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Problem BehaviorNCT05794893

Effects of Good Behavior Game in a Swedish Sample

A study testing Good Behavior Game in people with Problem Behavior, run by Region Skane at 5 sites in Sweden.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This project seeks to study the impact of Good Behavior Game (GBG), a behavior management program, on classroom environment and problem behavior in K-3 classrooms. The goal of this randomized trial is to study the impact of Good Behavior Game (GBG), a behavior management program, on classroom environment and problem… Read more about this study

Who is it for?
Ages 5 to 10 years
Conditions the study is for
Problem Behavior
What is being tested?
Good Behavior Game
Could I receive a placebo?
No, everyone receives an active treatment
How many people
44 participants
Where
5 sitesSweden
Study dates
17 Aug 2021to 14 Jun 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 5 to 10 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Eligibility is based on school or classroom level factors. Schools must have at least one classroom with a group of students enrolled in grades K, 1, 2, or 3.

Who cannot join

  • Special education classrooms are not eligible, though inclusive classrooms with a minority of students needing special education can be included.

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

Sweden5 sites
  • Johannesskolan

    Malmö

  • Klagshamnsskolan

    Malmö

  • Malmö friskola

    Malmö

  • Monbijouskolan

    Malmö

  • Ängsdals skola

    Malmö

Other trials in Sweden

About this study

Official title: Good Behavior Game - a Randomized Controlled Study Among Young Children in Swedish Primary Schools.

This project seeks to study the impact of Good Behavior Game (GBG), a behavior management program, on classroom environment and problem behavior in K-3 classrooms.

The goal of this randomized trial is to study the impact of Good Behavior Game (GBG), a behavior management program, on classroom environment and problem behavior in K-3 classrooms in Sweden. The main question it aims to answer is:

  • Does GBG decrease problem behaviors in K-3 classrooms?

Teachers in the intervention group will be trained in GBG and asked to implement it in their respective classrooms. Teachers in the comparison group will provide usual practice.

Read the detailed description

Background: Early conduct problems are prevalent and a prominent risk factor for several adverse health-related and psychosocial outcomes in later life. Good Behavior Game (GBG) is a promising school-based behavior management program with the potential of reaching many children in their formative years.

Primary objective: To study the effectiveness of Good Behavior Game in reducing problem behaviors in Swedish K-3 classrooms under real-world conditions.

Secondary objectives: To investigate changes in problem behaviors in common school areas, classroom climate, teacher collective efficacy, on-task behavior, and behavioral management practices as a result of teacher training in GBG. The study also seeks to investigate implementation as a moderator, as well as potential barriers and facilitators in regards to implementation.

Type of trial: Cluster-randomized controlled trial

Trial design and methods: Recruitment of schools in a Swedish municipality started early 2021. In May 2021, 5 schools were randomized to either intervention group or wait-list (service-as-usual). Data collection started in August 2021 and ended in June 2022. The intervention group received training in GBG from September 2021 to May 2022 by certified trainers who also collected fidelity data through observations throughout the school year. Teacher ratings and observer data was collected at baseline (August 2021), along with a first (November 2021) and second follow-up (May 2022, primary endpoint) throughout the first school year of implementation.

Statistical methodology and analysis: Statistical analysis will primarily include frequentist intent-to-treat analysis, and comparisons of estimates with a corresponding Bayesian model using weakly informative priors.

Being tested
Good Behavior Game
Keywords
Problem Behavior, School, Prevention
Medical subject headings
Problem Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Good Behavior GameBehavioural

    Universal school-based intervention reinforcing prosocial behaviors and discouraging disruptive behaviors in young students.

Study groups in NCT05794893
Study groupRoleWhat they receive
Good Behavior GameExperimental28 classes receiving Good Behavior Game intervention
Receives: Behavioral: Good Behavior Game
Service-as-usualNo intervention16 classes receiving usual classroom teaching

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Teacher-rated problem behavior in the classroom

    A teacher-rated scale listing 20 common problem behaviors in the classroom. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day).

    Measured: Baseline

  2. Teacher-rated problem behavior in the classroom

    A teacher-rated scale listing 20 common problem behaviors in the classroom. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day).

    Measured: 3 months

  3. Teacher-rated problem behavior in the classroom

    A teacher-rated scale listing 20 common problem behaviors in the classroom. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day).

