Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review

Background Disciplinary behaviour management strategies are implemented in schools to manage pupil behaviour. There is limited evidence of their intended impact on behaviour but there is growing concern around the potential negative impacts on pupil wellbeing. Methods We carried out a systematic review to examine the impact of these strategies on psychosocial outcomes in pupils (PROSPERO Registration: CRD42021285427). We searched multiple sources and double-screened titles, abstracts, and full texts. Data extraction and risk of bias assessment were done by one reviewer and checked by another. Results were narratively synthesised. Results We included 14 studies, from 5375 citations, assessing temporary suspension (n=10), verbal reprimand (n=2), and mixed strategies (n=2). Depression was the most common outcome (n=7), followed by academic grades (n=4) and behaviour in class (n=4). All except one study were at high risk of bias. We found a recurring pattern in the evidence of disciplinary strategies associated with poor mental wellbeing and behaviour in pupils. The effect on academic attainment was unclear. Conclusions Disciplinary behaviour management strategies may have negative impact on pupil mental wellbeing and class behaviour. These important consequences should be assessed in better designed studies before these strategies are implemented.


Methods
We carried out a systematic review to examine the impact of these strategies on psychosocial outcomes in pupils (PROSPERO Registration: CRD42021285427).We searched multiple sources and double-screened titles, abstracts, and full texts.Data extraction and risk of bias assessment were done by one reviewer and checked by another.Results were narratively synthesised.

Results
We included 14 studies, from 5375 citations, assessing temporary suspension (n=10), verbal reprimand (n=2), and mixed strategies (n=2).Depression was the most common outcome (n=7), followed by academic grades (n=4) and behaviour in class (n=4).All except one study were at high risk of bias.We found a recurring pattern in the evidence of disciplinary strategies associated with poor mental Any reports and responses or comments on the article can be found at the end of the article.

Open Peer Review
wellbeing and behaviour in pupils.The effect on academic attainment was unclear.

Conclusions
Disciplinary behaviour management strategies may have negative impact on pupil mental wellbeing and class behaviour.These important consequences should be assessed in better designed studies before these strategies are implemented.

Plain English Summary
How does school discipline affect pupil mental health and wellbeing?A systematic review In England, a variety of approaches are used in schools to manage pupils' behaviour.There isn't much evidence about their impact on behaviour, but there's growing concern they might negatively affect pupils' wellbeing.
We systematically reviewed the published research to understand the impact of these behaviour management strategies on pupils' wellbeing.We searched multiple sources and two people looked at titles, abstracts and full papers.
One reviewer extracted the data and assessed the studies for risk of bias, while another checked this work.Results from all studies were combined together in text and tables.
We included 14 studies from the 5,375 papers that we looked at.
Included studies explored at a range of strategies, including temporary suspension (10 studies), verbal reprimand or being told off (2 studies), and a combination of strategies (2 studies).
Seven studies looked at whether these strategies led to depression, four looked at the impact on exam grades and four on behaviour in class.All except one study were at high risk of bias, meaning we can't fully trust their findings.
Many of the studies showed these disciplinary strategies were linked to poor mental wellbeing and behaviour in pupils.The effect on exam results wasn't clear.
It appears pupil mental wellbeing and class behaviour was made worse by these strategies.These are important impacts and should be researched in high quality studies before these strategies are used further.

