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Shyness is a form of social withdrawal that encompasses wariness and anxiety in the face of social novelty and perceived social evaluation (Rubin & Coplan, 2004). Results from an increasing amount of studies have linked shyness to maladjustment across the lifespan, particularly internalizing issues, loneliness, social anxiety, lower self-worth and a low repertoire of coping strategies. (Bohlin, Hagekull & Andersson, 2005; Coplan & Prakash, 2003; Coplan, Prakash, O'Neil & Armer, 2004). Greco and Morris (2001) have highlighted the need for early intervention and prevention programmes that are particularly tailored to the needs of the shy child.
The Pyramid Plus model of intervention was developed during the late 1970s in the United Kingdom. During latency, all children are postulated to experience a social hunger for acceptance by their peers. Gazelle (2010) has highlighted that peer exclusion is the key mediator of pathological anxiety and depression for shy children. Shy children desire interaction with their peers (normal levels of social approach motivation), but they avoid social interaction because they are worried that they will be rejected (high in social avoidance motivation). Gazelle (2006) has shown that these children are particularly ‘at risk’ of developing internalizing problems in classrooms with negative emotional climates characterized by disruptive behaviour and infrequent pro-social peer interaction. Gazelle and Ladd (2003) proposed a diathesis-stress model where peer problems reinforce social anxiety, which in turn trigger depressive symptoms.
The Pyramid approach aims to provide a safe environment for shy children where their sense of social belongingness can be nurtured. This encompasses the Pyramid rationale for providing targeted as opposed to universal interventions. Externalizing aggressive behaviours would immediately pose a social threat for these children and interfere with the de-sensitization process. Targeted interventions constitute a specialized health intervention for a specific subgroup of a population, as opposed to a universal approach where all members of a population receive the intervention. A recent systematic review on preventive interventions for internalizers revealed that targeted interventions run by trained interventionists were consistently associated with larger effect sizes than universal approaches delivered by endogenous providers such as teachers (Stice, Shaw, Bohon, Marti & Rohde, 2009).
Each individual child is postulated to have two distinct belongingness orientations, a growth orientation and a deficit reduction orientation. Belongingness orientation influences how they are perceived and treated by others (Lavigne, Vallerand & Crevier-Braud, 2011). A growth orientation is associated with genuine interest and compassion for others and has been found to be associated with emotional competence, subjective well-being, peer acceptance and resilience (Diener, 2000). The deficit reduction orientation, on the other hand, is associated with social interactions that are motivated by a need to fill a void. This is associated with loneliness, social anxiety and low self-esteem (Lavigne et al. 2011; Figure 1).
There have been two informal evaluations of Pyramid reported in the ‘grey literature’; these both found reductions in depressive symptoms and social withdrawal in attendees in comparison with nonattendees (Davies, 1999; Skinner, 1996). It was, however, the research carried out by Dr Ohl that has been instrumental in moving the efficacy investigation process towards a more empirical and objective grounding. These studies have been published in peer-reviewed journals (Ohl, Fox & Mitchell, 2012; Ohl, Mitchell, Cassidy & Fox, 2008) and the analyses revealed a significant group x time interaction for total difficulty scores [F (1,92) = 4.25, p = .04) in 2008 and significant group x time interactions for Emotional Symptoms (F (1,371) = 25.69, p < .001] and Pro-social behaviour (F (1,370) = 12.25, p < .01) in 2012 (Figure 2).
This evaluation was set up by Barnardo's based on the UK evaluation process. This is currently the only primary school-based intervention in NI that aims to address the vulnerabilities of shy children during latency. In NI, clubs are run during school hours. Anxiety has been shown to produce a state of physiological arousal that narrows the focus of attention on perceived threat; this is associated with poor class engagement, school refusal and reduced short-term memory capacity. Anxiety has consistently been shown to be associated with underachievement at school in cross-sectional research (Langley, Bergman, McCracken & Piacentini, 2004). Longitudinal evaluations of CBT-based anxiety reduction programmes have shown that treatment-associated reductions in anxiety were followed by enhanced academic performance (Wood, 2006).
NI suffered civil conflict for over 30 years and although there has been a paramilitary ceasefire since 1994, there are still outbreaks of sporadic sectarian violence. The findings of Muldoon and Trew (2000) found that the experience of conflict for NI children was associated with lower behavioural adjustment associated with aggression and externalizing behaviours. More recent research has elucidated that sectarian violence was associated with mothers' perceptions of children's emotional security about community (Goeke-Morey et al., 2009). This study examined the impact of community conflict on child adjustment, including emotional and conduct problems, via mothers' perceptions. They found that sectarian and non-sectarian violence exposure were significant predictors of children's internalizing and externalizing symptoms and lower pro-social behaviour. The highlighted evidence suggests that witnessing such violence predicts both internalizing and externalizing problems in children. Shy children are known to be at increased risk of developing disorders in classrooms with negative emotional climates, which highlights the need for targeted interventions for shy children in school areas where there are high levels of externalizing behaviours and low levels of pro-social orientation.
