International Journal of

Environmental Research
and Public Health

Article
Can We Manage Behavioral Problems through the
Development of Children’s Social-Emotional Regulated
Behavior? Longitudinal Study of a Preschool Program
Ana Justicia-Arráez * , María Carmen Pichardo , Miriam Romero-López and Guadalupe Alba

Department of Developmental and Educational Psychology, University of Granada, 18071 Granada, Spain;
pichardo@[Link] (M.C.P.); miriam@[Link] (M.R.-L.); guadalupe@[Link] (G.A.)
* Correspondence: anajus@[Link]; Tel.: +34-958249845

Abstract: Behavioral problems are early indicators of antisocial behavior and should be targeted
from a preventive perspective from early childhood. The purpose of the study was to analyze the
effectiveness of the AC1 preschool program that develops social-emotional skills that facilitate the
adjustment and regulation of the person. A total of 102 children aged 3–4 years old participated in
the research, 52 belonging to the experimental group and 49 to the control group. Program-trained
skills (ROAC-3), social skills (PKBS-2), and externalizing problems (CBCL C-TRF) were assessed in
the pre- and post-intervention phase. Data analysis was carried out using a generalized linear mixed
model analysis (GLMM). The results show that the children in the experimental group scored higher





 on the variables trained by the program and on social skills than those in the control group. They
also obtained lower scores in the observed externalizing problems. The effect of the program was
Citation: Justicia-Arráez, A.;
high in the emotion identification and expression, communication skills, prosocial behaviors (sharing
Pichardo, M.C.; Romero-López, M.;
Alba, G. Can We Manage Behavioral
and helping), problem-solving, and social interaction. Social-emotional learning in early childhood
Problems through the Development is essential for the prevention of behavioral problems to facilitate the development of adjusted and
of Children’s Social-Emotional regulated behavior. Thus, preschool programs could play a key role.
Regulated Behavior? Longitudinal
Study of a Preschool Program. Int. J. Keywords: externalizing problems; socio-emotional competence; social skills; regulated behavior;
Environ. Res. Public Health 2021, 18, emotional regulation; childhood; preschool; universal intervention; prevention
8447. [Link]
ijerph18168447

Academic Editor: Paul B. Tchounwou 1. Introduction

Childhood behavior problems are considered early indicators of antisocial behavior,
Received: 27 July 2021
especially aggressive and destructive behavior [1,2]. They have been characterized as
Accepted: 7 August 2021
Published: 10 August 2021
persistent and repetitive patterns of behavior in which the basic rights of others, norms, or
age-appropriate social rules are not respected [3]. Specifically, externalizing problems are
Publisher’s Note: MDPI stays neutral
uncontrolled behaviors that the person directs outward or toward others such as attention
with regard to jurisdictional claims in
problems, aggressive behaviors, or hyperactivity.
published maps and institutional affil-
These types of problems have aroused great interest within the scientific field because
iations. they generate devastating consequences for the individual and society [4] and also in the
educational field because they affect the learning process, academic performance, classroom
climate and social relations [2,5,6], self-regulation [7,8], and they have even been related to
subsequent involvement in other phenomena such as bullying [9].
The prevalence rate of externalizing problems varies from one country to another
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
depending on the type of problem and also on the measuring instrument. In Spain, there
This article is an open access article
are studies that place the rate of the child and adolescence conduct problem between 10
distributed under the terms and
and 15% [10]. Moreover, the latest National Health Survey indicates that the prevalence of
conditions of the Creative Commons conduct disorders in the population aged 0–14 years was 1.8%, which has remained stable
Attribution (CC BY) license (https:// since 2006 [11].
[Link]/licenses/by/ Several studies have indicated that behavioral problems in early childhood have a
4.0/). certain stability over time [12], which is usually higher after four years of age and tends

Int. J. Environ. Res. Public Health 2021, 18, 8447. [Link] [Link]
Int. J. Environ. Res. Public Health 2021, 18, 8447 2 of 18

to increase [13,14]. In addition, the persistence over time of behavioral problems can
lead to other more serious pathologies such as aggression, delinquency and antisocial
behavior [15], inattention, hyperactivity, anxiety or inability to help others [16] as well as
other types of mental health, educational, social, occupational, or physical problems [17].
Therefore, effective early intervention is necessary so that behavioral problems do not
worsen over time [18]. In this sense, the preschool years are a key time for the prevention
of behavioral problems. From this preventive approach, we should highlight that a large
part of the intervention programs are focused on the development of adaptive behavior,
specifically social and emotional competence [19].
Social competence has been defined as the ability to manage thoughts, feelings, and
actions according to personal goals and the demands of the situation and culture [20] and
the dimensions in preschool including problem-solving, peer relations, compliance with
rules, and frustration tolerance [21]. On the other hand, emotional competence is defined
as the ability to adequately manage the emotions that arise in social transactions [22]. In
preschoolers, this competence involves the acquisition of emotion knowledge (expres-
sive/receptive recognition), emotion expression (predominantly positive expression), and
emotion regulation (adaptive self-regulatory strategies) [21,23].
Social and emotional learning involves the development of five components that
include a variety of thoughts, behaviors, and attitudes [24,25]: (1) self-awareness, to under-
stand one’s emotions, thoughts and actions; (2) self-management, that is, self-regulatory
capacity linked to emotions, impulse control, delay of gratification, stress management
and goal attainment; (3) social awareness, related to empathy, social perspective-taking,
or understanding of social norms; (4) relationship skills necessary for the maintenance of
healthy relationships in accordance with social norms; and (5) responsible decision-making
at the personal and social level adjusting to the context.
As can be seen, social and emotional competence requires a high level of management
and regulation by the individual. Self-regulation strategies play an important role in
social and emotional performance, since the person must plan, supervise, and adjust
their behavior in changing social circumstances and emotional states. Accordingly, some
authors have pointed out that the construct of self-regulation encompasses competencies
that include the control of emotions or positive relationships with others [26]. In fact,
the positive association between self-regulation and social skills [26,27] and the negative
relationship with externalizing problems has been demonstrated [8,28]. Similarly, early
self-regulation skills predict positive school adjustment [29].
Research on the evidence for the effectiveness of programs that promote socio emo-
tional learning (SEL) has been growing in recent years and different studies have high-
lighted its benefits. A recent review of SEL programs in early childhood [30] points
to the effectiveness of some of these interventions in improving social-emotional compe-
tence [31,32], cognitive regulation [33,34], interpersonal problem solving [35], and academic
performance [33] as well as in reducing conduct problems and aggressive behaviors [34].
As far as we know, there are only a few evidence-based programs that develop these
types of competencies in the Spanish preschool population. It is a field that is in full
development, but there are still not many studies with data on the effectiveness of the
programs. This is evident in the publication of various meta-analyses [36,37], which
show that most of the programs that have evaluated their effectiveness are American or
Canadian [38].
Therefore, it is essential to carry out studies with a Spanish population to analyze the
efficacy of intervention programs focused on preventing behavioral problems. Research
in this field is essential, especially if we take into account that in Spain, the schooling rate
at three years old is 96.1% [39]. In this sense, and coinciding with Greenberg et al. [25] on
the need to consider SEL as a public health approach to education in order to improve the
general population’s wellbeing, schools become ideal spaces for developing this type of
competencies and skills, since most children spend a significant time each day at school.
Int. J. Environ. Res. Public Health 2021, 18, 8447 3 of 18

In order to contribute to this field, the purpose of this study was to provide evidence
of the efficacy of the Aprender a Convivir program, a universal preschool prevention
program focused on improving various skills related to social and emotional competence
and reducing conduct problems. Preliminary studies in which there was no control group
have already shown the positive effect of the program on social competence and behavioral
problems in 3-year-old children [40]. On the other hand, there are studies that have
shown the effect of this program on the improvement in social skills and the reduction in
internalizing and externalizing problems in 4-year-old children [41]. In addition, its impact
has been analyzed on social competence after three years of intervention [42].
Specifically, this study focuses on the impact of the program in 3–4-year-old children
and the following objectives are proposed:
1. To present and analyze the effects of the aspects that the program trains (rules, emotion
identification and expression, emotion regulation, communication skills, sharing and
helping, sharing personal belongings, and problem solving). It is expected that the
students who participate in the intervention will improve these skills significantly
compared to the control group.
2. To analyze the impact of the program on social skills and externalizing problems. In
this case, the objective is to check if there is a transference and the program improves
other types of social skills that require greater self-regulation when interacting with
the behavior of others such as social cooperation, social interaction and social inde-
pendence, and it reduces externalizing problems. In this sense, it is expected that
children in the experimental group will improve in these variables compared to those
in the control group.

