.5%, <emph>n</emph> = 18), followed by reversal/variation design (24.2%, <emph>n</emph> = 8), alternating treatment design (9.1%, <emph>n</emph> = 3), mixed design (12.1%, <emph>n</emph> = 4), and multiple treatment design (3%, <emph>n</emph> = 1). The three mixed designs include MBD combined with reversal design (Davis & Reichle, [<reflink idref="bib9" id="ref39">9</reflink>]; Fox et al., [<reflink idref="bib12" id="ref40">12</reflink>]; Strain et al., [<reflink idref="bib50" id="ref41">50</reflink>]) and an ABC multiple baseline design with counterbalanced treatment order (Benish & Bramlett, [<reflink idref="bib3" id="ref42">3</reflink>]).</p> <hd id="AN0164066385-31">Intervention features</hd> <p>The social skills interventions in the included studies were summarized and presented in Table 2. The majority of the studies (<emph>n</emph> = 21) used measures of social interactions as dependent variables (see Table 3). Positive verbal or motor‐gestural behaviors were used as dependent variables for four studies, and play behaviors was used as the dependent variable for three studies. Three studies used correct responding during instruction, one study used engagement in class activity and one study measured aggressive behaviors as the dependent variable. As to the implementers of the interventions, 12 studies used classroom teachers or teaching assistants to implement social skills interventions, 19 studies used researchers or social skills instructors trained by the researchers to implement the intervention, One study involved teacher and researcher collaboration in the intervention implementation and one study was implemented by peers who were similar‐age children and received training to deliver the intervention to the target children. Regarding the intervention components, 14 studies included sociodramatic play while 19 studies did not include sociodramatic play. A total of 20 studies included skills instruction in the intervention while 13 studies did not include skills instruction (see Table 4).</p> <p>2 Table Social skills interventions in the included studies.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Study</th><th>Social skills intervention</th></tr></thead><tbody valign="top"><tr><td>Zimmerman (<xref ref-type="bibr" rid="bibr56">2019</xref>)</td><td>Social story, visual suppport</td></tr><tr><td>Oh‐Young et al. (<xref ref-type="bibr" rid="bibr42">2018</xref>)</td><td>Peer networking, peer video modeling, time delay, and least to most prompting, and praise</td></tr><tr><td>Anderson (<xref ref-type="bibr" rid="bibr1">2018</xref>)</td><td>Social skills instruction, adult mediation, self‐evaluation and reinforcement, and parent involvement</td></tr><tr><td>Green et al. (<xref ref-type="bibr" rid="bibr17">2017</xref>)</td><td>Video modeling</td></tr><tr><td>Lane (<xref ref-type="bibr" rid="bibr33">2017</xref>)</td><td>Progressive time delay instruction on peer preferences and sharing, reinforcement</td></tr><tr><td>Smart et al. (<xref ref-type="bibr" rid="bibr43">2016</xref>)</td><td>Video modeling</td></tr><tr><td>Urlacher et al. (<xref ref-type="bibr" rid="bibr53">2016</xref>)</td><td>Progressive time delay, teach sign words and commenting, prompts, and reinforcement</td></tr><tr><td>Lemmon and Green (<xref ref-type="bibr" rid="bibr34">2015</xref>)</td><td>Self‐video modeling</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr45">2015a</xref>)</td><td>High scope curriculum play organizer + play + review</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr46">2015b</xref>)</td><td>High scope curriculum play organizer + play + review</td></tr><tr><td>Green et al. (<xref ref-type="bibr" rid="bibr16">2013</xref>)</td><td>Video modeling</td></tr><tr><td>Hughett et al. (<xref ref-type="bibr" rid="bibr24">2013</xref>)</td><td>Buddy skills intervention</td></tr><tr><td>Benish and Bramlett (<xref ref-type="bibr" rid="bibr3">2011</xref>)</td><td>Social story</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr48">2011</xref>)</td><td>High scope curriculum play organizer + play + review</td></tr><tr><td>Stanton‐Chapman et al. (<xref ref-type="bibr" rid="bibr44">2008</xref>)</td><td>High scope curriculum play organizer + play + review</td></tr><tr><td>Macy and Bricker (<xref ref-type="bibr" rid="bibr37">2007</xref>)</td><td>Teacher embedding learning opportunities into classroom activities that addressed their target children's social goals</td></tr><tr><td>Stanton‐Chapman et al. (<xref ref-type="bibr" rid="bibr47">2006</xref>)</td><td>(1) storybooks, (2) thematic play materials, and (3) High scope curriculum play organizer + play + review</td></tr><tr><td>Frea et al. (<xref ref-type="bibr" rid="bibr13">1999</xref>)</td><td>SIA: Thematic play, leader role modeling, verbal prompting, GFA: sing songs and incorporate interactive activities</td></tr><tr><td>Gronna et al. (<xref ref-type="bibr" rid="bibr20">1999</xref>)</td><td>Puppet script training</td></tr><tr><td>Davis and Reichle (<xref ref-type="bibr" rid="bibr9">1996</xref>)</td><td>High‐p intervention and praise</td></tr><tr><td>Liews (<xref ref-type="bibr" rid="bibr35">1994</xref>)</td><td>(1) social skill instruction (review + introduction of new skill + teaching essential rule + modeling + student role play + testing; (2) prompt and praise</td></tr><tr><td>Storey et al. (<xref ref-type="bibr" rid="bibr49">1994</xref>)</td><td>skills instruction, modeling, prompts and token system</td></tr><tr><td>Lindeman (<xref ref-type="bibr" rid="bibr36">1993</xref>)</td><td>Double‐prompting and contingent social praise</td></tr><tr><td>Hundert and Houghton (<xref ref-type="bibr" rid="bibr25">1992</xref>)</td><td>Classwide social skills program (CSSP): social skills instructions, puppet modeling, teacher prompting and reinforcement</td></tr><tr><td>McConnell et al. (<xref ref-type="bibr" rid="bibr39">1991</xref>)</td><td>social skills instructions, modeling, prompts and priase</td></tr><tr><td>Brown (1), (<xref ref-type="bibr" rid="bibr5">1988</xref>)</td><td>group socialization procedures: script training and prompting</td></tr><tr><td>Brown (2), (<xref ref-type="bibr" rid="bibr5">1988</xref>)</td><td>group socialization procedures: script training and prompting</td></tr><tr><td>Goldstein (1), (<xref ref-type="bibr" rid="bibr15">1988</xref>)</td><td>social dramatic script training and role prompt</td></tr><tr><td>Goldstein (2), (<xref ref-type="bibr" rid="bibr15">1988</xref>)</td><td>social dramatic script training and role prompt</td></tr><tr><td>Fox et al. (<xref ref-type="bibr" rid="bibr12">1986</xref>)</td><td>verbal and physical prompts and contingent praise</td></tr><tr><td>Odom et al. (<xref ref-type="bibr" rid="bibr41">1985</xref>)</td><td>peer‐initiation intervention, confederate training, teacher prompt, and token reinforcement</td></tr><tr><td>Strain et al. (<xref ref-type="bibr" rid="bibr50">1976</xref>)</td><td>a combination of verbal and physical prompts, plus verbal praise contingent on appropriate social behaviors</td></tr><tr><td>Strain and Timm (<xref ref-type="bibr" rid="bibr51">1974</xref>)</td><td>reinforcement</td></tr></tbody></table> </ephtml> </p> <p>3 Table Study characteristic.