Introduction
Disciplinary behaviour management strategies are implemented in schools to help manage pupil behaviour.There are several approaches towards behaviour management.There are punitive strategies which align with the theory of assertive discipline 1 , which set out clear rules that reward good behaviour and punish poor behaviour.Punitive approaches will typically directly respond to poor behaviour, whereby punishing a pupil is anticipated to reduce the likelihood of repeated disruptive behaviour.However, if a pupil misbehaves again or dependent on the misbehaviour itself, increasingly severe forms of punishment are then used.Punitive approaches include strategies such as verbal reprimanding (e.g., being shouted at in class), detentions, isolation rooms, in-and out-of-school suspensions, and expulsion (permanent exclusion).These punitive approaches are commonplace in the western world 2,3 , and are more common in secondary schools in UK 4,5 .
Conversely, there are alternative approaches that aim to understand why pupils act as they do, in the context of poor behaviour, and then work with the child to reduce the likelihood of these behaviours recurring.These include restorative approaches 6 , trauma informed approaches 7 , collaborative problem solving 8 , positive behavioural intervention and support (PBIS) 9 , or attachment-based strategies 10 .These strategies support pro-social behaviour between pupils, and collaborative interaction between pupils and teachers 11 .The evidence base in support of these alternative approaches has developed in recent years [12][13][14] .
There is limited evidence regarding the intended impact of punitive approaches on behaviour and academic outcomes for affected pupils and their peers [15][16][17][18] .There is also a growing concern for the potential negative implications that punitive approaches may have on wellbeing outcomes later in life 19,20 .This is important given that young people's mental health has declined in recent years in the UK, partly due to disruptions in school and home routines following COVID-19 and the pandemic response strategies 21 .
This concern about the potential negative mental health impact on pupils was voiced by secondary school age young people in a public consultation meeting in Bristol (England) when collaboratively identifying research priorities.
This review was then developed with input from these young people to investigate the existing evidence on the effects of punitive behaviour management strategies on mental health and wellbeing in secondary school age children and young people 22 .

Objectives
To examine whether the use of disciplinary behaviour management strategies (interventions) in secondary schools leads to adverse psychosocial outcomes for pupils Secondary objectives were: • To explore whether adverse effects differ between children of different socio-demographic backgrounds

•
To determine whether there is evidence of effectiveness for these disciplinary behaviour management strategies in improving behaviour and academic outcomes This review was registered with the international Prospective Register of Systematic Reviews (PROSPERO) in October 2021.Registration number CRD42021285427 23 .

Public Involvement
We held three involvement sessions with young people aged between 11 and 16 years old to develop the broad research questions.The first session involved the Young People's Advisory Group (YPAG; a local public involvement group for young people interested in research) raising concerns about the effect of disciplinary behaviour management strategies on pupil wellbeing.A second workshop was conducted with funding from Create to Collaborate 24 to explore these concerns with a broader group of young people affiliated with a mental health charity.In this workshop, young people suggested that some school discipline practices affect their wellbeing negatively.We then ran a third workshop to refine the review questions and search terms with the input from YPAG.

Eligibility criteria
We included randomised and non-randomised study designs (including longitudinal and cross-sectional surveys).We excluded solely qualitative studies as this review's scope was limited to effects of interventions.
Based on our public involvement work with young people, we were interested in zero-tolerance, punishment-based, or punitive disciplinary strategies that include verbal reprimanding,

Amendments from Version 1
We have updated the text of our original submission in response to peer review.
We added information in the background about the review's focus on secondary schools.
We elaborated further in the methods why any meta-analyses were not conducted.
We have provided more specific reasons for the exclusion of studies in the PRISMA diagram.
We have included further reflection on link between punitive disciplinary strategies and poor academic outcomes, and the potential value of alternative approaches in discussion.
We have added further reflections on our search for grey literature in the limitation section.
See our detailed response to the reviews for specific locations of these updates.
Any further responses from the reviewers can be found at the end of the article behaviour monitoring and reporting, isolation, detentions (either during-or after-school hours), and suspension (inclusive of temporary-or fixed-term exclusion).We did not include studies which only focused on permanent exclusion or expulsions from schools.
We limited our inclusions to the UK and other high-income countries in The Organisation for Economic Co-operation and Development (OECD).This meant that approaches such as corporal punishment, and physical-or chemical-restraint were not included given that they are not implemented in a UK (or similar) context.
We included studies of children and young people from the general population, aged 11-16 years, attending a main-stream school.We excluded studies focused on pupils in specialist schools, such as secure centres for children (similar to a juvenile correction facility in the USA), special behavioural units, and Special Educational Needs and Disability (SEND) schools.
Our primary outcomes were any measures of mental health and wellbeing.We included academic and social outcomes as secondary outcomes.