2. Materials and Methods

2.1. Participants
A total of 101 children aged 3–4 years (M = 42.55 months, SD = 3.42) participated in
the study, 44.6% boys and 55.4% girls. The pupils were enrolled in the first year of the
second cycle of preschool according to the Spanish educational system and they came
from two schools with similar characteristics located in Granada, Spain. Both schools are
semi-private schools (private school that received public funding), located in the same
metropolitan area (they are close to each other), have the same enrollment capacity, and a
similar educational approach.
The schools were randomly assigned to the experimental condition. The experimental
group included 52 children, 22 boys, and 30 girls (Mage = 42.64 months, SDage = 3.57) whereas
the control group was formed by 49 children, 23 boys and 26 girls (Mage = 42.46 months,
SDage = 3.31). All participants were Caucasian and middle socioeconomic level. None of the
participants had relevant special educational needs.

2.2. Instruments
The Observation Scale of the Aprender a Convivir program for 3-year-old children
(ROAC-3) [43] was used to assess the variables trained by the program. It is a Likert
questionnaire with response values ranging from 0 (never) to 4 (frequently). It is structured
by 26 items grouped in seven factors: (1) rules (six items), associated with following the
rules established in class (e.g., “Tidies up materials after activities”); (2) emotion identifica-
tion and expression (emotion IE) (four items) (e.g., “Differentiates between happiness and
sadness”); (3) emotion regulation (two items) (e.g., “Controls his or her feelings”); (4) com-
munication skills (four items), associated with basic interpersonal communication skills
such as listening, asking for the word or giving thanks (e.g., “Keeps quiet when others are
talking”); (5) sharing and helping (four items) (e.g., “Helps peers when needed”); (6) shar-
ing personal belongings (two items), a factor that assesses sharing behavior (e.g., “Protests
when she/he has to share her/his materials”); and (7) solving problems (four items), which
assesses how the child acts when a conflict arises (e.g., “Talks to solve problems”). The
Int. J. Environ. Res. Public Health 2021, 18, 8447 4 of 18

original instrument shows adequate values and fit indexes, and the internal consistency is
adequate in the Spanish preschool population [43].
Social skills were assessed using the Spanish version [44] of the Preschool and Kinder-
garten Behavior Scale for Teachers and Caregivers (PKBS-2) [45]. It is a Likert scale with
response values ranging from 0 (never) to 3 (often) composed of 34 items grouped into three
factors: (1) Social cooperation (12 items) assesses important skills needed to follow adult
instructions, to cooperate and compromise with peers, and to show self-control at the same
time (e.g., “Shows self-control” or “Responds appropriately when corrected”); (2) social
interaction (11 items) measures behaviors necessary to gain and maintain acceptance and
friendship from others (e.g., “Try to understand another child’s behavior”); and (3) social
independence (11 items) assesses behaviors such as accepting temporal separation from
adults or having confidence, which encourages the child to acquire a social independence
that promotes personal autonomy (e.g., “Adapts well to different environments” or “Is
confident in social situations”). The Spanish version of the PKBS-2 shows adequate values
and fit indexes and the internal consistency is adequate [44,46].
Externalizing problems were measured with the Child Behavior Checklist for ages 11/2 –
5 Caregiver–Teacher Report Form (CBCL 11/2 –5, C-TRF) [47]. This instrument measures
two dimensions of behavioral problems (internalized-externalized). Only the externalizing
problems scale was used for the present research. It is a Likert scale with response values
ranging from 0 (not true) to 2 (often true). It is composed of 34 items that assess the
attention problems related to dispersion of thought and difficulty to focus on something
(e.g., “Quickly shifts from one activity to another”) and aggressive behavior involving
disruptive behaviors directed at people or objects that may cause physical, psychological,
or social harm (e.g., “Temper tantrums or hot temper”). The internal consistency indexes
obtained with the study sample were adequate (α = 0.91).

2.3. Aprender a Convivir Program

This program is an educational intervention published in three volumes corresponding
to the second cycle of preschool (3–6 years), in accordance with the Spanish educational
system. In this research, only the Aprender a Convivir 1 program (AC1 program) was used,
aimed at children aged 3–4 years [48]. The aim of the program is to develop student’s social
skills in order to prevent the appearance of behavioral problems. It consists of 12 sessions
that are applied twice a week with a duration of 45 min and organized in four blocks of
content: (1) Rules and compliance with them, where we work on rules of coexistence and
interpersonal relationships as well as values; (2) Feelings and emotions, which deal with
the identification, expression, and regulation of basic emotions; (3) Communication skills,
focused on developing skills such as listening, asking for the floor, asking for things please
or saying thank you; and (4) Help and cooperation, which promotes a series of prosocial
behaviors such as sharing, helping, or cooperating. In a cross-cutting way, in each of the
blocks, the regulation and resolution of problems is worked on. In addition, work is carried
out in a targeted manner with the family, proposing activities to be carried out at home
every 15 days.
The program presents an active methodology focused on the use of puppets, which
are responsible for transmitting the main objectives in each session. Dialogue and the
expression of ideas are encouraged and various resources such as stories, songs, games,
and activities are used. Sessions generally have the same structure: (1) introduction with
puppets; (2) activity (and an alternative activity); and (3) home activity (and an alternative
home activity).

2.4. Procedure
The study followed the protocols established by the schools and with the current Span-
ish data protection law to obtain parental permission and informed consent. The research
was also conducted according to the ethics regulations of the University of Granada.
 an information letter with all the details of the study.
A series of phases were followed in the study (Figure 1). First, an external evaluator
was trained to observe and assess the study participants (pre-intervention phase). During
Int. J. Environ. Res. Public Health 2021, 18, 8447 5 of 18
this phase, students were observed at different times at school and the person in charge
was provided with a register in which the frequency of the behaviors under analysis was
registered. Once the observation was completed, the external observer filled the scales
To initiate the research, one of the school areas of the city of Granada (Spain) was
used in the study. Inrandomly the meantime,
selected and a all
teacher from centers
the preschool outside werethe research
contacted. Amongwasthetrained to
schools that
carry out the AC1 program. Two members of the research team with academic training in
confirmed their interest, a random selection of two schools that finally took part in the
research was made. Subsequently, the schools were randomly assigned to the experimental
early childhood education and psychopedagogy carried out the training. Two 5-h train-
and control condition, and the permissions of the schools and the consent of the families
ing sessions were held. were Inobtained.
the first, theto AC1
Prior program
the start was presented:
of the research, an informationobjectives,
meeting was contents,
held for the
methodology, activities, resources,
teachers andof evaluation
and families system.
the classes involved. ThoseThewho second
could session,
not attend of an ap-
received an
information letter with all the details of the study.
plied nature, was aimedAatseries theofelaboration of the puppets and the presentation by the
phases were followed in the study (Figure 1). First, an external evaluator
teacher of two sessions wasof the program.
trained to observe and A assess
blindtheprocedure was used
study participants as the observer
(pre-intervention and
phase). During
the teacher were unaware of the objectives of the study.
this phase, students were observed at different times at school and the person in charge
was provided with a register in which the frequency of the behaviors under analysis was
This was followed by the intervention phase carried out by a teacher, which lasted
registered. Once the observation was completed, the external observer filled the scales
12 weeks. In the experimental used in the [Link], the
In the AC1 program
meantime, a teacher fromwasoutside
implemented, andtrained
the research was in the to
control group, there was no the
carry out intervention
AC1 [Link] Twoany kind of
members related to this
the research teamtopic. The interven-
with academic training in
early childhood education and psychopedagogy carried out the training. Two 5-h training
tion sessions were held two days a week for 45 min.
sessions were held. In the first, the AC1 program was presented: objectives, contents,
Four weeks after the end activities,
methodology, of the program
resources, and(latency period),
evaluation [Link] Thepost-intervention
second session, of an
phase began. The external evaluator observed and assessed the behavior
applied nature, was aimed at the elaboration of the puppets and the as inbythe
presentation the
teacher of two sessions of the program. A blind procedure was used as the observer and
pre-intervention phase.
the teacher were unaware of the objectives of the study.

Figure 1. Study phases.