The main aim of this research was to examine the effectiveness of Pyramid clubs on a sample of Primary four NI children. It was predicted that:
- The pre-intervention Emotional Symptom, Peer Problem and Pro-social Skill scores of the Pyramid attendee children would differ significantly from those of the comparison group.
- Pyramid participants' internalization scores would have decreased; to be approximately in line with those of the comparison group at time 2 and these changes would be maintained at follow-up.
- Pyramid participants' Pro-social scores would have increased, to be approximately in line with those of the comparison group at time 2, and these changes would be maintained at follow-up.
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The Descriptive statistics from this current sample were compared with UK norms and the differences were tested using independent t-tests, gender differences were also assessed. The findings indicated that the mean Emotional Symptom score from this sample 2.33(2.51) was significantly higher (t = 4.80, p < .0001) than the UK norm 1.50 (1.90). There were no significant gender differences on Emotional Symptoms (t = −1.27, p > .05) or Peer Problems (t = −1.33, p > .05) (Table 3).
Table 3. UK norm and current NI Primary 4 descriptive statistics for pertinent SDQ subscales
|SDQ subscale||UK norm (N = 4801)||NI sample (N = 199)|| t |
|Emotional||1.50 (1.90)||2.33 (2.51)||4.80***|
|Peer||1.40 (1.80)||1.44 (1.90)||.25|
|Pro-social||7.30 (2.40)||7.41 (2.46)||.51|
| ||Male (N = 88)||Female (N = 111)|| t |
|Emotional||2.08 (2.46)||2.53 (2.54)||−1.27|
|Peer||1.24 (1.79)||1.60 (1.98)||−1.33|
|Pro-social||6.97 (2.40)||7.75 (2.45)||−2.29*|
The results from the Chi square tests of independence are reported in Table 4. They suggest that children were allocated to Pyramid based on their presentation of somatic symptoms, worry, unhappiness, peer exclusion and victimization. At time 2, the only significant group differences were in relation to peer exclusion and peer victimization. At time 3, significant group differences re-emerged, namely somatic, worry and unhappiness.
Table 4. Chi square tests of Independence for the SDQ items at the three time points
|No good friend||6.64**||5.13*||.74|
|Best with adult||3.25||.80||.25|
To assess violations of the assumption of sphericity, which are quite common in repeated-measures ANOVA, Mauchly's test of sphericity was examined. This suggested that the underlying assumption of homogeneity associated with the covariance matrix was violated for the Emotional Symptom (MW = .83, p < .05), Peer Problem (MW = .93, p > .05) and Pro-social subscales (MW = .91, p > .05). To adjust for this violation, Girden (1992) recommends that when epsilon (Greenhouse-Geisser estimate) is >.75, then the correction according to Huynh and Feldt should be used. Epsilon values for the three subscales used in the current analysis were >.75 and this suggested that the Huynh and Feldt adjustment is preferred (Table 5).
Table 5. Mean and mean differences for both groups at the three time points
|Emotional||Pyramid||3.04 (2.75)||1.20 (1.65)||1.43 (1.95)|
| ||Comparison||1.37 (1.92)||.70 (1.65)||.80 (1.54)|
| t || ||−5.24**||−1.66||−2.22*|
|Peer problems||Pyramid||1.85 (2.09)||.74 (1.35)||.80 (1.54)|
| ||Comparison||.84 (1.44)||.30 (.67)||.64 (1.0)|
| t || ||−4.04**||−2.57**||−.70|
|Pro-social||Pyramid||7.03 (2.65)||7.87 (1.95)||7.78 (2.10)|
| ||Comparison||7.93 (1.09)||8.50 (1.97)||8.10 (1.89)|
| t || ||2.66*||1.76||.98|
The main phase of the analysis involved conducting the mixed between within ANOVA. The results indicate that longitudinal changes in Emotional Symptoms (F (1.75,85) = 9.05, p < .001) and Peer Problems (F (1.92, 85) = 7.35, p < .001) were dependent on group membership. There was no significant interaction effect for Pro-social Skills (F (1.90, 85) = 1.31, p = .28).
Shifts in scoring bands revealed that 33.3% of Pyramid children were experiencing borderline to abnormal levels of Emotional Symptoms at time 1; this decreased to 6.3% at time 2 and showed a slight increase to 10% at time 3. A similar trend was obvious for Peer Problems, with 22.8% experiencing borderline and abnormal indicators at baseline. This decreased to 3.2% at time 2 and increased only slightly to 5.8% at time 3. It can be concluded therefore that for the majority of participants, attending Pyramid helped to alleviate their Emotional Symptoms and Peer Problems (Table 6).