Search strategy
We developed search strategies with an information specialist (SD) and searched seven online databases from inception to October 15th, 2021: MEDLINE; Embase; PsycINFO; British Education Index; Australian Education Index; Education Resources Information Centre (ERIC); Web of Science Social Science Citation Index (SSCI).See Extended data for search strategies 25 .We also sent a standardised email through the Children and Young People's Mental Health Coalition 26 to their 237 member organisations to help identify grey literature.

Study selection
Titles and abstracts identified through electronic database-and web-searching were independently screened for relevance in duplicate (JN, SI, & LM) using Rayyan 27 .Full texts were then retrieved for all relevant references and assessed against the inclusion criteria, in duplicate.Reasons for exclusion were documented (see table S1 in supplementary file) at this stage.Any discrepancies between reviewers at either stage were resolved through discussion or via a third reviewer (JS).

Data extraction and risk of bias assessment
Data extraction was undertaken by one reviewer (JN) using a standardised form in Microsoft Excel.To minimise bias and errors, a second reviewer (SI) checked the data extracted from all included papers.We extracted information on the following: a) study design, b) sample size and characteristics, c) the behaviour management strategy being studied, d) control / comparator [where available], e) context and setting, and f) information about, and results pertaining to, the primary and secondary outcomes.We assessed risk of bias in included studies using Cochrane Effective Practice and Organisation of Care (EPOC) group's criteria for nonrandomised studies 28 .We considered a study to be at an overall low risk of bias when all items were scored at low risk, at an overall moderate risk of bias when more than half the items were at low risk of bias, and all others were rated high risk of bias.

Synthesis
We planned for a random effects meta-analysis if combinable data were available.However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs.The analyses presented were often unadjusted with numbers of analysed participants unclear.A narrative synthesis was therefore performed.Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations.

Description of included studies
Ten studies were from USA, followed by two from Australia and the UK respectively, and one from Poland.We found no randomised trials.Studies were either surveys or uncontrolled before and after designs.Sample sizes across studies varied widely, ranging from 23 pupils to 33 572 pupils (median = 1811 pupils).
The most common studied outcome was depression (n=7) [30][31][32]34,35,37,40   complaints, and anxiety/depression) 44 , one using Teacher observation of classroom adaptation checklist (TOCAC) 31 and Youth Self Report (YSR) in the other 41 . One study asessed externalising symptoms (i.e., problems of aggression, impulsivity, and inattention) 44 on adapted Behavior Assessment System for Children: second edition (BASC 2) scale 29 .Anxiety was assessed in one study 36 using a Polish version of State-Trait Anxiety Inventory for Children. Geeral mental wellbeing was assessed in three studies 33,38,39 , one using the Warwick and Edinburgh Mental Wellbeing Scale 33 , and two using author developed scales 38,39 . Fie studies 30,35,36,39,42 assessed impact of disciplinary strategies on educational attainment.See Table 1 for details of included studies.

Risk of bias in included studies
Studies were mostly at high risk of bias across all domains (see Figure 2).Only one study 31 was considered at an overall moderate risk of bias.None were considered at a low risk of bias.For most studies there is risk of bias due to confounding.For cross-sectional studies and surveys the risk of reverse causality is a key problem, i.e., we can't be sure whether poor mental health was the cause of 'bad behaviour' and thus the reprimand or suspension, rather than the consequence.

Effect of disciplinary strategies on pupil mental health and wellbeing outcomes • Depression i. School Suspension Strategies
Five studies 31,34,35,37,40 reported on depression due to suspension.
Odds of greater total difficulties (SDQ) were found to be significantly higher for those who were suspended in two studies 34,37 .Rushton et al. 40 also found that being suspended from school was associated with increased odds of depressive symptomology.Two studies 31,35 found self-reported depressive symptoms were not related to suspension.
ii. Verbal reprimand strategies None of the two studies assessing verbal punishment strategies reported on depression.
iii.Mixed strategies Two studies 30,32 reported depression assessing two slightly different strategies that included suspensions and some other forms of punishments together.Both found that punishment-based policies led to more depressive symptoms, but at different time points.
Chen et al. 30 found that Black pupils attending a school that disproportionately punished Black students had greater depressive symptoms as an adult ten years later (β= 0.11,95% CI: 0.04, 0.18), compared to their White peers.Eyllon et al. 32 found strict (vs lenient) policies to increase depression in pupils so that each unit increase in school's policy being strict led to a 1.03 unit rise in pupil depression scores on average (95% CI: 0.15, 1.91).

