While problematic behaviors can hamper children's early positive development, the teacher-child relationship can play a crucial role in mitigating children's externalizing problem behavior (EPB).This review aims to systematically examine and synthesize evidence on the effectiveness of interventions designed to enhance teacher-child interactions (TCIs) and assess their impact on reducing EPB among children in childcare settings. Systematic literature searches were performed on four electronic databases (EBSCO, ERIC, SCOPUS, and WOS). A complementary search of clinical trial registries (clinicaltrials.gov) was performed. The studies reported on interventions targeting the promotion of TCI to reduce children's EPB in childcare settings. The children were aged 0-6 years, and their EPB was assessed using self-report questionnaires and/or observational coding instruments. The risk of bias was evaluated using the Joanna Briggs Institute's Critical Appraisal Tool. The standardized mean differences were pooled using random effects, and a moderator analysis was conducted. The review included 26 studies, 12 of which were included in a meta-analysis, revealing a significant decrease in children's EPB (SMD = -0.240; 95% CI = [-0.362, -0.117]; p = 0.001). Tier-2 interventions implemented within the Multi-Tiered Systems of Support (MTSS) framework were particularly effective (SMD = -0.508; 95% CI: [-0.755, -0.261]). Furthermore, interventions that integrated video components also showed significant effectiveness (SMD = -0.303; 95% CI: [-0.434, -0.172]). This review emphasizes the importance of enhancing TCIs to reduce children's EPB and recommends innovative training methods and long-term follow-up studies for improved effectiveness.
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