Table 6. Mixed analysis of variance results showing main and interaction effects
|Outcome||Variable||F|| df ||Sig||PES|
|Group * Time||9.05||(1.75,85)||.00||.12|
|Group * Time||7.35||(1.92,85)||.00||.09|
|Group * Time||1.31||(1.90,85)||.28||.02|
The teacher-rated frequencies for the peer exclusion are reported in Table 7. This showed that 35.6% of Pyramid participants were experiencing peer exclusion before the intervention; this reduced to 13.7% at time 2, and increased, although not to baseline levels, to 24.3% at time 3.
Table 7. Shifts in SDQ scoring bands over 3 time points
|Emotional||Norm 80%||Borderline 10%||Abnormal 10%|
|Comparison T2||94.1%|| ||5.9%|
|Comparison T2||100%|| || |
|Comparison T3||98.3%||1.7%|| |
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The overall Emotional Symptom mean score for this sample was significantly higher than the UK mean. Goeke-Morey et al. (2009) found that sectarian and non-sectarian violence exposure were significant predictors of both children's' internalizing and externalizing symptoms in a recent NI sample. Prior to this, the impact of the troubles in NI on children was more focused on behavioural adjustment and externalizing psychopathology (Muldoon & Trew, 2000). Sectarian violence is still a fairly regular occurrence in both Belfast and Derry/Londonderry and the impact of the past and present ‘Troubles’ may still both directly and indirectly be influencing suffering in the NI child population (Bunting, Murphy, O' Neill & Ferry, 2011).
The results from the Chi square tests of independence showed clear distinctions between the comparison and intervention group at baseline. These highlighted the need for the intervention. There were no Emotional Symptom differences at time 2, although Pyramid children were still more likely to be friendless and to be experiencing bullying. At time three, group differences re-emerged on somatic symptoms, worry and unhappiness.
Examination of the Pyramid intervention model reveals very little in the line of therapeutic strategies to help anxious children with their cognitive vulnerabilities. The key variable associated with pathological levels of anxiety in shy children is the inability to inhibit the perception of threat in social situations. Evidence has consistently shown that anxious children overestimate the probability of danger, neglect rescue factors and ignore their own coping skills. The introduction of cognitive restructuring techniques into the Pyramid model may help the participants maintain the ground they have gained during the intervention itself. Cognitive restructuring techniques are seen as a secondary control strategy, where children are thought to recognize and change negative thoughts. Myles (2003) offers a variety of self-talk-based games and exercises that include ‘Spot the Message’ ‘Guess the Message’ ‘Fix the Feeling’ and ‘Emotional Toolbox’ that could be incorporated into the circle time element of the intervention model.
The current evaluation was constrained by the research design; future evaluations need to be mindful of the balance between a flexible design and the complex issues that then arise when analysing data where a randomization procedure has not been employed. Evaluations of this nature require the least disturbance of the up and running evaluation as possible, balanced with an understanding of the kind of evidence that is required to understand the dynamic components of the intervention process. For practical reasons, Randomized Control Trials will never be an option for these kinds of intervention evaluations, however; the quality of the evaluations could be sufficiently improved if the design incorporated measures of the proposed mediating mechanisms.
Future evaluations need to consider whether the exclusive use of SDQ (Goodman, 1997) is the most appropriate method for evaluating this intervention. The Social Anxiety Scale for Children (SAC, La Greca & Stone, 1993) includes three subscales that relate directly to the empirically identified issues associated with anxious solitude. Items on this measure include fear of negative evaluation, social avoidance and distress in situations. The need to assess social integration and loneliness is also of the utmost importance. The Social Inclusion Survey (Frederickson & Graham, 1999) would also be important as the teacher-rated measure of social exclusion used here is really only a very rough indicator of classroom dynamics. In this way, future research could incorporate ‘the voice of child’. It is acknowledged that to Barnardo's credit, they were very mindful that the teachers or children were not to be subjected to batteries of measurement instruments.
It is concluded that strongest aspect of the current intervention model is the targeted approach to early interventions for shy children during latency. The aims of the intervention are also congruent with empirical findings in relation to the buffering effects of friendship; however modifications may be required to treat the ‘within’ child factors that contribute to their social anxiety. In addition to this, there was no way of uncovering whether Pyramid participants felt stigmatized by attending club and that is an issue that may very well merit some qualitative research in the future.
Overall, the current findings offer preliminary support for the efficacy of Pyramid Plus but also highlight the need for modifications to the intervention and a more systematic and rigorous evaluation process. This investigation was carried out under the auspices of the CHILD (Child Health Initiatives in Life Development) programme at the University of Ulster (Table 8).
Table 8. Frequencies for peer exclusion
|Group||Not true||Somewhat true||True|