Figure 1. Study phases.
This was followed by the intervention phase carried out by a teacher, which lasted
12 weeks. In the experimental group, the AC1 program was implemented, and in the
2.5. Analysis
control group, there was no intervention of any kind related to this topic. The intervention
Taking into account the
sessions objectives
were of the
held two days study,
a week for 45 an
[Link] randomized trial ex-
Four weeks after the end of the
perimental study was designed with two groups (experimental program (latency period), the post-intervention
and control) and two
phase began. The external evaluator observed and assessed the behavior as in the pre-
evaluation phases (pre-intervention
intervention phase. and post-intervention).
Initially, descriptive analyses are carried out in which the means and standard de-
2.5. Analysis
viations of the variables considered are presented. Given the distribution of the data, and
Taking into account the objectives of the study, an individual randomized trial experi-
that this was a repeated
mentalmeasures study,with
study was designed thetwo
generalized linear and
groups (experimental mixed model
control) and two(GLMM)
evaluation
analysis with logit link function
phases with Poisson
(pre-intervention distribution with a random intercept for
and post-intervention).
each subject was used toInitially,
compare descriptive
the twoanalyses
groupsare carried
on the outprimary
in which the means andat
outcomes standard
two timedevi-
ations of the variables considered are presented. Given the distribution of the data, and
that this was a repeated measures study, the generalized linear mixed model (GLMM)
analysis with logit link function with Poisson distribution with a random intercept for each
subject was used to compare the two groups on the primary outcomes at two time points.
The independent variables in the model included a binary variable for group assignment
Int. J. Environ. Res. Public Health 2021, 18, 8447 6 of 18

(intervention vs. control), a binary variable for time (pre-intervention vs. post-intervention),
and their interaction term. Comparisons were made between the control and intervention
groups in the two phases considered (pre-intervention and post-intervention) using a t test
with sequential Bonferroni adjustment. Finally, the effect size of the differences between
the experimental and control groups is included. Considering that there was no normal
distribution of the data for the different variables, a non-parametric mean difference test
(Mann–Whitney U) was performed to obtain the effect size of the intervention, using
the values of this non-parametric test to obtain Cohen’s d [49]. Cohen established large
(d ≥ 0.80), medium (0.50 ≤ d ≤ 0.79), and small (0.20 ≤ d ≤ 0.49) effects [50].
The Statistics 24 for Mac version of the Statistical Package for the Social Sciences (SPSS)
(IBM, Armonk, NY, USA) was used for the different analyses carried out in the study.

3. Results
Table 1 shows the descriptive measures for the outcomes used in the AC1 program,
differentiated by groups (experimental and control) and time (pre-intervention and post-
intervention). As is shown, the participants in the experimental group started with higher
mean scores than the participants in the control group in all the trained skills variables ex-
cept emotion regulation and sharing personal belongings. Similarly, both groups increased
their mean scores in the post-intervention phase.

Table 1. Descriptive measures related to the variables used in AC1 program by groups and phases.

Pre-Intervention Post-Intervention
Outcome Variable
M (SD) Min. Max. M (SD) Min. Max.
G. Experimental
Rules 14.25 (0.36) 8.00 18.00 16.38 (0.17) 14.00 18.00
Emotion IE 9.65 (0.21) 6.00 12.00 11.96 (0.27) 11.00 12.00
Emotion regulation 3.18 (0.14) 1.00 4.00 3.82 (0.13) 2.00 6.00
Communication skills 6.55 (0.18) 4.00 9.00 11.08 (0.15) 8.00 12.00
Sharing and helping 8.92 (0.18) 6.00 12.00 10.62 (0.17) 8.00 12.00
Sharing personal
3.70 (0.13) 2.00 5.00 4.67 (0.12) 2.00 6.00
belongings
Solving problems 7.88 (0.23) 5.00 12.00 11.29 (0.16) 8.00 12.00
G. Control
Rules 13.61 (0.39) 8.00 18.00 15.49 (0.33) 10.00 18.00
Emotion IE 7.24 (0.36) 2.00 12.00 8.41 (0.37) 5.00 12.00
Emotion regulation 3.57 (0.17) 1.00 6.00 3.67 (0.20) 1.00 6.00
Communication skills 5.90 (0.21) 2.00 8.00 7.65 (0.28) 4.00 11.00
Sharing and helping 7.33 (0.34) 2.00 12.00 8.65 (0.33) 3.00 12.00
Sharing personal
4.90 (0.15) 3.00 6.00 4.75 (0.14) 3.00 6.00
belongings
Solving problems 4.96 (0.42) 0.00 9.00 5.73 (0.55) 0.00 12.00
Note. M = Mean, SD = Standard deviation.

Table 2 shows the descriptive measures of the social skills and externalizing problems
of the groups differentiated by intervention time. As the means of the social skills and
externalizing problems considered show, the participants in the experimental and control
groups obtained similar scores in the pre-intervention time. Taking into account the mean
scores obtained by both groups in the post-intervention phase, the participants of the
experimental group increased their scores in social cooperation, social interaction, and
social independence, and reduced their scores in externalizing problems. Participants in
the control group, on the other hand, obtained very similar scores in both phases.
Int. J. Environ. Res. Public Health 2021, 18, 8447 7 of 18

Table 2. Descriptive dates in social skills and externalizing problems by groups and phases.

Pre-Intervention Post-Intervention
Outcome Variable
M (SD) Min. Max. M (SD) Min. Max.
G. Experimental
Social cooperation 27.83 (0.72) 11.00 36.00 32.67 (0.35) 28.00 36.00
Social interaction 24.54 (0.80) 9.00 33.00 30.29 (0.36) 23.00 33.00
Social independence 27.04 (0.79) 13.00 33.00 31.15 (0.34) 25.00 33.00
Externalizing problems 7.90 (1.10) 0.00 35.00 4.28 (0.55) 0.00 16.00
G. Control
Social cooperation 28.24 (0.56) 19.00 34.00 30.00 (0.60) 19.00 36.00
Social interaction 21.04 (0.97) 6.00 31.00 22.94 (0.89) 10.00 33.00
Social independence 26.41 (0.69) 16.00 33.00 26.24 (0.64) 15.00 33.00
Externalizing problems 7.39 (1.24) 0.00 33.00 7.55 (1.12) 0.00 27.00
Note. M = Mean, SD = Standard deviation.

Initially, comparisons between groups (experimental, control), time (pre-intervention,

post-intervention), and interaction group*time were run. The analyses of the preliminary
fixed-effect comparisons are shown in Table 3. Significant differences were observed when
comparing by group in rules, emotion IE, communication skills, sharing and helping, shar-
ing personal belongings and solving problems. On the other hand, differences were found
between the pre-intervention and post-intervention phases in all program outcomes. Re-
lated to the group*time interaction, significant effects were observed in emotion regulation,
communication skills, sharing personal belongings and solving problems.
Later, predictive analysis, carried out by taking into account the random effects of
each participant in each of the phases assessed, showed significant differences between
the experimental and control groups in rules, emotion IE, communication skills, shar-
ing and helping, and solving problems. The contrast test between pre-intervention and
post-intervention times showed significant differences in the same variables. Finally, the
interactions group*time were significant in emotion regulation, communication skills,
sharing personal belongings, and solving problems.
The pairwise contrast, carried out by the model using the estimated means, taking
into account the random effects as it is a repeated measures model (see Table 4), indicates
the existence of significant differences between the experimental and control group, in
which the experimental group obtained a higher score in rules, emotion IE, communication
skills, sharing and helping, and solving problems. Similarly, there are differences between
the two groups, with the control group scoring higher in sharing personal belongings.
On the other hand, there were no differences in emotion regulation. Analyzing these
contrasts by pairs in the comparison over time (pre-intervention-post-intervention), the
results showed significant differences between both times in all variables. In all of them,
the scores obtained in the post-intervention time were higher than in the pre-intervention.
Int. J. Environ. Res. Public Health 2021, 18, 8447 8 of 18

Table 3. Results of generalized linear mixed models estimating change in the program’s outcomes.