    Measured: 9 months (primary endpoint)

Secondary outcomes (26)
  1. Classroom Atmosphere Measure

    Measure of 10 different behavioral classroom factors rated by an independent observer after 30 minutes of observing a classroom. The observer scores every item on a scale from 1-5, were 1 is generally considered very low and 5 is considered very high. A rating of 0 is used when the item/factor is not applicable or possible to rate. The following items are rated:

    1. Students' level of compliance during structured time
    2. Students seem to handle transitions well
    3. Students consistently follow rules appropriate to settings
    4. Students' level of cooperation
    5. Students attempt problem-solving
    6. Students express feelings appropriately
    7. Students' level of interest/enthusiasm/involvement
    8. Classroom is focused and on-task
    9. Classroom responsive to individual differences in students' needs, feelings, etc.
    10. Classroom is supportive of students' efforts

    Measured: Baseline

  2. Classroom Atmosphere Measure

    Measure of 10 different behavioral classroom factors rated by an independent observer after 30 minutes of observing a classroom. The observer scores every item on a scale from 1-5, were 1 is generally considered very low and 5 is considered very high. A rating of 0 is used when the item/factor is not applicable or possible to rate. The following items are rated:

    1. Students' level of compliance during structured time
    2. Students seem to handle transitions well
    3. Students consistently follow rules appropriate to settings
    4. Students' level of cooperation
    5. Students attempt problem-solving
    6. Students express feelings appropriately
    7. Students' level of interest/enthusiasm/involvement
    8. Classroom is focused and on-task
    9. Classroom responsive to individual differences in students' needs, feelings, etc.
    10. Classroom is supportive of students' efforts

    Measured: 3 months

  3. Classroom Atmosphere Measure

    Measure of 10 different behavioral classroom factors rated by an independent observer after 30 minutes of observing a classroom. The observer scores every item on a scale from 1-5, were 1 is generally considered very low and 5 is considered very high. A rating of 0 is used when the item/factor is not applicable or possible to rate. The following items are rated:

    1. Students' level of compliance during structured time
    2. Students seem to handle transitions well
    3. Students consistently follow rules appropriate to settings
    4. Students' level of cooperation
    5. Students attempt problem-solving
    6. Students express feelings appropriately
    7. Students' level of interest/enthusiasm/involvement
    8. Classroom is focused and on-task
    9. Classroom responsive to individual differences in students' needs, feelings, etc.
    10. Classroom is supportive of students' efforts

    Measured: 9 months

  4. Classroom Environment Scale

    Teacher rates 15 items about the classroom climate (e.g. how well students cooperate, task-orientation etc.). The items are rated on a 0-3 likert scale, some being reverse-coded.

    Measured: Baseline

  5. Classroom Environment Scale

    Teacher rates 15 items about the classroom climate (e.g. how well students cooperate, task-orientation etc.). The items are rated on a 0-3 likert scale, some being reverse-coded.

    Measured: 9 months

  6. On-task behavior: Planned activity check/PLACHECK

    Group-based measure of on task behavior in classroom. Rated by an independent assessor. Score is based on number of children on-task divided by total number of children in the classroom. On-task behavior is rated after 3-minute intervals for a total of 18 minutes. An average of the percentage scores is used as an outcome.

    Measured: Baseline

  7. On-task behavior: Planned activity check/PLACHECK

    Group-based measure of on task behavior in classroom. Rated by an independent assessor. Score is based on number of children on-task divided by total number of children in the classroom. On-task behavior is rated after 3-minute intervals for a total of 18 minutes. An average of the percentage scores is used as an outcome.

    Measured: 3 months

  8. On-task behavior: Planned activity check/PLACHECK

    Group-based measure of on task behavior in classroom. Rated by an independent assessor. Score is based on number of children on-task divided by total number of children in the classroom. On-task behavior is rated after 3-minute intervals for a total of 18 minutes. An average of the percentage scores is used as an outcome.

    Measured: 9 months

  9. Teacher-rated problem behavior in school

    A teacher-rated scale listing 20 common problem behaviors in the school's common/shared areas. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day).

    Measured: Baseline

  10. Teacher-rated problem behavior in school

    A teacher-rated scale listing 20 common problem behaviors in the school's common/shared areas. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day).

    Measured: 3 months

  11. Teacher-rated problem behavior in school

    A teacher-rated scale listing 20 common problem behaviors in the school's common/shared areas. The teachers bases their ratings on the week before. Every item is rated on a scale from 0 (no times last week) to 4 (several times a day).

    Measured: 9 months

  12. Collective teacher efficacy

    Teacher rates 12 items on the perceived efficacy of teachers as a collective being able to teach the students attending the school. Items are rated on a 0-5 likert scale, some being reverse-coded.

    Measured: Baseline

  13. Collective teacher efficacy

    Teacher rates 12 items on the perceived efficacy of teachers as a collective being able to teach the students attending the school. Items are rated on a 0-5 likert scale, some being reverse-coded.

    Measured: 9 months

  14. Positive behavior support

    The teacher rates 9 items on their own use of several practices that aim to increase desirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times).

    Measured: Baseline

  15. Positive behavior support

    The teacher rates 9 items on their own use of several practices that aim to increase desirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times).

