A Feasibility Study and a Pilot Cluster Randomised Controlled Trial of the PAX ‘Good Behaviour Game’ in Disadvantaged Schools

Student thesis: Doctoral ThesisDoctor of Philosophy


There remains a growing concern regarding the mental health of children and young people in Northern Ireland, despite the steps being taken globally and locally to address the issues. Research suggests that programmes delivered in schools in the form of prevention and early intervention may help address the problematic behaviours that can have immediate and long-term effects on mental health. The ability to self-regulate behaviour and emotions at a young age has been linked to mental health in later life.

This study looked at the PAX Good Behaviour Game (GBG) as a potential mental health prevention and early intervention approach for Northern Ireland classrooms, in particular those situated in areas of high socio-economic disadvantage. The GBG has been extensively studied in the United States and other international settings and has been proven to be a useful tool across various cultural, linguistic and socio-economic populations. It has been reported to have long lasting, positive effects on longitudinal behaviour change.

The aim of this study was to explore the effect of the PAX GBG on self-regulation, pro-social behaviour, self-esteem and cooperative learning with Primary 3 pupils (age 6-8). In addition, the aim was to assess the feasibility of the PAX GBG implementation in Northern Ireland. The study used a cluster randomised controlled trial design with a total of 15 schools (19 classes) randomised to intervention and control. The intervention group received training in the delivery of the PAX GBG and implemented the PAX GBG intervention for 12 weeks. The control schools did not receive the PAX GBG and proceeded as normal with regular curriculum and usual classroom activity. Effects of the PAX GBG were assessed on 353 pupils. Changes were measured by conducting pre and post test measures of all pupils. The outcome measures included both child and teacher reported behaviour. Qualitative data were also collected from teachers and a process evaluation supplemented the RCT to measure the fidelity, delivery and acceptability of programme.

Although the PAX GBG was developed in the USA, it was delivered effectively with high fidelity and was well received by the pupils and teachers. After the 12 weeks of implementation, this study provided some evidence that the PAX GBG may help improve self-regulation in participating pupils (β= .2, 95% CI 0.001 to 0.40; d=. 42). Exploration of subgroup analysis provided some evidence of differential effects, suggesting that the PAX GBG is more effective for males, pupils with Special Educational Needs and those living in areas of high deprivation. The programme had a low cost of £30.48 per pupil. This cost is in line with other versions of the GBG.

The preliminary evidence reported in this study suggested that the PAX GBG may offer a feasible and cost effective, mental health prevention and early intervention approach for Northern Ireland classrooms. However, a larger effectiveness study would be needed to verify the findings in this study
Date of AwardJul 2019
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorAllen Thurston (Supervisor), Frank Kee (Supervisor) & Liam O'Hare (Supervisor)

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