Impact on population subgroups
The two studies reporting data on ethnicity were not in agreement.While Chen et al. 30 found Black pupils to be disproportionately affected by disciplinary punishments and the consequent depression in later age, Eyllon et al. 32 found no link between ethnicity and higher depression due to strict school policies within one year.
• Anxiety No suspension or mixed strategy studies reported this outcome.
A single study set in Poland 36 found that higher school stress brought on by verbal reprimand strategies led to higher anxiety in pupils (R = 0.30, p <.001).
• Psychiatric disorder A single study 34 found children who had been suspended from school had higher odds of diagnosis of a new psychiatric disorder (OR 7.09; 95%CI 5.07 to 9.91; p < 0.001) compared to those not suspended.
No studies of verbal reprimand or mixed strategies reported this outcome.
• General mental wellbeing One study 33 assessing the effect of suspension found a nonsignificant (p=0.15)lower wellbeing (on Warwick Edinburgh Mental Wellbeing Scale) and significantly (p=0.003)greater use of mental health services for suspended children compared to pupils who have never been suspended.Another found children who were suspended were twice as likely to have poor mental health 39 .A single study 38 assessing link between verbal disciplinary strategies and pupil mental wellbeing (on author developed scale) reported no outcome data.
No study on mixed strategies reported this outcome.
• Internalising symptoms One study on suspension 41 found that each additional suspension per school led to increase in internalising scores by 0.05%, while another 31 found that suspensions were not associated with internalising problems.
No verbal reprimand or mixed strategy studies reported this outcome.
• Externalising symptoms A single study found that in schools which suspended proportionally more Black pupils than White pupils, Black pupils overall showed higher externalising symptoms 29 .
No verbal reprimand or mixed strategy studies reported this outcome.

Effect of disciplinary strategies on pupil social and behavioural outcomes i. School Suspension Strategies
Three studies 31,37,42 found suspension was associated with poorer (more disruptive, less pro-social) behaviour.
Two studies found suspensions were associated with lower perception of social belonging at school 29,37 .
School-level Black-White suspension gaps (i.e., excess risk of out-of-school suspension among Black students relative to White students,) were associated with Black students' perceptions of less school equity in a single study 29 .
A single study 35 found suspensions led to greater marijuana use but had no association with tobacco or alcohol use.A single study 41 found no association between out-of-school suspension and self-esteem.
ii. Verbal reprimand strategies A single study (Roache) found that aggressive verbal punishments from teachers led to increased disruptive behaviour in the classroom (r=0.48,p<0.05), being more distracted from class work (r=0.72,p<0.05), and reduced pupil interest in the subject being taught (r=-0.58,p<0.05).
No studies in this category reported social outcomes.

iii. Mixed strategies
No studies of mixed strategies reported social outcomes.
Effect of disciplinary strategies on academic outcomes i. School Suspension Strategies Of the three studies assessing educational outcomes, one comprehensively reported data and 35 found no link between suspension and grade scores.This effect remained non-significant (although direction was opposite) after adjusting for demographic factors including ethnicity.One study 39 did not report data on the effect of suspension on grades, and the other 42 said they found lower scores on a composite of academic performance habits and skills but did not report data to support this finding. ii.
Verbal reprimand strategies Piekars et al. 36 found that verbal punishments from teachers caused school stress which negatively impacted academic performance as grade point average. iii.
Mixed strategies While Chen et al. (2021) reported no direct effect of greater punishment on long-term educational attainment, they did find that for children who were not academically oriented, greater punishment was associated with lower educational attainment.This study included only Black American pupils.