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Study</th><th>Design</th><th><italic>N</italic></th><th><italic>n</italic></th><th><italic>M</italic></th><th>Disability</th><th>Settings</th><th>Implementer</th><th>So‐Dra</th><th>skills ins.</th><th>Dependent variable</th><th>Gen.</th><th>Main.</th></tr></thead><tbody valign="top"><tr><td>Zimmerman (<xref ref-type="bibr" rid="bibr56">2019</xref>)0002</td><td>ATD</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td>DD, IB</td><td>Kinder and pre</td><td>R</td><td>N</td><td>N</td><td>Engagement</td><td>N</td><td>N</td></tr><tr><td>Oh‐Young et al. (<xref ref-type="bibr" rid="bibr42">2018</xref>)</td><td>ATD</td><td align="char" char=".">11</td><td align="char" char=".">5</td><td align="char" char=".">5</td><td>DD, LD</td><td>IP</td><td>T</td><td>N</td><td>N</td><td>Positive verbal social interactions</td><td>Y</td><td>N</td></tr><tr><td>Anderson et al. (<xref ref-type="bibr" rid="bibr1">2018</xref>)</td><td>MBD</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td align="char" char=".">1</td><td>EB, IB</td><td>Kinder</td><td>R</td><td>N</td><td>Y</td><td>Social interaction</td><td>N</td><td>Y</td></tr><tr><td>Green et al. (<xref ref-type="bibr" rid="bibr17">2017</xref>)</td><td>MPD</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td align="char" char=".">2</td><td>EB, IB</td><td>Kinder</td><td>R</td><td>N</td><td>N</td><td>Positive social interactions with peers</td><td>N</td><td>Y</td></tr><tr><td>Lane (<xref ref-type="bibr" rid="bibr33">2017</xref>)</td><td>MPD</td><td align="char" char=".">6</td><td align="char" char=".">6</td><td align="char" char=".">5</td><td>DD, EB, IB</td><td>SEP</td><td>R</td><td>N</td><td>Y</td><td>Correct responding during peer preference instruction</td><td>Y</td><td>Y</td></tr><tr><td>Smart et al. (<xref ref-type="bibr" rid="bibr43">2016</xref>)</td><td>AB</td><td align="char" char=".">1</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td>IB</td><td>Kinder</td><td>R</td><td>N</td><td>N</td><td>Sharing, reciprocal peer interactions, positive verbalization, adult interaction</td><td>N</td><td>Y</td></tr><tr><td>Urlacher et al. (<xref ref-type="bibr" rid="bibr53">2016</xref>)</td><td>MPD</td><td align="char" char=".">6</td><td align="char" char=".">2</td><td align="char" char=".">2</td><td>LD, DD</td><td>IP</td><td>R</td><td>N</td><td>Y</td><td>Correct responding for sign words, correct responding for commenting</td><td>Y</td><td>Y</td></tr><tr><td>Lemmon and Green (<xref ref-type="bibr" rid="bibr34">2015</xref>)</td><td>MTD</td><td align="char" char=".">4</td><td align="char" char=".">1</td><td align="char" char=".">1</td><td>EB</td><td>Pre</td><td>R</td><td>N</td><td>N</td><td>Making an invitation to play, positive communication, and sustained interaction</td><td>N</td><td>Y</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr45">2015a</xref>)</td><td>MBD</td><td align="char" char=".">6</td><td align="char" char=".">6</td><td align="char" char=".">3</td><td>DD, LD</td><td>SEP</td><td>R</td><td>Y</td><td>Y</td><td>Commenting and request for verbal behavior</td><td>N</td><td>N</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr46">2015b</xref>)</td><td>MBD</td><td align="char" char=".">6</td><td align="char" char=".">3</td><td align="char" char=".">2</td><td>DD, LD</td><td>IP</td><td>R</td><td>Y</td><td>Y</td><td>Parallel play</td><td>N</td><td>N</td></tr><tr><td>Green et al. (<xref ref-type="bibr" rid="bibr16">2013</xref>)</td><td>MPD</td><td align="char" char=".">4</td><td align="char" char=".">4</td><td align="char" char=".">4</td><td>EB, IB</td><td>Kinder</td><td>R</td><td>N</td><td>Y</td><td>Social interactions</td><td>N</td><td>Y*</td></tr><tr><td>Hughett et al. (<xref ref-type="bibr" rid="bibr24">2013</xref>)</td><td>MBD</td><td align="char" char=".">9</td><td align="char" char=".">3</td><td align="char" char=".">2</td><td>SD, LD</td><td>IP</td><td>T</td><td>Y</td><td>Y</td><td>Cooperative play</td><td>N</td><td>Y</td></tr><tr><td>Benish and Bramlett (<xref ref-type="bibr" rid="bibr3">2011</xref>)</td><td>MBD</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td align="char" char=".">2</td><td>EB</td><td>HS</td><td>T</td><td>N</td><td>Y</td><td>Aggressive behavior</td><td>N</td><td>Y</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr48">2011</xref>)</td><td>MBD</td><td align="char" char=".">10</td><td align="char" char=".">10</td><td align="char" char=".">9</td><td>EBD, DD, LD</td><td>IP</td><td>R</td><td>Y</td><td>Y</td><td>Social initiations and responses</td><td>Y</td><td>N</td></tr><tr><td>T. Stanton‐Chapman et al. (<xref ref-type="bibr" rid="bibr44">2008</xref>)</td><td>MBD</td><td align="char" char=".">8</td><td align="char" char=".">8</td><td align="char" char=".">7</td><td>LD, DD</td><td>HS</td><td>R</td><td>Y</td><td>Y</td><td>Social communication strategy use and positive verbalizations</td><td>Y</td><td>N</td></tr><tr><td>Macy and Bricker (<xref ref-type="bibr" rid="bibr37">2007</xref>)</td><td>ABAB</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td>DD, IB</td><td>HS</td><td>R</td><td>N</td><td>N</td><td>Correct response to their target social goals</td><td>N</td><td>N</td></tr><tr><td>T. L. Stanton‐Chapman et al. (<xref ref-type="bibr" rid="bibr47">2006</xref>)</td><td>ATD</td><td align="char" char=".">8</td><td align="char" char=".">4</td><td align="char" char=".">2</td><td>LD</td><td>HS</td><td>R</td><td>Y</td><td>Y</td><td>Positive verbalizations</td><td>N</td><td>N</td></tr><tr><td>Frea et al. (<xref ref-type="bibr" rid="bibr13">1999</xref>)</td><td>ABAB</td><td align="char" char=".">2</td><td align="char" char=".">2</td><td align="char" char=".">1</td><td>DD, EB</td><td>HS</td><td>R</td><td>Y</td><td>N</td><td>Positive interactions</td><td>Y</td><td>N</td></tr><tr><td>Gronna et al. (<xref ref-type="bibr" rid="bibr20">1999</xref>)</td><td>MBD</td><td align="char" char=".">6</td><td align="char" char=".">4</td><td