CI 95%
Outcome Variable F Coefficient (SE) t p-Value
Inferior Superior
Rules
Group 5.66 * 0.09 (0.02) 3.50 0.001 0.04 0.13
Time 77.39 *** −0.13 (0.02) −5.34 <0.001 −0.17 −0.08
Group*Time 1.29 −0.04 (0.03) −1.14 0.257 −0.10 0.02
Emotion IE
Group 65.18 *** 0.38 (0.04) 8.87 <0.001 0.30 0.47
Time 95.32 *** −0.15 (0.03) −5.24 <0.001 −0.20 −0.09
Group*Time 2.94 −0.06 (0.04) −1.72 0.088 −0.14 0.01
Emotion regulation
Group 0.29 0.04 (0.06) 0.68 0.496 −0.08 0.17
Time 9.17 ** −0.03 (0.05) −0.59 0.558 −0.12 0.07
Group*Time 4.81 * −0.15 (0.07) −2.19 0.029 −0.28 −0.01
Communication skills
Group 47.19 *** 0.38 (0.04) 9.97 <0.001 0.30 0.45
Time 317.30 *** −0.26 (0.03) −7.89 <0.001 −0.33 −0.19
Group*Time 36.22 *** −0.27 (0.04) −6.02 <0.001 −0.35 −0.18
Sharing and helping
Group 29.85 *** 0.22 (0.04) 5.39 <0.001 0.14 0.31
Time 68.15 *** −0.17 (0.03) −5.35 <0.001 −0.23 −0.10
Group*Time 0.04 −0.01 (0.04) −0.21 0.833 −0.09 0.07
Sharing personal belongings
Group 15.28 *** −0.02 (0.04) −0.39 0.699 −0.09 0.06
Time 18.75 *** 0.03 (0.03) 0.95 0.341 −0.03 0.09
Group*Time 31.82 *** −0.25 (0.04) −5.64 <0.001 −0.34 −0.17
Solving problems
Group 49.44 *** 0.85 (0.11) 7.59 <0.001 0.63 1.07
Time 61.33 *** −0.15 (0.05) −2.79 0.006 −0.25 −0.04
Group*Time 10.96 ** −0.21 (0.06) −3.11 0.001 −0.34 −0.09
Note. DF = 198, SE = Standard error, CI = Confidence intervals, * p < 0.01, ** p < 0.05, *** p < 0.001.

Table 4. Pairwise contrast of groups and times using means estimated by the model on the program’s variables.

CI 95%
Outcome Variable Estimation (SD) t p−Value
Inferior Superior
Rules
Group (Exp-Cont.) 0.98 (0.42) 2.38 0.018 0.17 1.82
Time (pre-pos) −2.17 (0.23) −9.30 <0.001 −2.62 −1.71
Emotion IE
Group (Exp-Cont.) 3.20 (0.40) 7.95 < 0.001 2.41 3.99
Time (pre-pos) −1.62 (0.16) −10.01 < 0.001 −1.95 −1.31
Emotion regulation
Group (Exp-Cont.) −0.11 (0.19) −0.54 0.588 −0.49 0.628
Time (pre-pos) −0.36 (0.12) −3.02 < 0.003 −0.59 −0.12
Communication skills
Group (Exp-Cont.) 1.86 (0.27) 6.84 <0.001 1.32 2.39
Time (pre-pos) −2.98 (0.35) −17.86 <0.001 −3.31 −2.65
Sharing and helping
Group (Exp-Cont.) 1.92 (0.35) 5.44 <0.001 1.22 2.62
Time (pre-pos) −1.49 (0.18) −8.38 <0.001 −1.84 −1.14
Sharing personal belongings
Group (Exp-Cont.) −0.64(0.16) −3.89 <0.001 −0.96 −0.31
Time (pre-pos) −0.44 (0.10) −4.36 <0.001 −0.63 −0.24
Solving problems
Group (Exp-Cont.) 4.90 (0.75) 6.50 <0.001 3.42 6.39
Time (pre-pos) −1.63 (0.23) −7.09 <0.001 −2.09 −1.18
Note. SD = Standard deviation, CI = Confidence intervals.
Int. J. Environ. Res. Public Health 2021, 18, 8447 9 of 18

Table 5 shows the pairwise contrasts for the interaction group*time, taking into account
the estimated means of the random effects model. The results showed that in both groups,
there were significant differences between the pre-intervention and post-intervention
phases in rules, emotion IE, communication skills, sharing and helping, and solving
problems, with higher scores in the post-intervention phase in both groups. However, the
differences between both phases were greater in the experimental group in all variables.
Nevertheless, in the variables emotion regulation and sharing personal belongings, the
differences between both times were only significant in the experimental group. In addition,
in these variables, the scores of the participants in the experimental group were higher in
the post-intervention phase.

Table 5. Pairwise contrast of the group*time interaction, using means estimated by the model on the program’s variables.

CI 95%
Outcome Variable Estimation (SD) t p−Value
Inferior Superior
Rules
Experimental (pre-pos) −2.53 (0.33) −7.58 <0.001 −3.19 −1.87
Control (pre-pos) −1.82 (0.32) −5.61 <0.001 −2.46 −1.18
Emotion IE
Experimental (pre-pos) −2.29 (0.25) −9.14 <0.001 −2.78 −1.79
Control (pre-pos) −1.12 (0.21) −5.37 <0.001 −1.54 −0.71
Emotion regulation
Experimental (pre-pos) −0.61 (0.16) −3.69 < 0.001 −0.93 −0.28
Control (pre-pos) −0.10 (0.17) −0.59 0.558 −0.44 0.24
Communication skills
Experimental (pre-pos) −4.53 (0.25) −17.75 <0.001 −5.03 −4.03
Control (pre-pos) −1.74 (0.22) −7.97 <0.001 −2.17 −1.31
Sharing and helping
Experimental (pre-pos) −1.71 (0.26) −6.51 <0.001 −2.22 −1.19
Control (pre-pos) −1.30 (0.24) −5.44 <0.001 −1.77 −0.83
Sharing personal belongings
Experimental (pre-pos) −0.94 (0.13) −6.93 <0.001 −1.20 −0.67
Control (pre-pos) 0.14 (0.15) 0.95 0.343 −0.15 0.44
Solving problems
Experimental (pre-pos) −3.37 (0.44) −7.72 <0.001 −4.24 −2.51
Control (pre-pos) −0.65 (0.24) −2.69 0.008 −1.13 −0.17
Note. SD = Standard deviation, CI = Confidence intervals.

Figure 2 shows the pairwise contrast for the group*time interaction taking into account
the means estimated by the model on the program’s variables.
In order to analyze the effect of the intervention program, the effect sizes between
groups were calculated using the non-parametric Mann–Whitney test. The results showed
a low effect size for rules (d = 0.37) and emotion regulation (d = 0.07), medium effect size
for sharing personal belongings (d = 0.59), and high effect size for emotion IE (d = 1.36),
communication skills (d = 0.83), sharing and helping (d = 0.82), and solving problems
(d = 1.42).
On the other hand, in order to contrast the effects of the program not only on the
variables trained by the AC1 program, but also on the social skills and externalizing
problems, a generalized linear mixed model was also carried out considering both groups
and intervention times. The results of the analysis are shown in Table 6. The initial results
of the fixed effects analysis showed significant differences between the experimental and
control groups in the social skills factors: social interaction and social independence. There
were no differences in social cooperation and no differences in externalizing problems.
On the other hand, the results showed significant differences between pre-intervention
and post-intervention times in all social skills variables (cooperation, interaction and
 Int. J. Environ. Res. Public Health 2021, 18, 8447 10 of 18

Int. J. Environ. Res. Public Health 2021, 18, xindependence) and

FOR PEER REVIEW also in Externalizing problems. Finally, regarding the group*time
10 of 18
interaction, the results show significant interactions in all the variables analyzed.

Figure
Figure 2. Pairwise
2. Pairwise contrast
contrast in group*time
in the the group*time interaction
interaction using
using the model-estimating
the model-estimating means
means for the
for the program’s
program’s variables.
variables.

On the other hand, in order to contrast the effects of the program not only on the
variables trained by the AC1 program, but also on the social skills and externalizing
problems, a generalized linear mixed model was also carried out considering both
groups and intervention times. The results of the analysis are shown in Table 6. The ini-
tial results of the fixed effects analysis showed significant differences between the ex-
perimental and control groups in the social skills factors: social interaction and social
independence. There were no differences in social cooperation and no differences in ex-
ternalizing problems. On the other hand, the results showed significant differences be-
Int. J. Environ. Res. Public Health 2021, 18, 8447 11 of 18

Table 6. Results of generalized linear mixed models estimating change in outcomes social skills and externalizing problems.