Summary of findings
Our review illustrates that evidence on the impact of disciplinary strategies in schools is scarce and of low quality.Although at high risk of bias, five out of seven studies assessing depressive symptomatology found it to be associated with exposure to disciplinary strategies.All three studies on general mental wellbeing found it to be associated with exposure to disciplinary strategies.Single studies on anxiety, psychiatric disorder diagnosis, and externalising symptoms also found that disciplinary strategies were associated with these issues.Internalising symptoms, and a similar link with externalising symptoms, were only seen in one of the two studies to be associated with a disciplinary approach.Similar effect was seen with social outcomes where, overall, disciplinary strategies were associated with poor social behaviour (n=4), lower school belonging (n=2), and greater marijuana use (n=1), but had no association with tobacco use or self-esteem (n=1).Evidence of the impact on educational attainment was limited and it was not clear how they were related to disciplinary strategies.A recent qualitative synthesis has found some evidence of a link between punitive disciplinary strategies and poor academic outcomes 45 .

Comparison to other systematic reviews
While there are reviews on suspensions and exclusions as outcomes 2,46 , we did not find any that examine the mental health or wellbeing impact of these strategies.We found one systematic review reporting that pupils experiencing exclusionary discipline were more likely to have subsequent contact with the justice system 47 .To our knowledge, our systematic review is the first to question the impact of these strategies on mental wellbeing of school children.Considering the increasing levels of mental health problems in young people in the UK 48 it is important to assess these strategies for their potential impact on these outcomes which are important to pupils, their families and society.
Most of the evidence available was on suspensions.Suspensions have been rising in recent years in the UK, with the main reason for suspensions being disruptive behaviour 49 .
Our review shows that suspensions can potentially increase disruptive behaviour, thus creating a vicious cycle of increase in both.
Although not the main focus of our review, we did see across three studies that children of Black, Asian, and Minority Ethnicities (BAME) origin were often at higher risk of disciplinary actions from teachers.This is in line with recent findings from both USA 50 and the UK 49 , indicating that the interaction of race and adverse childhood experiences predispose students of colour to be subject to school discipline.Future research should explore these links, and schools should consider these potential equality risks when implementing disciplinary strategies.Governments place importance on the safeguarding of all pupils' wellbeing in their expectations from teachers 51,52 .Our review suggests that currently approved strategies can negatively impact student wellbeing, which can make it hard for teachers to fulfil these expectations.This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing.There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behaviours in schools 53,54 that are less likely to negatively impact pupil wellbeing.

Limitations of our review
We followed PRISMA standards when reporting the review and searched comprehensively using relevant scientific databases and grey literature sources.We were inclusive in our criteria for studies to allow us to examine the full range of effects of these commonly used strategies.Considering how widespread their use is, the empirical evidence on these strategies is limited for wellbeing, behaviour or academic outcomes.We found no studies from grey literature.Some of the databases we searched would have contained certain types of grey literature (e.g.conference abstracts, theses and dissertations).However, had we searched repositories of grey literature (e.g.OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc.It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources.
Included studies were at high risk of bias in most domains.This is a major limitation of our findings.There is a need for better quality research to address these questions.
We searched for, and included studies that reported at least one primary (mental wellbeing) outcome.Our restriction to primary outcome reporting has likely overlooked evidence on educational and behavioural outcomes reported in studies without a focus on general mental wellbeing.Thus, our findings on these outcomes are likely not to be comprehensive, although they may be indicative of the general trend.This review included studies conducted only in mainstream schools and therefore the findings do not extend to other settings.However, when screening the literature, there were studies that focused on specialist schools or exclusively including pupils with additional learning needs (e.g., attention deficit hyperactivity disorder) and these should be assessed in a separate review.
We included all author definitions for strategies (e.g., suspension or temporary exclusion could be anything from a few hours to several days, and may or may not include supervised confinement to a room or location in school) to not miss any relevant evidence.There is however a lack of clear definitions and descriptions for any of the disciplinary strategies.Thus, there is a need to clearly define these interventions and their proposed impact before research on these can give clear conclusion on their relative impacts.For example, UK defines suspensions as any fixed time exclusion between one school period (length of a lesson varies from 30 minutes to 120 minutes) and 45 school days 49 .This definition may be different from those used in other nations.This would invariably also be reflected in studies from different countries.We would anticipate that the effect of a 45-minute isolation may be different from that of a week-long or monthlong suspension.A differential or dose response effect may only be elicited if the definitions used in each study are clear.

