Academic journal article Journal of Evidence-Based Psychotherapies

Using Friends to Combat Internalizing Problems among Primary School Children in Hong Kong

Academic journal article Journal of Evidence-Based Psychotherapies

Using Friends to Combat Internalizing Problems among Primary School Children in Hong Kong

Article excerpt


The primary objective of this study was to evaluate the effectiveness of FRIENDS, a well-validated emotional resiliency program, to reduce internalizing problems among primary school children aged 8-10. 47 children who reached at least the cutoff point for internalizing score, as measured using a standardized test on child behaviour, were allocated to either the intervention or the wait-list control condition. All children completed measures on internalizing symptoms and self-esteem both before and after an 8-week FRIENDS intervention or wait period. Results showed that children from the FRIENDS program showed significantly higher self-esteem and fewer internalizing symptoms when compared to those in the waitlist group. Modifications done on adapting FRIENDS to culturally and contextually appropriate content for Hong Kong children with internalizing problems were discussed. Limitations of this study were also addressed.

Key words: FRIENDS, internalizing problems, school children.


Children's behaviour problems were broadly classified into two groups: externalizing behaviours and internalizing behaviours (Achenbach, 1991; Cocchetti & Toth, 1991). Externalizing behaviour patterns were directed towards the social environment and could be characterized as an under-controlled and outer-directed mode of responding. Examples included aggression, disruption, impulsivity/hyperactivity. In contrast, internalizing behaviour patterns were directed towards the individual and represent an over-controlled and innerdirected pattern of behaviours. Examples of these behaviours included social withdrawal, depression and anxiety. Algozzine (1977) characterized externalizing behaviours as "disturbing" to others in the social environment and internalizing behaviours as "disturbing" to the individual. As such, internalizing behaviour problems were not identified as frequently as those with externalizing behaviour because of its covert and non-intrusive nature. Compared to externalizing behaviour, internalizing behaviour problems often went unnoticed (Kauffman, 2001). In addition, children with internalizing problems tended to be impaired in various social and school activities, as well as in their perceived self-competence (e.g., Messer & Beidel, 1994; Silverman & Ginsburg, 1998). This impairment could hinder children's readiness for learning (Pianta, 1997) and could increase the risk for suicide attempts (Lewinsohn, Rohde, & Seeley, 1998). Furthermore, these internalizing problems might intensify over time and were likely to develop into psychiatric conditions (Kendall & Chu, 2000; Lewinsohn, et al., 1998). For example, internalizing problems in childhood might play a causal role in the development of depressive disorders and anxiety disorders (e.g., Seligman & Ollendick 1998), conduct disorders as well as substance use disorders (e.g., Cheng & Myers, 2005). Failure to intervene early with effective treatments might render the child vulnerable to impairments in a wide range of functioning and result in deleterious effects on the person's long-term emotional development. For instance, a longitudinal study found that children with anxiety disorders faced a two- to four-fold increased risk for having an adult anxiety disorder (Pine, Cohen, Gurley, Brook, & Ma, 1998). Increased understanding on how to treat these disorders in children was therefore imperative not just because of the frequency with which these disorders were encountered, but because, when present, they engender significant immediate distress and impairment and could often lead to lifelong difficulties in overall functioning.

Internalizing problems among children in Hong Kong also reached an alarming point. A recent report released by Health, Welfare and Food Bureau of HKSAR (Apple Daily, October 8, 2004) estimated that about 5 to 10 percent of children is suffering from anxiety disorders while 2 percent is suffering from depressive disorders. …

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