align="char" char=".">2</td><td>IB</td><td>IP</td><td>R</td><td>Y</td><td>Y</td><td>Correctly performed social skills</td><td>Y</td><td>Y</td></tr><tr><td>Davis and Reichle (<xref ref-type="bibr" rid="bibr9">1996</xref>)</td><td>MBD and ABAB</td><td align="char" char=".">6</td><td align="char" char=".">4</td><td align="char" char=".">2</td><td>EBD</td><td>Daycare and kinder</td><td>Peers</td><td>N</td><td>N</td><td>Compliance to low‐p requests</td><td>N</td><td>Y*</td></tr><tr><td>Liews (<xref ref-type="bibr" rid="bibr35">1994</xref>)</td><td>ABAB</td><td align="char" char=".">4</td><td align="char" char=".">4</td><td align="char" char=".">3</td><td>LD</td><td>IP</td><td>T</td><td>N</td><td>Y</td><td>Social interactions</td><td>N</td><td>N</td></tr><tr><td>Storey et al. (<xref ref-type="bibr" rid="bibr49">1994</xref>)</td><td>MPD</td><td align="char" char=".">5</td><td align="char" char=".">5</td><td align="char" char=".">4</td><td>IB</td><td>Pre and HS</td><td>T</td><td>Y</td><td>Y</td><td>Social initiations and responses, peer strategy use</td><td>Y</td><td>N</td></tr><tr><td>Lindeman (<xref ref-type="bibr" rid="bibr36">1993</xref>)</td><td>MBD</td><td align="char" char=".">4</td><td align="char" char=".">4</td><td align="char" char=".">1</td><td>IB</td><td>Pre</td><td>T</td><td>N</td><td>N</td><td>Social initiations and social interactions</td><td>N</td><td>Y</td></tr><tr><td>Hundert and Houghton (<xref ref-type="bibr" rid="bibr25">1992</xref>)</td><td>MBD</td><td align="char" char=".">14</td><td align="char" char=".">14</td><td align="char" char=".">12</td><td>DD, EBD</td><td>IP</td><td>C</td><td>Y</td><td>Y</td><td>Positive play</td><td>Y</td><td>Y</td></tr><tr><td>McConnell et al. (<xref ref-type="bibr" rid="bibr39">1991</xref>)</td><td>ABAB</td><td align="char" char=".">11</td><td align="char" char=".">4</td><td align="char" char=".">1</td><td>IB</td><td>IP</td><td>R</td><td>Y</td><td>Y</td><td>Social initiations and responses</td><td>Y</td><td>N</td></tr><tr><td>Brown (1), (<xref ref-type="bibr" rid="bibr5">1988</xref>)</td><td>MBD</td><td align="char" char=".">20</td><td align="char" char=".">2</td><td align="char" char=".">1</td><td>IB, DD</td><td>HS</td><td>T</td><td>N</td><td>N</td><td>Prompted and unprompted Social interactions</td><td>Y</td><td>N</td></tr><tr><td>Brown (2), (<xref ref-type="bibr" rid="bibr5">1988</xref>)</td><td>MBD</td><td align="char" char=".">17</td><td align="char" char=".">2</td><td align="char" char=".">2</td><td>ED, ID</td><td>Pre for at risk</td><td>T</td><td>N</td><td>N</td><td>Prompted and unprompted social interactions</td><td>Y</td><td>N</td></tr><tr><td>Goldstein (1), (<xref ref-type="bibr" rid="bibr15">1988</xref>)</td><td>ABAB</td><td align="char" char=".">6</td><td align="char" char=".">2</td><td align="char" char=".">2</td><td>LD, EB</td><td>IP</td><td>T</td><td>Y</td><td>Y</td><td>Social responses</td><td>N</td><td>N</td></tr><tr><td>Goldstein (2), (<xref ref-type="bibr" rid="bibr15">1988</xref>)</td><td>ABA</td><td align="char" char=".">6</td><td align="char" char=".">6</td><td align="char" char=".">3</td><td>LD</td><td>Summer program</td><td>R</td><td>Y</td><td>Y</td><td>Social responses</td><td>N</td><td>N</td></tr><tr><td>Fox et al. (<xref ref-type="bibr" rid="bibr12">1986</xref>)</td><td>MBD and ABAB</td><td align="char" char=".">20</td><td align="char" char=".">3</td><td align="char" char=".">2</td><td>IB</td><td>IP</td><td>T</td><td>N</td><td>Y</td><td>Social initiations and extended interactions</td><td>N</td><td>Y</td></tr><tr><td>Odom et al. (<xref ref-type="bibr" rid="bibr41">1985</xref>)</td><td>MBD</td><td align="char" char=".">6</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td>IB</td><td>IP</td><td>T</td><td>Y</td><td>Y</td><td>Social interactions</td><td>N</td><td>N</td></tr><tr><td>Strain et al. (<xref ref-type="bibr" rid="bibr50">1976</xref>)</td><td>MBD and ABAB</td><td align="char" char=".">10</td><td align="char" char=".">3</td><td align="char" char=".">3</td><td>EBD</td><td>SEP</td><td>T</td><td>N</td><td>N</td><td>Positive and negative behaviors</td><td>N</td><td>N</td></tr><tr><td>Strain and Timm (<xref ref-type="bibr" rid="bibr51">1974</xref>)</td><td>ABAB</td><td align="char" char=".">21</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td>LD</td><td>SEP</td><td>R</td><td>N</td><td>N</td><td>Positive motor‐gestural behaviors</td><td>N</td><td>N</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 Abbreviations: ATD, alternating treatment design; C, collaboration between researcher and teacher; DD, developmental delay; EB, externalizing behavior; EBD, emotional and behavioral disorder; Gen., generalization; HS, Head Start; IB, internalizing behavior; IP, inclusive preschool; LD, language delay; M, number of male target participants; Main., maintenance; MBD, multiple baseline design; MPD, multiple probe design; MTP, multiple treatment design; N, no; n, number of target participants; N, number of total participants; Kinder, kindergarten; Pre, preschool; R, researcher; SEP, special education preschool; Skill Ins., social skills instruction; So‐Dra, socio‐dramatic play; T, teacher or TA; Y, yes.</item> <item>3 a The study included five participants in total. Only three of them met the inclusion criteria in this review.</item> <item>4 Table Evaluation using what works clearinghouse design standards for single‐case design.</item> </ulist> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Study/ID</th><th>Design</th><th>Participant ID</th><th>OV</th><th>DS‐1</th><th>DS‐2A</th><th>DS‐2B</th><th>DS‐3</th><th>DS‐4A</th><th>DS‐4B</th></tr></thead><tbody valign="top"><tr><td>Zimmerman (<xref ref-type="bibr" rid="bibr56">2019</xref>)*</td></tr><tr><td /><td>ATD</td><td>Jason</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Marc</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Michael</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>N/A</td></tr><tr><td>Oh‐Young et al. (<xref ref-type="bibr" rid="bibr42">2018</xref>)</td></tr><tr><td /><td>ATD</td><td>Abe</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Bruce</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Cyrus</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Darian</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Flavio</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td>Anderson (<xref ref-type="bibr" rid="bibr1">2018</xref>)*</td></tr><tr><td /><td>MBD x P</td><td>Billy</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Rachel</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Lauren</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Green