Social violence has steadily increased in the world and has also emerged in children and youth. It is estimated that around the world every day, 227 children and adolescents (aged 0~19 years) die due to violence, and many more are injured [1]. Violence has an adverse effect on both the perpetrators and victims, impacting children's physical, mental and psychosocial development [2]. Violence in schools threatens students' need for security [3], draws them away and diminishes their desire to attend school [4], while bullying in school can create a setting for substance abuse and other emotional and behavioral problems [5].

Bullying, defined as an individual's use of repeated physical and mental violence against another defenseless individual [6], is widely witnessed even in four year-olds and is accompanied by behavioral problems related to the state of either being a bully or a bully-victim, and leads to somatic and peer issues [7].

Violence and bullying experienced in childhood continue to have an effect in adulthood. A review of articles published during 1960~2015, which examine the effects of childhood bullying in adulthood, revealed that victims were at risk of developing internalizing disorders; bullies were at a risk of developing externalizing disorders, engaging in violent crimes, and illicit drug misuse; and bully-victims were at risk of experiencing all these problems [8].

Some studies indicate that bullying leads to criminal acts in adulthood, psychiatric problems [9, 10, 11], substance abuse [5, 12], and a continuation of bullying habits at the workplace [13]. Furthermore, victims of bullying have been known to experience loneliness, low self-esteem, psychosomatic symptoms, depression, suicidal thoughts, suicide attempts as well as to suffer from borderline personality disorders. Owing to these reasons, it is important to identify and resolve issues of violence in early childhood to ensure lifelong good health of children and everyone they come into contact with.

Studies have shown that children who engage in violent behavior exhibit inadequacy in social skills [14, 15], have poor interpersonal relations; are unable to empathize with others [16, 17] or control their negative emotions [18]. Inadequacy in social skills increases children's risk of being exposed to bullying [19, 20] and exhibiting aggression or emotional reactions [21], while developing favorable social relations and effective problem-solving skills help them to avoid becoming peer victims [21, 22, 23]. A meta-analysis of 153 studies has indicated that a child's lack of competence in problem-solving and a negative attitude towards self or others, are primary factors in becoming a bully, a victim or a bully-victim [24]. Social development programs have been found to reduce violent behavior in children [25, 26, 27].

The initial six years of life constitute a critical period in which the child's first experiences of cognitive, behavioral, and emotional integration, as well as social development gain momentum. Positive communication, empathy, problem-solving and emotional control skills gained in early childhood are elements that shape a child's later years [28, 29, 30]. Besides learning the skills of agreement, compromise, loyalty, and cooperation, the child also learns to develop negative attitudes of disagreeableness, conflict, and confrontation in the family and school settings [31]. Inconsistent, oppressive, authoritarian, punitive, and indifferent parental attitudes set the scene for family violence and support a tendency toward violence among children in such families [32]. The negative attitudes of teachers can also have similar effects [33]. Hence, efforts to develop a child's social skills need the combined cooperation of families, teachers, and school nurses.

School nurses can conduct effective training programs that consider children's individual, familial, and environmental risk factors [34], and thereby contribute to developing children's skills in empathy, problem-solving, and emotional control. These skills not only improve children's self-esteem and reduce their aggressive reactions but also make use of effective communication methods to lower the chances of them becoming the targets of their aggressive peers. Educational programs for pre-school children should make use of techniques that provide children the opportunity to learn while doing and experiencing, and support children in all areas of development, while providing them with an environment to learn through repetition and active use of all their senses [35]. In this context, Gardner's Theory of Multiple Intelligences has the potential of providing a strong foundation for social skill development programs [36].

At 60~72 months, children are at the end of the pre-school period; and at the start of the schooling period that is one of the most critical stages in a child's development. At the age of six, children begin to display signs of the negative attitudes they had displayed at the age of two and a half, and once again face the difficulties of making decisions as when they were two and a half years, and waver between the positive and negative sides of an issue. In this period, children are unstable, defy rules, and display rebellious attitudes and behaviors [25, 31]. It was in this context that this study, addressing both children and parents, aimed at determining the effect of a social skills development program based on Gardner's theory of multiple intelligences on violent behavior in children.

No differences were found between the experimental and control groups in terms of the children's ages, gender, full-day or half-day school attendance, previous attendance in pre-school, their parents' ages, educational levels, employment status, the number of children in the family, and the parents' attitudes toward their children (p>.050) (Table 2).

Table 2
Characteristics of Children and Parents

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While there was no significant difference between the SSAS subscale and overall scores of the experimental and control group children in the first measurement, there were significant differences between all the scores in the subscales other than in the SCS subscale in the second measurement, and between all the subscale and overall scores in favor of the experimental group in the third measurement (p<.050) (Table 3).

Table 3
Comparison of Children's SSAS Measurements by Time

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The scores of both the experimental and control group children showed a rise in the SSAS subscales and total scores at the second and third measurements, and this difference was supported in the statistical analysis. The advanced analysis revealed that the difference stemmed from the fact that the first measurement score of the experimental group was lower than the others and that the third measurement score of the control group was higher than the others (p<.050) (Table 3).