CI 95%
Outcome Variable F Coefficient (SE) t p-Value
Inferior Superior
Social cooperation
Group 2.44 3.40 (0.02) 3.84 <0.001 0.04 0.13
Time 54.55 *** −0.06 (0.02) −2.81 0.005 −0.10 −0.02
Group*Time 11.25 ** −0.10 (0.03) −3.35 0.001 −0.16 −0.04
Social interaction
Group 30.03 *** 0.31 (0.04) 7.36 <0.001 0.23 0.39
Time 62.38 *** −0.09 (0.03) −3.08 0.002 −0.14 −0.03
Group*Time 10.91 ** −0.12 (0.04) −3.30 0.001 −0.20 0.05
Social independence
Group 12.49 ** 0.18 (0.03) 6.53 <0.001 0.12 0.23
Time 17.57 *** 0.01 (0.02) 0.30 0.765 −0.04 0.05
Group*Time 21.40 *** −0.15 (0.03) −4.63 <0.001 −0.21 −0.08
Externalizing problems
Group 2.81 −0.51 (0.20) −2.54 0.012 −0.91 −0.11
Time 27.12 *** 0.22 (0.10) 2.09 0.038 0.01 0.42
Group*Time 6.11 * 0.39 (0.16) 2.47 0.014 0.08 0.71
Note. DF = 198, SE = Standard error, CI = Confidence intervals, p < 0.01, ** p < 0.05, *** p < 0.001.

Later on, the predictive analysis carried out, considering the random effects of each
participant in each of the phases evaluated, showed significant differences between the ex-
perimental and control groups in social cooperation, social interaction, and social indepen-
dence. Similarly, differences were also observed between the two groups in externalizing
problems. In the case of social skills, the experimental group obtained higher scores in all
variables. On the other hand, in externalizing problems, the experimental group obtained
lower scores than the control group. The analysis of differences between the different
evaluation moments (time) showed significant differences between pre-intervention and
post-intervention in social cooperation, social interaction, and externalizing problems.
In the case of social cooperation and social interaction, scores were higher in the post-
intervention phase. In contrast, in externalizing problems, the score was higher in the
pre-intervention phase. As for the group*time interaction, significant interaction effects
were observed in all social skills variables and also in externalizing problems.
The results of the pairwise contrast according to groups (experimental and control)
and time (pre-intervention and post-intervention), carried out by the model, using the
estimated means, taking into account the random effects, can be seen in Table 7. Differences
between groups were observed in social interaction and social independence, with higher
scores in both groups in the experimental group. On the other hand, there were no
significant differences between the two groups in social cooperation and externalizing
problems. Related to the differences between the pre-intervention and post-intervention,
differences were observed in all the variables analyzed. In social cooperation, social
interaction, and social independence, the scores in the post-intervention were higher than
in the pre-intervention. In the case of externalizing problems, the highest scores were found
in the pre-intervention phase.
Int. J. Environ. Res. Public Health 2021, 18, 8447 12 of 18

Table 7. Pairwise contrast of groups and times using means estimated by the model on social skills and externalizing
problems.

CI 95%
Outcome Variable Estimation (SD) t p-Value
Inferior Superior
Social cooperation
Group (Exp-Cont.) 1.11 (0.71) 1.56 0.120 −0.92 2.51
Time (pre-pos) −3.26 (0.41) −7.62 <0.001 −4.11 −2.42
Social interaction
Group (Exp-Cont.) 5.94 (1.09) 5.44 <0.001 3.79 8.10
Time (pre-pos) −3.57 (0.43) −8.31 <0.001 −4.41 −2.72
Social independence
Group (Exp-Cont.) 2.90 (0.82) 3.53 <0.001 1,28 4.51
Time (pre-pos) −1.85 (0.43) −4.29 <0.001 −2.70 −1.00
Externalizing problems
Group (Exp-Cont.) −1.74 (1.06) −1.64 0.102 −3.84 0.35
Time (pre-pos) 2.29 (0.50) 4.56 <0.001 1.30 3.28
Note. SD = Standard deviation, CI = Confidence intervals.

Pairwise contrasts on the interaction group*time, taking into account the estimated
means of the random effects model (see Table 8) showed differences between the two-time
phases in the experimental group in social cooperation, social interaction, social inde-
pendence, and externalizing problems. Participants in the experimental group obtained
significantly higher scores in the post-intervention on all social skills outcomes, and lower
scores in the post-intervention on externalizing problems. In the case of the control group,
significant differences were also observed between the two-time phases in social coop-
eration and social interaction, with higher scores in the post-intervention. However, the
differences between the two phases were smaller than those observed in the experimental
group. No significant differences were observed in social independence and externalizing
problems in the control group.

Table 8. Pairwise contrast of the group*time interaction, using means estimated by the model on
social skills and externalizing problems.

Estimation CI 95%
Outcome Variable t p-Value
(SD) Inferior Superior
Social cooperation
Experimental (pre-pos) −4.84 (0.60) −8.06 <0.001 −6.02 −3.65
Control (pre-pos) −1,75 (0.61) −2.86 0.005 −2.95 −0.54
Social interaction
Experimental (pre-pos) −5.73 (0.64) −8.91 <0.001 −6.99 −4.46
Control (pre-pos) −1.83 (0.57) −3.19 <0.002 −2.97 −0.70
Social independence
Experimental (pre-pos) −4.10 (0.61) −6.70 <0.001 −5.31 −2.90
Control (pre-pos) 0.18 (0.61) 0.30 0.765 −1.02 1.38
Externalizing problems
Experimental (pre-pos) 2.90 (0.71) 4.11 <0.001 1.51 4.29
Control (pre-pos) 1.40 (0.71) 1.97 0.051 −0.01 2.80
Note. SD = Standard deviation, CI = Confidence intervals.

Figure 3 shows the pairwise contrast for the group*time interaction taking into account
the means estimated by the model on social skills and externalizing problems variables.
 Int. J. Environ. Res. Public Health 2021, 18, 8447 13 of 18
Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 13 of 18

Figure 3. Pairwise contrast in the group*time interaction using the model-estimating means for the program’s variables.
Figure 3. Pairwise contrast in the group*time interaction using the model-estimating means for the program’s variables.
Finally, the effect sizes between groups were calculated using the non-parametric
Finally, the effect sizes between groups were calculated using the non-parametric
Mann–Whitney test. The results showed a low effect size for externalizing problems
Mann–Whitney test. The results showed a low effect size for externalizing problems (d =
(d = 0.24), medium effect size for social cooperation (d = 0.68) and social independence
0.24), medium effect size for social cooperation (d = 0.68) and social independence (d =
(d = 0.73), and high effect size for social interaction (d = 0.94).
0.73), and high effect size for social interaction (d = 0.94).
4. Discussion
4. Discussion
The main purpose of the research was to analyze the effectiveness of the AC1 program
aimedTheat main purposeaged
preschoolers of the research
three to four [Link] Toanalyze
this end,thetwo
effectiveness
objectives wereof theestablished:
AC1 pro-
gram
(1) to aimed
test theateffect
preschoolers aged three
of the program on theto four
skillsyears. To this
it trains; andend,(2) totwo objectives
analyze whether werea
established:
transfer occurs (1) toandtestthethe effect ofhas
program theanprogram
effect, in onaddition
the skillstoitthe
trains; andskills,
trained (2) to on
analyze
other
whether a transfer
social skills occurs and problems.
and externalizing the program has an effect, in addition to the trained skills,
on other social skills and externalizing
Related to the first objective, the results problems. showed that the participants in the experi-
Related to the first objective,
mental group achieved higher scores after the the results showed that the
intervention inparticipants
all the variables in the experi-
analyzed
mental group achieved
(rules, emotion IE, emotion higher scores after
regulation, the intervention
communication skills,in all theand
sharing variables
helping, analyzed
sharing
(rules,
personal emotion
belongings,IE, emotion
and solving regulation,
problems). communication
The control group skills,
alsosharing
increased and helping,
their scores
sharing
in some personal
[Link], and solving problems). The control group also increased
their scores in some variables.
The improvement in both groups in these skills is logical due to the socializing effect
that The
school plays by facilitating
improvement social interactions
in both groups in these skills andisself-regulation,
logical due to the since children invest
socializing effect
more
that time in
school playsrelationships
by facilitating withsocial
peersinteractions
[51], assume andnew rules of coexistence,
self-regulation, and must
since children in-
adjust
vest theirtime
more behavior to the school
in relationships withcontext.
peersHowever,
[51], assume evennewtaking
rules intoofaccount the initial
coexistence, and
differences
must adjust between
their behaviorthe groups,
to thethe gaincontext.
school was greater in the even
However, childrentakingwho participated
into account the in
the AC1
initial [Link]
differences In addition, it should
the groups, thebe gainnoted
wasthat emotion
greater in theregulation
children who and sharing
partici-
personal
pated belongings
in the AC1 program. only increased in theitexperimental
In addition, should be noted group.
that emotion regulation and
sharing personal belongings only increased in the experimentalimprovement
In this sense, the initial hypothesis that indicated that an group. in the skills
trained
In this sense, the initial hypothesis that indicated that an improvement inthe
by the program was expected in the intervention group compared to thecontrol
skills
group was confirmed. We can conclude that the AC1 program
trained by the program was expected in the intervention group compared to the control is effective and promotes
the learning
group of social-emotional
was confirmed. skills, with
We can conclude thata the
greater
AC1effect on aspects
program related
is effective andto promotes
the identi-
fication
the and expression
learning of emotions,
of social-emotional communication
skills, with a greater skills, solving
effect problem,
on aspects or prosocial
related to the
identification and expression of emotions, communication skills, solving problem,per-
behaviors such as sharing and helping. The improvement in these aspects is key for the or
son to develop
prosocial behaviorsan adjusted and self-regulated
such as sharing and helping. social-emotional
The improvement behavior.
in theseCommunication
aspects is key
for the person to develop an adjusted and self-regulated social-emotional behavior.
Int. J. Environ. Res. Public Health 2021, 18, 8447 14 of 18