et al. (<xref ref-type="bibr" rid="bibr17">2017</xref>)*</td></tr><tr><td /><td>MPD</td><td>Ahmed</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Kirsty</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Kirk</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Lane (<xref ref-type="bibr" rid="bibr33">2017</xref>)*</td></tr><tr><td /><td>MPD</td><td>Chad</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Ellis</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Jared</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Michael</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Jessica</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Levi</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td>Urlacher et al. (<xref ref-type="bibr" rid="bibr53">2016</xref>)*</td></tr><tr><td /><td>AB</td><td>Aiden</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>0</td><td>1</td></tr><tr><td /><td /><td>Ben</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>0</td><td>1</td></tr><tr><td>Smart et al. (<xref ref-type="bibr" rid="bibr43">2016</xref>)*</td></tr><tr><td /><td>AB</td><td>Zara</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>N/A</td></tr><tr><td>Lemmon and Green (<xref ref-type="bibr" rid="bibr34">2015</xref>)*</td></tr><tr><td /><td>MTD</td><td>Tyler</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>1</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr45">2015a</xref>)*</td></tr><tr><td /><td>MBD</td><td>Joshua</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Ashley</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Montel</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Mia</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Shontelle</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Blake</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr46">2015b</xref>)*</td></tr><tr><td /><td>MBD x P</td><td>Cody</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Andre</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Monique</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Green et al. (<xref ref-type="bibr" rid="bibr16">2013</xref>)*</td></tr><tr><td /><td>MPD x P</td><td>Billy</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td>MPD x P</td><td>Oliver</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td>MPD x P</td><td>Harry</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td>MPD x P</td><td>Derek</td><td>0</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>0</td></tr><tr><td>Hughett et al. (<xref ref-type="bibr" rid="bibr24">2013</xref>)*</td></tr><tr><td /><td>MBD x P</td><td>Whalen</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Samantha</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Stuart</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Benish and Bramlett (<xref ref-type="bibr" rid="bibr3">2011</xref>)</td></tr><tr><td /><td>ABC and MBD x P</td><td>Lisa</td><td>0</td><td>1</td><td>0</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Kyle</td><td>0</td><td>1</td><td>0</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>John</td><td>0</td><td>1</td><td>0</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Stanton‐Chapman (<xref ref-type="bibr" rid="bibr48">2011</xref>)*</td></tr><tr><td /><td>MBD x P</td><td>Dyad A</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Dyad B</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Dyad C</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Dyad D</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Dyad E</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Stanton‐Chapman et al. (<xref ref-type="bibr" rid="bibr44">2008</xref>)</td></tr><tr><td /><td>MBD</td><td>Child A1</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Child A2</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Child B1</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Child B2</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td>Macy and Bricker (<xref ref-type="bibr" rid="bibr37">2007</xref>)*</td></tr><tr><td /><td>AB</td><td>Ron</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Aziano</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Earl</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td>Stanton‐Chapman et al. (<xref ref-type="bibr" rid="bibr47">2006</xref>)*</td></tr><tr><td /><td>ATD</td><td>Child A1</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Child B1</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Child C1</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Child D1</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td>Frea et al. (<xref ref-type="bibr" rid="bibr13">1999</xref>)*</td></tr><tr><td /><td>ABACAD</td><td>Arin</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Lou</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td>Gronna et al. (<xref ref-type="bibr" rid="bibr20">1999</xref>)*</td></tr><tr><td /><td>MBD x Skills</td><td>Skill 1</td><td>0</td><td>1</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td></tr><tr><td /><td /><td>Skill 2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td></tr><tr><td /><td /><td>Skill 3</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Skill 4</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Skill 5</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Davis and Reichle (<xref ref-type="bibr" rid="bibr9">1996</xref>)</td></tr><tr><td /><td>MBD and ABAB</td><td>Rhonda</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Peter</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Keith</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Patty</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Liews (<xref ref-type="bibr" rid="bibr35">1994</xref>)*</td></tr><tr><td /><td>ABAC</td><td>Ricky</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Maggie</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Tommy</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Paul</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td>Storey et al. (<xref ref-type="bibr" rid="bibr49">1994</xref>)</td></tr><tr><td /><td>MBD x P</td><td>Jeremiah</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>0</td></tr><tr><td /><td /><td>Drew</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>0</td></tr><tr><td /><td /><td>Zeus</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>0</td></tr><tr><td /><td /><td>Miko</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>0</td></tr><tr><td /><td /><td>Domicica</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>0</td></tr><tr><td>Lindeman (<xref ref-type="bibr" rid="bibr36">1993</xref>)</td></tr><tr><td /><td>MBD x P</td><td>Kerry</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Steven</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Erica</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Evelyn</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Hundert and Houghton (<xref ref-type="bibr" rid="bibr25">1992</xref>)</td></tr><tr><td /><td>MBD x P</td><td>Group 1</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Group 2</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Group 3</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Group 4</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>McConnell et al. (<xref ref-type="bibr" rid="bibr39">1991</xref>)*</td></tr><tr><td /><td>ABACAD</td><td>Candace</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Hilda</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Ramona</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Rupert</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td>Brown et al. (<xref ref-type="bibr" rid="bibr5">1988</xref>); Study 1</td></tr><tr><td /><td>MBD x P</td><td>Charles</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Julie</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td>Brown et al. (<xref ref-type="bibr" rid="bibr5">1988</xref>); Study 2</td></tr><tr><td /><td>MBD x P</td><td>Howard</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Shaun</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>1</td></tr><tr><td>Goldstein et al. (<xref ref-type="bibr" rid="bibr15">1988</xref>); Study 1*</td></tr><tr><td /><td>ABAB</td><td>Sean</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>David</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Scott</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Bret</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Michele</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr><td /><td /><td>Melinda</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>N/A</td></tr><tr valign="bottom"><td>Goldstein et al. (<xref ref-type="bibr" rid="bibr15">1988</xref>); Study 2*</td></tr><tr><td /><td>ABA</td><td>Sharon</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Bobby</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Michael</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Mary</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Melissa</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td /><td /><td>Benjamin</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>1</td><td>N/A</td></tr><tr><td>Fox et al. (<xref ref-type="bibr" rid="bibr12">1986</xref>)*</td></tr><tr><td /><td>ABAB and MBD x P</td><td>Arthur</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Evelyn</td><td>0</td><td>1</td><td>1</td><td>1</td><td>1</td><td>1</td><td>0</td></tr><tr><td /><td /><td>Donald</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Odom et al. (<xref ref-type="bibr" rid="bibr41">1985</xref>)*</td></tr><tr><td /><td>MBD x S x P</td><td>Gary</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Garvin</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Jack</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Strain et al. (<xref ref-type="bibr" rid="bibr50">1976</xref>)*</td></tr><tr><td /><td>MBD x P and ABABA</td><td>Dan</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Hank</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td /><td /><td>Ricky</td><td>2</td><td>1</td><td>1</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td>Strain and Timm (<xref ref-type="bibr" rid="bibr51">1974</xref>)*</td></tr><tr><td /><td>ABABA</td><td>Martha</td><td>0</td><td>1</td><td>1</td><td>1</td><td>0</td><td>2</td><td>N/A</td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 <emph>Note</emph> : For column OV and DS‐4A, 2 = meets the standard without reservation, 1 = meets the standard with reservation, 0 = does not meet the standard.</item> <item>5 Abbreviations: 0, does not meet the standard; 1, meets the standard; ATD, alternating treatment design; DS, design standard; MBD, multiple baseline design; MPD, multiple probe design; MTP, multiple treatment design; N/A, not relevant; OV, overall; OV, overall; x P, across participants; x S, across skills.</item> </ulist> <hd id="AN0164066385-32">Methodological quality</hd> <p></p> <hd id="AN0164066385-33">Overall ratings</hd> <p>Each study was assessed with the adapted WWC quality rubric and given an overall rating of methodological quality. For studies including more than one dependent variable, one major dependent variable was selected for the evaluation. This resulted in the evaluation of 33 studies and 33 line graphs of the main dependent variables across 31 articles. Only one line graph of the main dependent variable decided by the author was chosen for each study. 45.5% of all the studies (15 studies) were classified as <emph>Meets the Standards without Reservations</emph>, about 12.1% of all the studies (<emph>n</emph> = 4) <emph>Meets the Standards with Reservations</emph>, and about 42.4% of all the studies (14 studies across 13 articles) <emph>Does Not Meet the Standards</emph>. The overall ratings were based on the four design standards included in the WWC standards which did not include treatment fidelity.</p> <hd id="AN0164066385-34">Individual design standards ratings</hd> <p>The quality rubric evaluated four design standards (DSs): systematic manipulation of independent variable (DS‐1), interobserver agreement including sufficient number of IOA (DS‐2A) and adequate high level of IOA (DS‐2B), experimental control (DS‐3) meaning more than three attempts to replicate effects, demonstration of effect including a sufficient number of data points (DS‐4A) and additional criteria for MBD (DS‐4B). Additionally, a fifth standard on treatment fidelity was also evaluated in the review. Treatment fidelity included more than 20% of total sessions reported treatment fidelity (DS‐5A) and adequate high level of treatment fidelity (DS‐5B). Table 3 displayed the WWC standards applied to the 33 single‐case studies across 31 articles. A total of 122 cases within the studies were analyzed. Failing to meet experimental control (DS‐3) was the primary reason for studies being classified as <emph>Does not Meet Design Standards</emph> (39.3%, <emph>n</emph> = 13). The study by Benish and Bramlett ([<reflink idref="bib3" id="ref43">3</reflink>]) did not report a sufficient number of IOA (DS‐2A) and an inquiry email was sent to the corresponding author, but no reply with extra information was received. The study by Green et al. ([<reflink idref="bib16" id="ref44">16</reflink>]) only had the minimum number of data points (DS‐4A) to demonstrate effect, so this study was classified as <emph>Meets Standards with Reservation</emph>. The evaluation results of the five standards are presented below.