While there was no difference in mean scores of the experimental and control groups for violent behavior in the first month of observation (p=.992), the mean score of the experimental group in the sixth month was significantly lower than that of the control group (p=.030). It was found that the mean scores for violent behavior in the sixth month of both the experimental and control groups were significantly lower than the first month mean scores (p=.001 and p=.002 for the experimental and control groups, respectively) (Table 4).

Table 4
Comparison of the Mean Number of Children in the Experimental and Control Groups Exhibiting Violent Behavior in1^st Month and 6^th Month

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All the experimental group children's parents stated that they had observed examples of positive behavior in their children, while 58.3% of them said that their child had learned anger control. The parents expressed the change in their children as, “He used to get angry for no reason, yell, be stubborn, but now he counts to himself (9 children), draws (6 children), takes a deep breath to relax, and even teaches us how we can relax when we get angry (5 children).”

In addition to describing the changes in their children, the mothers of the experimental group explained the change in themselves as being able to listen more effectively, empathizing with their child, acting consistently when applying rules, giving explanations before dealing out punishment, applying a time-out instead of immediately reprimanding the child, and engaging in more activities with their child. It was interesting to note that the parents of the control group children largely provided examples of their children's behavior in terms of the child's communications, sharing abilities, manual skills, and self-care skills, but did not mention anything about behavior related to anger and violence. The control group parents did not mention any change of behavior in themselves after their children had started school.

The significantly higher SSAS total and subscale scores of the experimental group children compared to the control group in the second and third measurements (Table 3) showed that the program implemented had a positive effect on the children in terms of social skill development (i.e., interpersonal relations, anger control and adapting to change, coping with peer pressure, listening skills). This finding confirmed the first and second hypotheses. It is believed that the fact that the program's topics were based on Gardner's theory of multiple intelligences and were conducted with activities directed at eight domains of intelligence increased the program's effectiveness. Various other studies on the subject have also shown that social skills programs planned for pre-school children have concentrated on themes such as social skills [29], interpersonal problem-solving [46], empathy [47], communication [48], through which the children's skills have been enhanced [28]. The study's results were similar to that of other previous studies.

An examination of the SSAS scores of the experimental and control group children over time revealed that the experimental group children showed significant increases at the second and third measurements, while the control group children at the third measurement, and the increases were greater in the experimental group (Table 3). The development of social skills in the experimental group children started earlier and was at a higher level, which indicated that the program that had been implemented was more effective. Also, these findings suggested that the effect of the program continued even after three months in the children's behavior. The SSAS scores of the control group children showing a significant rise at the third measurement, indicates that the pre-school education programs implemented by the teachers did in fact support the development of the children's social skills. Other studies on the subject have also reported that pre-school education contributes to a child's social skills development [49], and to the development of reading and writing skills, self-care, problem-solving, motor, social, emotional, and language skills [50].

While there was no difference in mean scores of the experimental and control groups for violent behavior in the first month of observation (p=.992), the experimental group's mean score in the sixth month was significantly lower than that of the control group (p=.030). It was found that the mean scores for violent behavior in the sixth month of both the experimental and control groups were significantly lower than the first month's mean scores (p=.001 for experimental group, p=.002 for control group) (Table 4). The finding showed the effectiveness of the program and confirmed the third and fourth hypotheses. Similarly, previous studies also reported that social skill development plays an important role in preventing and reducing aggression in children [15, 25, 26, 27, 29]. The findings of these studies indicated that rather than developing general social skills, developing skills in specific areas such as interpersonal communications, communicative problem-solving, and anger control is more effective in preventing aggression.

The examples of positive behavior that the mothers of the experimental group observed in their children relating to anger management, problem-solving, sharing, polite communication, etc., supported the scores on the scale. It was seen that even after the conclusion of the program of education, the experimental group parents listened to their children more effectively, took care to use the “I message” when speaking with their children, tried to empathize, said they had learned to be more patient and consistent when applying rules, and had stopped comparing their children with others. These findings were supported by the statements that parents made about the changes they observed in their children and in themselves. The group discussions held with the parents and the case histories presented during the training had been effective in eliciting a positive change, thus showing that parents' participation in education as a means of contributing to the development of a child's social skills is of vital importance.

Being aggressive/bullying, being a victim, or a bully-victim affects children not only in the present moment but also has an impact on their future bio-psycho-social health and leaves an imprint on their entire life. Since childhood aggression is likely to continue into adulthood, this has the potential of increasing the number of aggressive individuals in society. Aggression leads to various psychological issues both in the aggressor/bully and in their victims, and this paves the way for more serious issues such as substance abuse and stealing, which in turn increase the severity of related problems. Hence, it is vitally important to reduce children's tendencies toward aggression by encouraging them to develop social skills starting from an early age.

The developing social skills program implemented in this study was found to reduce violent behavior, which proves that this model can be used in early childhood to prevent aggression from becoming a permanent behavior. The program's simplicity and its entertaining, goal-oriented, and easily implemented activities will not only help children to learn while having fun but will also require minimum effort on the part of teachers and school nurses.