Conclusions
Existing evidence indicates that disciplinary behaviour strategies might lead to poorer mental wellbeing and behaviours for pupils.There is some evidence to suggest these strategies may also inadvertently increase inequalities.However, the limitations of quality and size of the evidence precludes clear conclusions.This means schools, and decision makers within educational systems, need to be cautious when adopting and advocating these strategies until better evidence on these is available.It would also be advantageous for schools to share data on disciplinary strategies and pupil health outcomes with research teams to facilitate a deeper level of exploration.
There is a need to assess wellbeing, social and academic effects of these disciplinary strategies (and other strategies) ideally in robustly designed trials comparing school clusters with different strategies in place.These trials (natural experiments) should be complemented with qualitative exploration of pupil perceptions of these strategies and their outcomes in various contexts.There are county-wide surveys and school-based surveys in the UK that routinely measure the health and wellbeing of pupils.These data could be compared to respective school level suspension rates and other disciplinary strategies (e.g., isolation/isolation rooms).As these wellbeing surveys are repeated annually, we should also be able to see trends of wellbeing over time, as well as the potential impacts of changing national or regional disciplinary policies on these outcomes at school level.Follow up data should also be gathered beyond the school period (into adulthood) as disciplinary strategies may have long term consequences 30,47 .
Disciplinary strategies aimed at improving behaviour at school may have negative effects on the pupil mental wellbeing as well as school behaviour.These are important consequences and should be assessed in better designed studies before these strategies can be recommended.

Extended data
Open Science Framework: Behaviour management in schools review https://doi.org/10.17605/OSF.IO/AJHGR 25 This project contains the following extended data: • Supplementary data file-BMS review.docx Reporting guidelines PRISMA checklist and flowchart for 'Disciplinary behaviour management strategies in schools and their impact on student psychosocial outcomes: A systematic review'.https://doi.org/10.17605/OSF.IO/AJHGR 25 impact, and concerns regarding unintended impact.
Researchers singled out psychosocial outcomes as a focus and conducted a systematic review to examine the impact of behaviour management on these outcomes.The question, in lay English was: How does school discipline affect pupil mental health and wellbeing?
The introduction provided a good explanation of punitive approaches to school discipline, and alternative approaches (e.g.trauma informed, restorative, collaborative problem solving, etc.).The concern, that disciplinary strategies in school could be negatively impacting pupils' mental health, was raised in by young people within a consultation meeting in Bristol.
Methods: The review was developed with input from young people -this involvement is described briefly in the public involvement section.It would be good to know whether this involvement was evaluated at all.The review had two secondary objectives: to assess whether the potential negative effects differed between different SES groups, and to see whether there was any evidence of the strategies positively impacting behaviour or academic outcomes.The focus are disciplinary measures of most concern was guided by young people -punitive measures, stopping short of permanent exclusion or expulsion.The review was limited to UK and OECD countries -justification that this does not include corporal punishment or other forms of restraint, which is reasonable.The population was young people aged 11 to 16, and the context mainstream school (not specialist schools).Primary outcomes -any measures of mental health and wellbeing.Secondary outcomes -academic and social outcomes.
The search involved an information specialist and is well described.Grey literature was sought through targeted emails (via a network) -given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy?The process and conduct of the systematic review was as according to best practice.A narrative synthesis of the findings was the only thing possible, given the quality and type of data.
In the description of included studies, the numbers don't add up.The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland.That makes 15.I counted 9 from USA in table 1.What was the 10th?
The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'.I'm wondering how this study fits the inclusion criteria?