and conflict resolution skills are fundamental for maintaining healthy social interactions,
and emotional understanding is essential for social adaptation and maintaining friend-
ships [52].
The program has had a minor impact on the acquisition of rules (which may be
logical due to the effect that the school itself exerts on this aspect) and on the regulation of
emotions. Regarding the latter, we know that at three years old, children usually express
the emotions they feel [53] and progressively learn to regulate, plan, supervise, and adjust
their behavior to changing expectations and social circumstances, knowing that showing
certain emotions may be appropriate in one situation, but not in another [54]. Although the
effect of this variable has been weak, the children in the experimental group are the only
ones who have made significant progress in controlling their emotions (mainly anger). We
know that emotional regulation is a complex skill that requires a higher cognitive level, but
the results indicate that its early development can be very positive, since without direct
training, it is difficult to achieve notable progress at this age.
The results obtained were similar to those achieved by other preschool intervention
programs such as the Socio-Emotional Program -SEP- [21], Al’s Pals: Kids Making Healthy
Choices [55], or PATHS [32]. Specifically, Ştefan’s study, carried out with 158 4-year-old
children, showed how the children in the experimental group (n = 89) improved their
socio-emotional competencies compared to those in the control group, showing greater
management in skills related to emotion identification, prosocial behaviors, and conflict
resolution [21].
In relation to the second objective, we can see how the program had, not only, an effect
on those aspects that it develops, but also a transfer and impact on other types of social
skills and externalizing problems. The results of the pairwise contrast taking into account
the estimated means showed an increase in social cooperation, social interaction, and social
independence observed in the children of the experimental group as well as a reduction in
the presence of externalizing problems. In contrast, the control group only increased their
scores in cooperation and interaction, with no significant improvement in the rest of the
variables. These results support the second hypothesis.
The program had a moderate effect on social cooperation and social independence
and a high effect on social interaction. The development of prosocial behaviors such
as sharing, helping or working in team as well as the assimilation of certain rules of
harmony coexistence promoted by the AC1 program may have been key to improved
social cooperation. On the other hand, the program also affects the development of
communication skills, the search for solutions to problems, or the regulation of basic
emotions, aspects that play an important role in the child’s autonomy. The effect of the
program on cooperation and independence translates into greater regulation of behavior
in social situations, as it has been observed that the children in the experimental group
have improved in aspects such as the acceptance of rules, adaptation to group decisions or
knowing how to control themselves, and feeling safe in different situations (they play with
autonomously, play with different children, and accept separation from their parents).
The highest effect size was found in the social interaction variable. After participation
in the program, the children in the experimental group showed a greater communicative
capacity in class, they were more understanding with others, and were also warmer.
The results achieved in the social skills variables were consistent with those of other
studies in which early intervention programs have been evaluated [32,56,57]. The Strong
Start program was effective in improving the prosocial behaviors of 67 kindergarten
students (5–6 years) after 35 sessions of 37 min duration [56].
The effectiveness of the Second Step program has also been analyzed in preschoolers.
The study by Ocasio et al. [58] evaluated the impact of this program in 268 preschoolers
aged 3–4 years old using the same instrument as in this research (PKBS-2). The results
showed an improvement in cooperation, interaction, and social independence in all par-
ticipants, although this time, it was not compared with a control group. The study by
Kemple et al. [12] evaluated the effectiveness of the program using a control group, al-
Int. J. Environ. Res. Public Health 2021, 18, 8447 15 of 18

though with a smaller sample (n = 45) composed of children between three and four years
of age. The results of the study showed an improvement in social knowledge, total social
skills, cooperation, assertion, and self-control after 28 sessions in which contents related to
empathy, emotion management, and problem-solving were worked on [12].
With respect to externalizing problems, the results showed that the experimental group
significantly reduced their scores on this variable, as less aggressive behavior and minor
attention problems were observed after the application of the AC1 program. Although
the control group also showed a decreasing trend, the reduction was not the same as in
the intervention group. Schooling has a positive effect and helps to reduce this type of
problematic behavior. The rules that govern the school context, the directed work carried
out at school, or the opportunities offered by this environment to establish relationships
with peers, support the regulation of the children’s behavior. However, the results suggest
that this acceleration in the reduction in externalizing problems in the experimental group
may be due to the effect caused by the program.
In this sense, a small effect size was obtained in this variable, similar to those found
in other intervention programs such as Projet Primar [59] or PATHS [32]. The effect size
levels were lower for this variable. A similar finding and according to Ştefan [21], it is
likely that changes in problem behaviors are more difficult to observe in the normalized
population (used in this study), that is, in children who do not present a high-risk of
behavioral problems.
The results obtained on the effectiveness of the program in reducing externalizing
problems are in accordance with other studies already mentioned [12,32,55,58]. Specifically,
SEP program significantly reduced externalizing problems in 89 children aged 4–5 years
old after having participated in 37 sessions related to social competence (compliance with
rules, prosocial behavior, and problem solving) and emotional competence (recognition
and regulation) [60].
Finally, we must highlight a series of limitations of the research, which should be
taken into account when interpreting the magnitude of the results obtained. The first refers
to the origin of the participant sample, which makes external validity difficult. However,
we can highlight other studies that have evaluated the efficacy of the AC1 program in other
schools in Granada [40–42,61,62] or in other cities of Spain [63]. The program is also being
adapted and validated in different Latin American countries thanks to research projects.
Another limitation would be associated with the evaluation, which was reduced in this
case to a single external evaluator. It would be interesting to carry out a hetero-evaluation
and include observations provided by parents and teachers, as has been done in other
studies [21].
Finally, it would also be important to analyze the long-term effects of the program.
Some longitudinal studies have been carried out over three years of intervention [42], but
it would be desirable to include a follow-up phase to analyze this type of effect afterward
including a cost–benefit analysis of the intervention.

5. Conclusions
In consonance with the results found, we conclude that the AC1 program could be
beneficial in promoting the learning of social-emotional skills that facilitate regulated
behavior, reducing the presence of externalizing problems. However, we consider that it
would be important to include specific strategies focused on the reduction in behavioral
problems that more directly involve behavioral regulation in prevention programs. Social-
emotional competence and self-regulation are two closely related but distinct constructs [64]
and children with behavioral problems often present difficulties with the management of
self-regulation skills [7].
Despite the limitations noted above, the research presents a number of strengths and
implications for professionals working in schools. The program can be of great utility
to teachers as it is easily applicable and can also be inserted into the school curriculum.
Int. J. Environ. Res. Public Health 2021, 18, 8447 16 of 18

Since it is a universal intervention, it can be implemented at other schools and reach more
preschoolers, thus acquiring a preventive character.
The results obtained, together with those achieved by other intervention programs,
contribute to the growth of a research body that supports the inclusion of social-emotional
learning in the preschool curriculum. Social-emotional competence in early childhood is
fundamental for the positive development of the person [65], and as we have argued, this
type of competence is closely related to regulated adaptive behavior and helps to reduce
the presence of behavioral problems.