</p> <hd id="AN0164066385-35">Systematic manipulation of the independent variable (DS‐1)</hd> <p>All 122 cases within the 33 studies received the social skills interventions under systematically manipulation in their studies.</p> <hd id="AN0164066385-36">Inter‐observer agreement (DS‐2)</hd> <p>The majority of the evaluated studies (<emph>n</emph> = 32, 97%) reported IOA on more than 20% of their data at or above 80% for percentage agreement or 60% for Cohen's Kappa. Only one study failed to report the percentage of the IOA data points they collected (Benish & Bramlett, [<reflink idref="bib3" id="ref45">3</reflink>]). Inquiry emails were sent to the corresponding authors, but no reply with extra information was received. 27.3% (<emph>n</emph> = 9) of studies did not specify if IOA was collected at least once for each condition.</p> <hd id="AN0164066385-37">Experimental control (DS‐3)</hd> <p>Approximately 60.7% (<emph>n</emph> = 20) of the included studies met this standard. The other 39.3% (<emph>n</emph> = 13) of the evaluated studies did not demonstrate intervention effects for at least three different points in time. Of the 13 studies, four studies used multiple baseline design across participants, but the intervention began at less than three time points (Brown et al., [<reflink idref="bib5" id="ref46">5</reflink>]; T. Stanton‐Chapman et al., [<reflink idref="bib44" id="ref47">44</reflink>]; Storey et al., [<reflink idref="bib49" id="ref48">49</reflink>]). The other eight studies used reversal design or variations of reversal design, but they had less than three phase contrasts to demonstrate intervention effects (Frea et al., [<reflink idref="bib13" id="ref49">13</reflink>]; Goldstein et al., [<reflink idref="bib15" id="ref50">15</reflink>]; Lewis, [<reflink idref="bib35" id="ref51">35</reflink>]; Macy & Bricker, [<reflink idref="bib37" id="ref52">37</reflink>]; McConnell et al., [<reflink idref="bib39" id="ref53">39</reflink>]; Smart et al., [<reflink idref="bib43" id="ref54">43</reflink>]; Strain & Timm, [<reflink idref="bib51" id="ref55">51</reflink>]; Urlacher et al., [<reflink idref="bib53" id="ref56">53</reflink>]). One study that used multiple treatment design did not have three different points in time to show intervention effects (Lemmon & Green, [<reflink idref="bib34" id="ref57">34</reflink>]).</p> <hd id="AN0164066385-38">Demonstration of effect (DS‐4)</hd> <p>About 60.6% (<emph>n</emph> = 20) of the studies included at least three cases for multiple baseline design or at least one case for reversal or alternating treatment design with at least five data points in each phase. 33.3% (<emph>n</emph> = 11) of the studies used designs that included at least three cases with three to four data points in each phase, so they were only classified as <emph>Meets Standard with Reservation</emph>. The other 6.1% of the studies (<emph>n</emph> = 2) were classified as <emph>Does not Meet the Standard</emph>.</p> <hd id="AN0164066385-39">WWC evidence evaluation</hd> <p>The summary of the evidence evaluation was presented in Table 5. For all the studies that met the standards without reservation or met the standards with reservation, WWC evidence standards were used to evaluate their evidence. Ten studies across 10 articles were rated as showing strong evidence of the effects of social skills interventions, one study was rated as showing moderate evidence, and eight studies were rated as showing no evidence. A total of 39 participants were included in the 10 studies showing strong evidence. Four participants were included in the one study showing moderate evidence. The 11 studies showing evidence of the effects of social skills interventions were conducted by 10 different research teams.</p> <p>5 Table Summary of evidence evaluation</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th>Evidence</th><th>No evidence</th></tr></thead><tbody valign="top"><tr><td>Baseline/less effective intervention (ATD)</td><td>13 (68.4%)</td><td>6 (18.2%)</td></tr><tr><td>Intervention/better intervention (ATD)</td><td>15 (78.9%)</td><td>4 (12.1%)</td></tr><tr><td>Between phase</td><td>11 (57.9%)</td><td>8 (42.1%)</td></tr><tr><td>Overall evidence</td><td>11 (57.9%)</td><td>8 (42.1%)</td></tr></tbody></table> </ephtml> </p> <p>6 ATD, alternating treatment design.</p> <hd id="AN0164066385-40">Treatment fidelity</hd> <p>About 51.5% (<emph>n</emph> = 17) of the studies reported treatment fidelity, and 48.5% of the studies (<emph>n</emph> = 16) did not report treatment fidelity. Failing to report treatment fidelity (DS‐5) was the most common shortage in the included studies (48.5%, <emph>n</emph> = 16). With one exception (Hughett et al., [<reflink idref="bib24" id="ref58">24</reflink>]), the evaluated articles published after 2010 all reported treatment fidelity.</p> <hd id="AN0164066385-41">DISCUSSION</hd> <p>The purpose of this scoping and quality indicator review was to evaluate the evidence base of the social skills interventions for preschoolers at risk of EBD due to emotional and behavioral problems. In this review, descriptive information was reported as well as indicators of methodological quality. Four research questions were proposed in the review. The findings for each question were discussed below. First, is there sufficient evidence for social skills interventions for preschoolers with or at risk for EBD? Overall, this scoping and quality indicator review examined 33 studies across 31 published articles on social skills interventions for preschoolers with or at risk of emotional and behavioral problems according to WWC single‐case research standards consisting of 18 interventons. Of these 19 studies met the WWC design standards, 11 studies showed <emph>strong evidence</emph> or <emph>moderate evidence</emph>. In total, 43 participants in 11 studies conducted by 10 research teams showed evidence to support social skills interventions as effective interventions. According to the standard proposed by Horner et al. ([<reflink idref="bib22" id="ref59">22</reflink>]), a practice could be considered evidence‐based when a minimum of 5 single‐subject studies with at least 20 participants conducted by 3 different research teams were published in peer‐reviewed journals. The evidence of the single case research for social skills interventions for preschoolers with emotional and behavioral problems were summarized and presented in this review. Second, what are the features of the participants and interventions for the SCR studies on social skills interventions for preschoolers with or at risk for EBD? The main features of the participants were presented in Table 1. Most of the included studies reported enough information regarding participants and their educational settings. However, 65.6% of the target participants did not have any reported ethnicity information.