Discussion
Evidence on the effects of school disciplinary strategies is scarce and of low quality.
There are caveats associated with the low quality evidence, but findings suggest a link between punitive disciplinary strategies and pupil mental health and wellbeing, and also social outcomes (social behaviour).Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess?-have other reviews looked at this?).I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all.The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing.This could have usefully been followed up with a short discussion of what this might include.

Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes
Are sufficient details of the methods and analysis provided to allow replication by others?Yes

Is the statistical analysis and its interpretation appropriate? Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?Yes Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Health services and public health research focusing on social determinants of health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
Author Response 10 May 2024

Sharea Ijaz
Thank you for your generous comments on and appreciation of our work.We have listed the queries in your review below and have responded to each.
The review was developed with input from young people -this involvement is described briefly in the public involvement section.It would be good to know whether this involvement was evaluated at all.

○
The PPI for this project was not itself evaluated.However, some of the young PPI members have remained involved as stakeholders throughout the project and we presented our findings to them before finalizing this paper.Some of the young PPI members also became peer interviewers for the second part of the project, which is a qualitative study of pupil experience, and their experience as peer interviewers was evaluated qualitatively and this second part is currently being drafted as another paper: https://arc-w.nihr.ac.uk/research/projects/how-does-school-discipline-affectpupil-mental-health-and-wellbeing/Grey literature was sought through targeted emails (via a network) -given none was found, it would be useful to reflect on whether the authors might have missed any grey literature that they might have found via another strategy?The process and conduct of the systematic review was as according to best practice.A narrative synthesis of the findings was the only thing possible, given the quality and type of data.

○
We used a pragmatic approach to find relevant literature in a field that has limited evidence.
We have added the below text to acknowledge the limitation of our grey search: We found no studies from grey literature.Some of the databases we searched would have contained certain types of grey literature (e.g.conference abstracts, theses and dissertations).However, had we searched repositories of grey literature (e.g.OpenGrey or Overton (policy documents)), or the websites of international and regional education authorities, and government departments associated with our topic, we may have identified additional research published as monographs, reports, policy documents etc.It was difficult to translate our detailed search across to these grey literature sources, and we thought it more practical to talk to experts considering our limited resources.
In the description of included studies, the numbers don't add up.

Nicholas A Gage
Special Education Policy and Practice, WestEd, San Francisco, California, USA Thank you for the opportunity to review, Disciplinary behavior management strategies in schools and their impact on student psychosocial outcomes: A systematic review.This systematic review provides insights about the limited research and support for punitive disciplinary approaches in school.Overall, the manuscript is clearly written and the OSF materials provide more detail about the review.That being said, I do have a few concerns.First, at the start of the methods section, the authors note that they focus on secondary schools.There is no mention of secondary schools in the introduction/literature review.Consider noting differences between elementary and secondary school and discipline to justify why the study focuses on secondary schools.Second, there is not enough information or justification for why a meta-analysis was not conducted.I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed.In fact, a quantitative synthesis would be very helpful to better understand the results.Essentially, if the authors want to not provide a meta-analysis, a stronger rationale needs to be provided in the manuscript.Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity.Consider revising with clearer language and reasons.
Are the rationale for, and objectives of, the Systematic Review clearly stated?Yes Are sufficient details of the methods and analysis provided to allow replication by others?not conducted.I understand that a number of outcome domains have only one study, but as an example, there are five studies focused on suspensions and depression that could be meta-analyzed.In fact, a quantitative synthesis would be very helpful to better understand the results.Essentially, if the authors want to not provide a meta-analysis, a stronger rationale needs to be provided in the manuscript.A meta-analysis was not conducted for the outcome of depression for suspensions as the 5 studies were very heterogeneous in not just populations (one study with 75% Black pupils, one study's data from 1996), follow up times (no follow up in two studies, 1 year in two and 3 year in one study), outcome measures (dichotomous in 3 studies, continuous in 2) effect measures (odds ratios in 3 and regression coefficients in 2), comparisons (unspecified in three studies) but also study designs (one-time survey in two studies, repeated survey in two studies, and one controlled before-after study) and analyses (adjustment for confounders and numbers of analysed participants unclear in 3 studies).We found the same for mixed strategies for depression outcome where the two studies (Chen 2021; Eyllon 2022) were very heterogeneous in study sample, follow up, and effect size.We believe that pooling these disparate data from high risk of bias studies would not have changed our conclusions and recommendations but presented as a forest plot may give a false sense of validity to reader.
We have now edited the text to explain our choice in our synthesis methods:

We planned for a random effects meta-analysis if combinable data were available. However, a meta-analysis was not conducted as the studies were highly heterogeneous across populations, comparisons, follow up times, outcome measures, effect measures, and notably, study designs. The analyses presented were often unadjusted with numbers of analysed participants unclear. A narrative synthesis was therefore performed. Pooling these disparate data from high risk of bias studies in a meta-analysis would not have changed our conclusions and recommendations.
Lastly, I found the exclusion reasons in the PRISMA figure to be lacking specificity.Consider revising with clearer language and reasons.

○
We had carried out screening of title/abstract and full texts in Rayyan and used these inbuilt labels in the platform to exclude and include studies.We have now revised the description in PRISMA to be more specific about the reasons.
Competing Interests: No competing interests were disclosed.

Figure 1 .
Figure 1.PRISMA Flow diagram of review process.

Figure 2 .
Figure 2. Risk of bias in included studies in the review.

you for spotting this. We are sorry for the error and have now corrected it: 9 studies from USA, 2 each from UK and Australia and 1 from Poland, equalling 14 in total
The paper states there are 14 studies in total: 10 from US, 2 from Australia and the UK (it's 2 from each, but this isn't very clear from the text), and 1 from Poland.That makes 15.I counted 9 from USA in table1.What was the 10th?
○Thank .The study from Poland was in a primary school setting and the age of pupils is stated as 'not reported'.I'm wondering how this study fits the inclusion criteria?○Thiswas an oversight from us.

Thanks for pointing this out. "Primary school" in Poland lasts eight years (grades 1-8, starting at age 6 or 7 and lasting until 14-15). This overlaps with primary and secondary school age in the UK. This specific study included 13-14-year-old students, which is compatible with secondary school age in the UK. We have now corrected and clarified this in the table
.Evidence of impact on educational attainment is limited (though that wasn't the focus of this review I guess?-have other reviews looked at this?).○You

are correct that this was a secondary outcome and not a focus of our review. In addition, the included study evidence was of very limited size and quality, so we did not expand on this. Within our search we found two reviews on educational attainment outcome although they did not study our interventions of interest: Craggs H, Kelly C. Adolescents' experiences of school belonging: A qualitative meta-synthesis. Journal of Youth Studies. 2018;21(10):1411-25. https://www.tandfonline.com/doi/full/10.1080/13676261.2018.1477125 1. Lee A, Gage NA. Updating and expanding systematic reviews and meta-analyses on the effects of school-wide positive behavior interventions and supports. Psychology in the Schools. 2020;57(5):783-804. https://onlinelibrary.wiley.com/doi/abs/10.1002/pits.22336 2. We found the following review outside of our search that included some evidence of link between academic outcomes and punitive disciplinary strategies: Duarte CD, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences
literature.Ann N Y Acad Sci.2023 Jan;1519(1):129-152. doi: 10.1111/nyas.14922.PMID: 36385456; https://pubmed.ncbi.nlm.nih.

gov/36385456/ We have now added a sentence to expand on the evidence in reference to this review.
I found it a bit disappointing that the discussion didn't go into alternative disciplinary measures at all.The section ends: This can be remedied by enabling teachers use of evidence-based interventions that can reliably support pupil wellbeing.This could have usefully been followed up with a short discussion of what this might include. ○We

have now added a sentence to indicate what these alternative strategies may be and that these can be useful: There is growing evidence on trauma informed and restorative approaches for improving and managing disruptive behavior's in schools[52, 53] that are less likely to negatively impact pupil wellbeing. Competing Interests:
No competing interests were disclosed.
Reviewer Report 25 April 2024 https://doi.org/10.3310/nihropenres.14722.r31518© 2024 Gage N.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.