Anger coping intervention for aggressive children: Conceptual models and outcome effects

Effectiveness of Community-Based Programs on Aggressive Behavior Among Children and Adolescents: A Systematic Review and Meta-Analysis

Adolescent aggressive behavior has increasingly become a central issue affecting the safety of both school campuses and the broader society. Despite the existence of numerous community interventions targeting this issue, there has been a paucity of efforts to consolidate the findings on the effectiveness of community-based programs in preventing aggressive behavior. This meta-analysis sought to address this gap by reviewing and assessing the impact of community-based initiatives on reducing adolescent aggression. A thorough search was carried out on 12 electronic databases: EBSCO, ERIC, PubMed, PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Theses, the China National Knowledge, Wanfang Databases, and China Science and Technology Journal Database. Sixteen studies were finalized, and meta-analyses were performed using a random effect model on RevMan v5.4 software developed by Cochrane. The analysis encompassed 16 published studies, involving a total of 2,585 participants. The key components of existing programs for aggression reduction included providing behavioral skills and training for adolescents, employing a problem-solving approach to address behavioral issues, offering psychological treatment, and emphasizing community supervision. The results indicate a significant positive effect of community-based interventions on aggression reduction (standardized mean difference = -0.26, 95% confidence intervals [-0.39, -0.13], Z = 3.84, p < .001). The subgroup analyses revealed that the intervention's effectiveness was moderated by the duration of the intervention, its theoretical foundation, and the sample size. This study furnishes empirical evidence supporting the enhancement of policies and practices to foster community engagement in mitigating aggressive behavior.

Evidence-based psychosocial treatments of conduct problems in children and adolescents: an overview

The aims of the present study were to identify empirically supported psychosocial intervention programs for young people with conduct problems and to evaluate the underpinnings, techniques and outcomes of these treatments. We analyzed reviews and meta-analyses published between 1982 and 2016 concerning psychosocial intervention programs for children aged 3 to 12 years with conduct problems. Parent training should be considered the first-line approach to dealing with young children, whereas cognitive-behavioral approaches have a greater effect on older youths. Family interventions have shown greater efficacy in older youths, whereas multi-component and multimodal treatment approaches have yielded moderate effects in both childhood and adolescence. Some limitations were found, especially regarding the evaluation of effects. To date, no single program has emerged as the best. However, it emerges that the choice of intervention should be age-specific and should take into account developmental differences in cognitive, behavioral, affective and communicative abilities.

Coping power for preschool-aged children: a pilot randomized control trial study

AIM

Preschoolers with behavioural difficulties, both at clinical and sub-clinical levels, are at higher risk for several negative outcomes. The current paper reports the results from a randomized clinical trial evaluating an adaptation of the Coping Power for preschool-aged children. In the present study, Coping Power is adapted as a universal prevention intervention, in which teachers deliver a curriculum that is designed to improve children's social competence and reduce problem behaviours.

METHODS

Ten nursery school classes (164 children, mean age 54.40 months) from two Italian schools were randomly assigned to Coping Power or to the control group, which received the standard academic curriculum provided in Italian nursery schools. Teachers in the five intervention classes implemented weekly lessons and extension activities over a 6-month period. Teacher and parent reports of child behaviour assessments were collected at the beginning and end of the school year. At each assessment period, teachers completed the Strengths and Difficulties Questionnaire.

RESULTS

The findings suggest that after exposure to Coping Power, intervention children showed lower levels of behavioural difficulties, rated both by parents and teachers.

CONCLUSIONS

The results of this study are promising and can be interpreted as providing initial support for the efficacy of the preschool version of Coping Power.

An Exploratory Study of Member Attraction, Climate, and Behavioral Outcomes of Anger-Coping Group Therapy for Children with Emotional Disturbance

This exploratory study examined member attraction, group climate, and behavioral outcomes of anger-coping group therapy with children in an urban school. Two facilitators co-led a 6-week cognitive-behavioral group intervention with five children who were identified with either emotional disturbance (ED) or exhibited difficulty with anger management. Pretest and posttest ratings on the Behavioral Assessment System for Children (BASC) were gathered from children, parents, and teachers. Children also completed the Group Attitude Scale (GAS) after the first, middle, and last group session. All group sessions were videotaped, and three independent observers viewed the tapes and completed the Group Climate Questionnaire–Short Form (GCQ-S) following each session. Results indicated that the children formed a cohesive, healthy functioning group. Parents indicated significant improvement in children's behavior on the BASC, although teachers and children did not note these changes. Clinical implications for interventions for children with ED and directions for future research are discussed