    Measured: 9 months

  16. Behavioral correction

    The teacher rates 8 items on their own use of several practices that aim to punish, reduce or correct undesirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times).

    Measured: Baseline

  17. Behavioral correction

    The teacher rates 8 items on their own use of several practices that aim to punish, reduce or correct undesirable behaviors in the classroom. The teacher will report based on the last 30 days. The items can be rated on a scale from 0 (0 times) to 7 (more than 20 times).

    Measured: 9 months

  18. Observed general praise

    An independent observer counts the number of times the teacher uses general praise towards one or more students by the teacher. General praise counts as praise were the behavior eliciting praise is not specified, for example "good job". Can also be non-verbal. The observation and counting lasts for 30 minutes.

    Measured: Baseline

  19. Observed general praise

    An independent observer counts the number of times the teacher uses general praise towards one or more students by the teacher. General praise counts as praise were the behavior eliciting praise is not specified, for example "good job". Can also be non-verbal. The observation and counting lasts for 30 minutes.

    Measured: 3 months

  20. Observed general praise

    An independent observer counts the number of times the teacher uses general praise towards one or more students by the teacher. General praise counts as praise were the behavior eliciting praise is not specified, for example "good job". Can also be non-verbal. The observation and counting lasts for 30 minutes.

    Measured: 9 months

  21. Observed specific praise

    An independent observer counts the number of times behavioral specific praise is used towards one or more students by the teacher. Behavioral specific praise counts as praise or feedback that also entails a description of the behavior eliciting praise, such as "good work reading that out loud". The observation and counting lasts for 30 minutes.

    Measured: Baseline

  22. Observed specific praise

    An independent observer counts the number of times behavioral specific praise is used towards one or more students by the teacher. Behavioral specific praise counts as praise or feedback that also entails a description of the behavior eliciting praise, such as "good work reading that out loud". The observation and counting lasts for 30 minutes.

    Measured: 3 months

  23. Observed specific praise

    An independent observer counts the number of times behavioral specific praise is used towards one or more students by the teacher. Behavioral specific praise counts as praise or feedback that also entails a description of the behavior eliciting praise, such as "good work reading that out loud". The observation and counting lasts for 30 minutes.

    Measured: 9 months

  24. Observed reprimands

    An independent observer counts the number of times reprimands are used towards one or more students by the teacher. Reprimands are verbal or non-verbal cues were the teacher demands on students ceasing a certain behavior or otherwise point out a behavior that should not be occuring. The observation and counting lasts for 30 minutes.

    Measured: Baseline

  25. Observed reprimands

    An independent observer counts the number of times reprimands are used towards one or more students by the teacher. Reprimands are verbal or non-verbal cues were the teacher demands on students ceasing a certain behavior or otherwise point out a behavior that should not be occuring. The observation and counting lasts for 30 minutes.

    Measured: 3 months

  26. Observed reprimands

    An independent observer counts the number of times reprimands are used towards one or more students by the teacher. Reprimands are verbal or non-verbal cues were the teacher demands on students ceasing a certain behavior or otherwise point out a behavior that should not be occuring. The observation and counting lasts for 30 minutes.

    Measured: 9 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Apr 2023
  2. Study start17 Aug 2021
  3. Primary completion14 Jun 2022
  4. Study completion14 Jun 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
All participants in the intervention group receive the same GBG intervention. The control condition consists of service-as-usual (SAU).
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
44 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05794893
Sponsor's protocol ID
2020-06804
Status last verified
Mar 2023
First submitted
8 Mar 2023
Last updated
3 Apr 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: The study does not collect individual participant data. Only group/aggregated data is collected. This data may be made available to other researchers unless conflicting with regulations, consent or other aspects of the ethical review.

Publications

  • Djamnezhad D, Bergstrom M, Delfin C, Hofvander B. Classroom effects of a preventive behavioral management program: A pragmatic cluster-randomized trial of Good Behavior Game. PLOS Ment Health. 2025 Dec 23;2(12):e0000487. doi: 10.1371/journal.pmen.0000487. eCollection 2025.

    PubMed 41662083
  • Djamnezhad D, Bergstrom M, Andren P, Hofvander B. Good behavior game - study protocol for a randomized controlled trial of a preventive behavior management program in a Swedish school context. Front Psychiatry. 2023 Oct 5;14:1256714. doi: 10.3389/fpsyt.2023.1256714. eCollection 2023.

    PubMed 37867765

Questions about this trial

What is this clinical trial studying?

A study testing Good Behavior Game in people with Problem Behavior, run by Region Skane at 5 sites in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Teacher-rated problem behavior in the classroom (time frame: Baseline). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05794893, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Apr 2023.

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