</p> <p>The reviewed studies included intervention packages using High scope curriculum (T. L. Stanton‐Chapman & Brown, [<reflink idref="bib45" id="ref60">45</reflink>]; T. L. Stanton‐Chapman & Brown, [<reflink idref="bib46" id="ref61">46</reflink>]; T. L. Stanton‐Chapman et al., [<reflink idref="bib47" id="ref62">47</reflink>]), social story (Benish & Bramlett, [<reflink idref="bib3" id="ref63">3</reflink>]; Zimmerman et al., [<reflink idref="bib56" id="ref64">56</reflink>]), social skills instructions (Anderson et al., [<reflink idref="bib1" id="ref65">1</reflink>]; Hundert & Houghton, [<reflink idref="bib25" id="ref66">25</reflink>]; Lewis, [<reflink idref="bib35" id="ref67">35</reflink>]; McConnell et al., [<reflink idref="bib39" id="ref68">39</reflink>]; Storey et al., [<reflink idref="bib49" id="ref69">49</reflink>]), video modeling (Green et al., [<reflink idref="bib16" id="ref70">16</reflink>], [<reflink idref="bib17" id="ref71">17</reflink>]; Lemmon & Green, [<reflink idref="bib34" id="ref72">34</reflink>]; Oh‐young et al., [<reflink idref="bib42" id="ref73">42</reflink>]; Smart et al., [<reflink idref="bib43" id="ref74">43</reflink>]), and script training (Goldstein et al., [<reflink idref="bib15" id="ref75">15</reflink>]; Gronna et al., [<reflink idref="bib20" id="ref76">20</reflink>]). The most commonly used behavior strategies included in the packages were prompting, modeling and reinforcement.</p> <p>Third, what is the methodological quality of SCR studies on social skills interventions for preschoolers with or at risk for emotional and behavioral problems? After the application of WWC quality standards to evaluate all 33 studies, the results indicated there was enough evidence to support social skills interventions as evidence‐based intervention strategies for at‐risk preschoolers. For the methodological quality review, 15 studies met the standards without reservation, 4 studies met the standards with reservation. Overall, the literature base from this scoping review produced methodology of acceptable quality. Fourth, what are the methodological strengths and areas of improvement for the included SCR studies? From the evaluation, three areas of methodological weakness were identified: reliability, experimental control, and treatment fidelity.</p> <hd id="AN0164066385-42">Areas of concern</hd> <p>About 97% (<emph>n</emph> = 32) of the evaluated studies reported acceptable data IOA with an adequately high level. However, only 77.4% (<emph>n</emph> = 24) conducted IOA consistently across all the participants and phases. Nine studies in this review reported positive findings without adequate IOA measures according to WWC standards. Adequate collection and reporting of IOA increases confidence in the reliability of the effects reported in the studies. Conversely, insufficient IOA decreases the overall quality of data reported and reduces confidence in the results. It was encouraging to see more researchers reporting IOA in their studies which reflected the improvement of the research quality in the field. Compared to previous reviews on social skills interventions, more included articles collected and reported IOA in the present review. It is strongly recommended for future studies to collect and report adequate IOA according to the standards to ensure the confidence in the results.</p> <p>The second area of concern, demonstrating experimental control, was crucial in SCR. The appropriate experimental control ensured the functional relationship between the independent variable and dependent variable. In SCR, WWC standards required the study to have at least three demonstrations of experimental control at three different time points. Only 60.7% (<emph>n</emph> = 20) of the 33 evaluated studies included 3 or more demonstrations of experimental control at 3 different time points. Out of the 13 studies that did not show experimental control at 3 different time points, 9 studies reporting positive outcomes lack the internal validity to support their findings. Further single‐case studies with rigorous methodological design related to internal validity were needed to strengthen the evidence of social skills interventions for preschoolers with emotional and behavioral problems.</p> <p>More than half of the included studies (51.5%, <emph>n</emph> = 17) did not report treatment fidelity. However, the trend of more studies reporting treatment fidelity in the studies published after 2010 implicated improvement of the internal validity of the studies. Thirteen out of the 14 included studies published after 2010 reported treatment fidelity. Treatment fidelity data were crucial to ensure the interventions were carried out as they were designed. It is strongly recommended to report treatment fidelity in future studies.</p> <p>A small proportion of the included studies reported generalization and maintenance. Only 12 studies out of the 33 included studies included generalization phase and 14 studies included maintenance phase. As pointed out in the systematic review (Ke et al., [<reflink idref="bib29" id="ref77">29</reflink>]) on social skills interventions for youth and adults with ASD, difficulty in generalizing social skills to new or natural environment was observed and evidenced in existing research, the authors suggested a need to intentionally plan for generalization. Despite the agreement on the importance of generalization and maintenance in the field, including them in the research study was still rare in practice in the field. But there was a trend that higher percentage of recent publications report maintenance data in their studies as 64% of included studies published after 2010 reported maintenance data. It's highly recommended to include generalization and maintenance in social skills programs and report the data in research studies in the future. Only with generalization and maintenance data reported in research could we determine research‐based methods to improve the generalization of social skills.