Author Contributions: A.J.-A., M.C.P., M.R.-L. and G.A. have contributed equally. All authors have
read and agreed to the published version of the manuscript.
Funding: This study was funded by the Ministry of Science and Innovation as part of a research
project (EDU2009-11950).
Institutional Review Board Statement: The study was conducted according to the guidelines of the
Declaration of Helsinki and the ethics regulations of the University of Granada.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Data are available on request due to ethical restrictions.
Acknowledgments: The authors would like to thank the schools involved for their participation.
Conflicts of Interest: The authors declare no conflict of interest.

References
1. Calkins, S.D.; Keane, S.P. Developmental origins of early antisocial behavior. Dev. Psychopathol. 2009, 21, 1095–1109. [CrossRef]
2. Macklem, G.L. Preventive Mental Health at School; Springer: New York, NY, USA, 2014. [CrossRef]
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-5, 5th ed.; American Psychiatric
Publishing: Washington, DC, USA, 2013.
4. Ogden, T. Complex Roots and Branches of Antisocial Behavior. In Handbook of Child Well-Being. Theories, Methods and Policies in
Global Perspectives; Ben-Arieh, E., Casas, F., Frønes, I., Corbin, J., Eds.; Springer: Dordrecht, The Netherlands, 2014; pp. 2577–2591.
[CrossRef]
5. Estévez, E.; Jiménez, T.I.; Moreno, D. Aggressive behavior in adolescence as a predictor of personal, family and school adjustment
problems. Psichotema 2018, 30, 66–73. [CrossRef]
6. Hinshaw, S.P. Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relation-
ships and underlying mechanisms. Psychol. Bull. 1992, 111, 127–155. [CrossRef]
7. Fernández-Parra, A.; López Rubio, S.; Mata, S.; Calero, M.D.; Vives, M.C.; Carles, R.; Navarro, E. Cognitive Abilities, Adjustment
and Parenting practices in preschoolers with Disruptive Conduct Problem. Electron. J. Res. Educ. Psychol. 2013, 11, 577–602.
[CrossRef]
8. Agbaria, Q. The Relationship between Self Control Skills and Behavioral Problems among Special Education Primary Grades in
Israel. Int. J. Early Child. Spec. Educ. 2020, 13, 01–08. [CrossRef]
9. Monks, C.P. La agresión entre iguales en Educación infantil. In Prevención De La Violencia Interpersonal En La Infancia Y La
Adolescencia; Sánchez Jiménez, V., Ed.; Pirámide: Madrid, Spain, 2019; pp. 27–44.
10. del Barrio, V.; Carrasco, M.A. Problemas conductuales y emocionales en la infancia y la adolescencia. Padres Y Maest. 2016, 365,
55–61. [CrossRef]
11. Ministerio de Sanidad, Consumo y Bienestar Social. Encuesta Nacional de Salud ENSE, España. 2017. Available online:
[Link] (accessed on 15 July 2021).
12. Kemple, K.M.; Lee, I.; Ellis, S.M. The Impact of a Primary Prevention Program on Preschool Children’s Social–Emotional
Competence. Early Child. Educ. J. 2019, 47, 641–652. [CrossRef]
13. Hemphill, S.A. Characteristics of Conduct-Disordered Children and Their Families: A Review. Aust. Psychol. 1996, 31, 109–118.
[CrossRef]
14. Stanger, C.; Achenbach, T.M.; McConaughy, S.H. Three-year course of behavior/emotional problems in a national sample of 4- to
16-year-olds: III. Predictors of signs of disturbance. J. Consult. Clin. Psychol. 1993, 61, 839–848. [CrossRef]
15. McCabe, L.S.; Frede, E.C. Challenging behaviors and the role of preschool education. Natl. Inst. Early Educ. Res. 2007. Available
online: [Link] (accessed on 18 July 2021).
16. Tremblay, R.E. The Development of Youth Violence: An Old Story with New Data. Eur. J. Crim. Policy Res. 2007, 13, 161–170.
[CrossRef]
17. Frick, P.J. Developmental Pathways to Conduct Disorder: Implications for Future Directions in Research, Assessment, and
Treatment. J. Clin. Child Adolesc. Psychol. 2012, 41, 378–389. [CrossRef]
Int. J. Environ. Res. Public Health 2021, 18, 8447 17 of 18

18. Daly, B.P.; Nicholls, E.; Aggarwal, R.; Sander, M. Promoting social competence and reducing behavior problems in at-risk students:
Implementation and efficacy of universal and selective prevention programs in schools. In Handbook of School Mental Health:
Research, Training, Practice, and Policy; Weist, M.D., Lever, N.A., Bradshaw, C.P., Sarno Owens, J., Eds.; Springer Science + Business
Media: New York, NY, USA, 2014; pp. 131–144. [CrossRef]
19. Webster-Stratton, C.; Taylor, T. Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in
adolescence through interventions targeted at young children (ages 0–8 years). Prev. Sci. 2001, 2, 165–192. [CrossRef] [PubMed]
20. Del Prette, Z.A.P.; Del Prette, A. Psicologia Das Habilidades Sociais Na Infância. Teoria E Prática, 5th ed.; Editora Vozes: Petrópolis, RJ,
Brazil, 2011.
21. Ştefan, C.A. Social-Emotional Prevention Programs for Preschool Children’s Behavior Problems: A Multi-level Efficacy Assessment of
Classroom, Risk Group, and Individual Level; Palgrave McMillan: London, UK, 2018. [CrossRef]
22. Saarni, C. The continuity dilemma in emotional competence. Psychol. Inq. 2001, 12, 94–96. [CrossRef]
23. Denham, S.A. Social-emotional competence as support for school readiness: What is it and how do we assess it? Early Educ. Dev.
2006, 17, 57–89. [CrossRef]
24. CASEL [Collaborative for Academic, Social and Emotional Learning]. Effective Social and Emotional Learning Programs. Preschool
and Elementary School Edition; CASEL: Chicago, IL, USA, 2012; Available online: [Link]
1/[Link] (accessed on 15 July 2021).
25. Greenberg, M.T.; Domitrovich, C.E.; Weissberg, R.P.; Durlak, J.A. Social and Emotional Learning as a Public Health Approach to
Education. Future Child. 2017, 27, 13–32. [CrossRef]
26. Pandey, A.; Hale, D.; Das, S.; Goddings, A.L.; Blakemore, S.J.; Viner, R.M. Effectiveness of universal self-regulation-based
interventions to improve self-regulation, and effects on distant health and social outcomes in children and adolescents: A
systematic review and meta-analysis. Lancet 2017, 390, S66. [CrossRef]
27. Pandey, A.; Hale, D.; Das, S.; Goddings, A.L.; Blakemore, S.J.; Viner, R.M. Effectiveness of universal self-regulation–based
interventions in children and adolescents: A systematic review and meta-analysis. JAMA Pediatr. 2018, 172, 566–575. [CrossRef]
28. Olson, S.L.; Choe, D.E.; Sameroff, A.J. Trajectories of child externalizing problems between ages 3 and 10 years: Contributions of
children’s early effortful control, theory of mind, and parenting experiences. Dev. Psychopathol. 2017, 29, 1333–1351. [CrossRef]
[PubMed]
29. Blair, C.; Diamond, A. Biological processes in prevention and intervention: The promotion of self-regulation as a means of
preventing school failure. Dev. Psychopathol. 2008, 20, 899–911. [CrossRef]
30. Durlak, J.A.; Weissberg, R.P.L.; Dymnicki, A.B.; Taylor, R.D.; Schellinger, K.B. The impact of enhancing students’ social and
emotional learning: A meta-analysis of school-based universal interventions. Child Dev. 2011, 82, 405–432. [CrossRef] [PubMed]
31. McClelland, M.M.; Tominey, S.L.; Schmitt, S.A.; Duncan, R. SEL Interventions in Early Childhood. Future Child. 2017, 27, 33–47.
[CrossRef]
32. Domitrovich, C.E.; Cortes, R.C.; Greenberg, M.T. Improving Young Children’s Social and Emotional Competence: A Randomized
Trial of the Preschool “PATHS” Curriculum. J. Prim. Prev. 2007, 28, 67–91. [CrossRef]
33. Webster-Stratton, C.; Jamila Reid, M.; Stoolmiller, M. Preventing conduct problems and improving school readiness: Evaluation
of the Incredible Years Teacher and Child Training Programs in high-risk schools. J. Child Psychol. Psychiatry 2008, 49, 471–488.
[CrossRef] [PubMed]
34. Raver, C.C.; Jones, S.M.; Li-Grining, C.; Zhai, F.; Bub, K.; Pressler, E. CSRP’s Impact on Low-Income Preschoolers’ Preacademic
Skills: Self-Regulation as a Mediating Mechanism. Child Dev. 2011, 82, 362–378. [CrossRef]
35. Barnett, W.S.; Jung, K.; Yarosz, D.J.; Thomas, J.; Hornbeck, A.; Stechuk, R.; Burns, S. Educational effects of the Tools of the Mind
curriculum: A randomized trial. Early Child. Res. Q. 2008, 23, 299–313. [CrossRef]
36. Shure, M.B. I can problem solve (ICPS): Interpersonal cognitive problem solving for young children. Early Child Dev. Care 1993,
96, 49–64. [CrossRef]
37. Beelmann, A.; Lösel, F. Child social skills training in developmental crime prevention: Effects on antisocial behavior and social
competence. Psicothema 2006, 18, 603–610.
38. Ferrer-Wreder, L. Advancing child and adolescence well-being through positive youth development and prevention programs.
In Handbook of Child Well-Being. Theories, Methods and Policies in Global Perspectives; Ben Arieh, A., Casas, F., Frønes, I., Korbin, J.E.,
Eds.; Springer: Dordrecht, The Netherlands, 2014; Volume 2, pp. 3025–3041. [CrossRef]
39. Ministerio de Educación y Formación Profesional. Datos Y Cifras Curso Escolar 2020/2021. Available online: [Link]
[Link]/en/dam/jcr:89c1ad58-80d8-4d8d-94d7-a7bace3683cb/[Link] (accessed on 20 July 2021).
40. Fernández, M.; Benítez, J.L.; Fernández, E.; Justicia, F.; Justicia-Arráez, A. Desarrollo de la competencia social y prevención del
comportamiento antisocial en niños de 3 años. Infanc. Y Aprendiz. 2011, 34, 337–347. [CrossRef]
41. Benítez, J.L.; Fernández, M.; Justicia, F.; Fernández, E.; Justicia-Arráez, A. Results of the Aprender a Convivir program for
development of social competence and prevention of antisocial behavior in four-year-old children. School Psychol. Int. 2011, 32,
3–19. [CrossRef]
42. Justicia-Arráez, A.; Pichardo, M.C.; Justicia, F. Longitudinal Study of the Effects of the Aprender a Convivir Program on Children’s
Social Competence. J. Psychodidact. 2015, 20, 263–283. [CrossRef]
Int. J. Environ. Res. Public Health 2021, 18, 8447 18 of 18