</p> <hd id="AN0164066385-43">Limitations and future research</hd> <p>There were limitations of the review. First, it's required that only certified reviewers are qualified to apply the WWC stardards and draw conclusions about evidence‐based practices in education. As the authors were not certified reviewers yet, the evidence suggested here did not have the same level of defensibility. Second, only WWC standards were used to evaluate the quality of the included studies in this scoping review. If other quality standards such as the CEC standards could be applied to examine the quality of the included studies in the future, an analysis of convergent validity between the two standards would be possible. Third, social behavioral outcomes were the main focus of the present review, some academic outcomes reported in the included articles were not evaluated. Future research could evaluate outcomes across different areas to examine the effect of social skills interventions. This scoping review focus on preschoolers at risk of emotional and behavioral problems. Future reseach focus on other age groups could be compared with the results of this review as social skills vary according to different ages.</p> <hd id="AN0164066385-44">Implications for practice</hd> <p>Social skills interventions for preschoolers at risk of emotional and behavioral problems had an abundant evidence base. Most of the included studies showed positive social outcomes while some of the studies showed no evidence. The social skills interventions not only increased children's desired social outcomes, but also decreased the children's problem behaviors. Practitioners were encouraged to give social skills interventions to improve children's social skills and academic skills in classroom settings. Prompting, modeling and reinforcement were the most commonly used behavioral strategies in the intervention packages based on our analysis of intervention features. Therefore, including these behavioral strategies and combining these research‐based strategies in social skills intervention packages were recommended. It's necessary to include generalization and maintenance in the social skills intervention program to improve the generalization of any target social skills.</p> <hd id="AN0164066385-45">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0164066385-46">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p> <ref id="AN0164066385-47"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref30" type="bt">1</bibl> <bibtext> *Anderson, D. H., Trinh, S. M., Caldarella, P., Hansen, B. D., & Richardson, M. J. (2018). Increasing positive playground interaction for kindergarten students at risk for emotional and behavioral disorders. Early Childhood Education Journal, 46 (5), 487 – 496.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref13" type="bt">2</bibl> <bibtext> Bandura, A., & Walters, R. H. (1977). Social learning theory (1). 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Items – Name: Title
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  Data: Evidence from Single Case Research on Social Skills Interventions for Preschoolers At-Risk for EBD: A Scoping Review and Application of Quality Indicators
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  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Dong%2C+Xin%22">Dong, Xin</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-7380-0872">0000-0002-7380-0872</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sanchez%2C+Lisa%22">Sanchez, Lisa</searchLink><br /><searchLink fieldCode="AR" term="%22Burke%2C+Mack+D%2E%22">Burke, Mack D.</searchLink><br /><searchLink fieldCode="AR" term="%22Bowman-Perrott%2C+Lisa%22">Bowman-Perrott, Lisa</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. Jul 2023 60(7):2270-2295.
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  Label: Availability
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 26
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Preschool+Education%22">Preschool Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Antisocial+Behavior%22">Antisocial Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Development%22">Social Development</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Research%22">Research</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Education%22">Preschool Education</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/pits.22855
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0033-3085<br />1520-6807
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Research suggests that 10%-20% of preschoolers have emotional and behavioral problems that would place them at-risk for development of emotional and behavioral disorders (EBD). Preschool children who exhibit early onset of antisocial and externalizing problem behaviors require early social-behavioral interventions focused on social skills. A scoping review was conducted that identified 33 single-case research design studies on social skills interventions for preschoolers. Quality indicatiors were used to examine the design quality of the studies included. A total of 19 studies met quality standards with reservation or met standards without reservations. 43 participants in 11 studies conducted by 10 research teams showed evidence to support social skills interventions as effective interventions. The majority of the evaluated studies (97%) reported IOA. These findings contribute to the growing literature base underscoring social skills interventions in early childhood settings.
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  Data: 2023
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  Data: EJ1379693
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 26
        StartPage: 2270
    Subjects:
      – SubjectFull: Preschool Children
        Type: general
      – SubjectFull: Antisocial Behavior
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Intervention
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      – SubjectFull: Interpersonal Competence
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      – SubjectFull: Social Development
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      – SubjectFull: Research
        Type: general
      – SubjectFull: Preschool Education
        Type: general
    Titles:
      – TitleFull: Evidence from Single Case Research on Social Skills Interventions for Preschoolers At-Risk for EBD: A Scoping Review and Application of Quality Indicators
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