43. Justicia-Arráez, A.; Alba, G.; Romero-López, M.; Quesada-Conde, A.B. Análisis de la estructura factorial del registro de
observación del programa aprender a convivir en 3 años (ROAC-3). Int. J. Dev. Educ. Psychol. 2014, 4, 557–568. Available online:
[Link] (accessed on 20 July 2021). [CrossRef]
44. Fernández, M.; Benítez, J.L.; Pichardo, M.C.; Fernández, E.; Justicia, F.; García, T.; García-Berbén, A.B.; Justicia-Arráez, A.; Alba, G.
Análisis factorial confirmatorio de las subescalas del PKBS-2 para la evaluación de las habilidades sociales y los problemas de
conducta en educación infantil. Electron. J. Res. Educ. Psychol. 2010, 8, 1229–1252. [CrossRef]
45. Merrell, K.W. Preschool and Kindergarten Behavior Scales; Pro-Ed: Austin, TX, USA, 2002.
46. Benítez, J.L.; Pichardo, M.C.; García, T.; Fernández, M.; Justicia, F.; Fernández De Haro, E. Análisis de la estructura factorial de las
puntuaciones de la “Preschool and Kindergarten Behavior Scale” en población española. Psicothema 2011, 23, 314–321.
47. Achenbach, T.; Rescorla, L.A. Manual of ASEBA Preschool Forms and Profiles; University of Vermont, Departament of Psychiatry:
Burlington, VT, USA, 2000.
48. Justicia, F. Aprender a Convivir 1. Programa Para La Adquisición De Habilidades Sociales En Educación Infantil. Guía Didáctica Del
Profesorado; CEPE: Madrid, Spain, 2018.
49. Fritz, C.O.; Morris, P.E.; Richler, J.J. Effect Size Estimates: Current Use, Calculations, and Interpretation. J. Exp. Psychol. General
2012, 141, 2–18. [CrossRef]
50. Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; New York University: New York, NY, USA, 1988.
51. Trianes, M.V.; Infante, L. Intervención temprana en la competencia social. In Intervención Temprana. Desarrollo Óptimo De 0 A 6
Años; Gómez, A., Viguer, P., Cantero, M.J., Eds.; Pirámide: Madrid, Spain, 2007; pp. 155–174.
52. Denham, S. Dealing with feelings: How children negotiate the worlds of emotions and social relationships. Cogn. Brain Behav.
2007, 11, 1–48.
53. Ştefan, C.A.; Bălaj, A.; Porumb, M.; Albu, M.; Miclea, M. Preschool screening for social and emotional competencies–development
and psychometric properties. Cogn. Brain Behav. 2009, 8, 121–146.
54. Banerjee, M. Hidden emotions: Preschoolers’ knowledge of appearance-reality and emotion display rules. Soc. Cogn. 1997, 15,
107–132. [CrossRef]
55. Lynch, K.B.; Geller, S.R.; Schmidt, M.G. Multi-year evaluation of the effectiveness of a resilience-based prevention program for
young children. J. Prim. Prev. 2004, 24, 335–353. [CrossRef]
56. Kramer, T.J.; Caldarella, P.; Christensen, L.; Shatzer, R.H. Social and emotional learning in the kindergarten classroom: Evaluation
of the Strong Start curriculum. Early Child. Educ. J. 2010, 37, 303–309. [CrossRef]
57. Moraru, A.; Stoica, M.; Tomuletiu, E.A.; Filpisan, M.F. Evaluation of a program for developing socio-emotional competencies in
preschool children. Procedia-Soc. Behav. Sci. 2011, 30, 2161–2164. [CrossRef]
58. Ocasio, K.; Van Alst, D.; Koivunen, J.; Huang, C.; Allegra, C. Promoting preschool mental health: Results of a 3-year primary
prevention strategy. J. Child Fam. Stud. 2015, 24, 1800–1808. [CrossRef]
59. Koglin, U.; Petermann, F. The effectiveness of the behavioural training for preschool children. Eur. Early Child. Educ. Res. J. 2011,
19, 97–111. [CrossRef]
60. Ştefan, C.A.; Miclea, M. Effects of a multifocused prevention program on preschool children’s competencies and behavior
problems. Psychol. Sch. 2013, 50, 382–402. [CrossRef]
61. Alba, G.; Fernández-Cabezas, M.; Justicia, F.; Pichardo, M.C. The longitudinal effect of the Aprender a Convivir (learning to live
together) programme in childhood: The development of social competence. Cult. Y Educ. 2015, 27, 186–220. [CrossRef]
62. Justicia-Arráez, A.; Pichardo, C.; Justicia, F. Efecto del programa Aprender a Convivir en la competencia social y en los problemas
de conducta del alumnado de 3 años. An. De Psicol. 2015, 31, 825–836. [CrossRef]
63. Frías, C. Mejora De La Competencia Social En Niños De 2.◦ Ciclo De Educación Infantil A Través Del Programa Aprender A
Convivir. Ph.D. Thesis, University of Zaragoza, Zaragoza, Spain, 2016.
64. Graziano, P.A.; Hart, K. Beyond behavior modification: Benefits of social–emotional/self-regulation training for preschoolers
with behavior problems. J. School Psychol. 2016, 58, 91–111. [CrossRef] [PubMed]
65. Weissberg, R.P.; Durlak, J.A.; Domitrovich, C.E.; Gullotta, T.P. Social and emotional learning: Past, present, and future. In
Handbook of Social and Emotional Learning; Durlak, J.A., Domitrovich, C.E., Weissberg, R.P., Gullotta, T., Eds.; Guildford: New York,
NY, USA, 2015; pp. 3–19.