Doing Anger Differently: A Group Percussion Therapy for Angry Adolescent Boys

This paper describes Doing Anger Differently (DAD), a group treatment for young adolescent boys with high levels of anger. The approach is school-based, 10 weeks long, and utilizes music in the form of percussion to engage this difficult to treat population into treatment and to represent the experience of anger. A tri-level intervention is described: the experience of anger and its influence on action; the formation of meaning and identity resulting from anger and aggression; and the emphasis on group work and the interpersonal basis of anger. Techniques used throughout the group are discussed and illustrative case vignettes are provided.

The role of anxiety in the development, maintenance, and treatment of childhood aggression

The majority of aggressive children exhibit symptoms of anxiety, yet none of our developmental models of aggression incorporate the role of anxiety, and our treatments ignore this comorbidity. This article outlines a novel theoretical model that specifies three hypotheses about comorbid anxious and aggressive children: (a) unpredictable parenting induces anxiety in children that in turn triggers aggressive behavior; (b) prolonged periods of anxiety deplete children's capacity to inhibit impulses and trigger bouts of aggression, and aggression in turn functions to regulate levels of anxiety; and (c) minor daily stressors give rise to anxiety while cognitive perseveration maintains anxious moods, increasingly disposing children to aggress. Little or no research has directly tested these hypotheses. Extant research and theory consistent with these claims are herein reviewed, and future research designs that can test them specifically are suggested. The clinical implications most relevant to the hypotheses are discussed, and to improve the efficacy of treatments for childhood aggression, it is proposed that anxiety may need to be the primary target of treatment.

Development of the Juvenile Justice Anger Management Treatment for Girls

Female juvenile offenders exhibit high levels of anger, relational aggression, and physical aggression, but the population has long been ignored in research and practice. No anger management treatments have been developed specifically for this population, and no established anger management treatments are empirically supported for use with delinquent girls. Thus, to alleviate anger and reduce the frequency and severity of aggressive behaviors in this underserved population, we developed the gender-specific, Juvenile Justice Anger Management (JJAM) Treatment for Girls. This cognitive-behavioral intervention was adapted from the Coping Power Program (Lochman & Wells, 2002), a school-based anger management treatment for younger children that has established efficacy and effectiveness findings with its target populations. This paper describes how the content of JJAM was developed to meet the unique needs of adolescent girls in residential juvenile justice placements. It also traces the process of developing a manualized treatment and the steps taken to enhance efficacy and clinical utility. An overview of the treatment, a session-by-session outline, an example session activity, and an example homework assignment are provided. A randomized controlled trial is currently being conducted to evaluate the efficacy of the JJAM Treatment for Girls.

Children's sympathy for peers who are the targets of peer aggression

Although a goal of many aggression intervention programs is to increase children's concern (often termed sympathy or empathy) for their peers as a means of ultimately reducing aggressive behavior, there are no measures specifically of children's concern for peers who are the targets of peer aggression. A participatory action research (PAR) model was used to create a culturally-sensitive measure of urban African American children's sympathy for peers who are the targets of physical aggression, relational or social aggression, verbal aggression, and property damage. In Study 1, 40 children (M (age) = 9.71 years; 47.5 % female) were interviewed about the types of incidents that lead them to feel sympathy for a peer. Based upon these findings, the 15-item Peer Sympathy Scale (PSS) was developed. In Study 2, the PSS was administered to 517 children (M (age) = 9.82 years; 47.4 % female) to examine the psychometric properties of the measure and to explore the association between children's sympathy for their peers and their social behavior. Greater sympathy was associated with less overt and relational aggression according to both peer and teacher reports as well as with less oppositional-defiant behavior according to teacher reports. The clinical utility of the PSS as an outcome assessment tool for social skills intervention programs is discussed.

Gender differences in the assessment, stability, and correlates to bullying roles in middle school children

The current study investigated bullying behaviors in 284 school children in the fourth through seventh grades at the time of the initial assessment. Peer ratings of bullying behavior were obtained at the end of the spring semester of one school year and at the end of the fall semester of the next school year. Importantly, peer ratings were obtained by assessing not only the level at which participants actually bully other students but also whether participants help bullies to hurt the victim (assister), encourage bullies (reinforce), or help the victim of bullying (defender). Our results did not support the utility of differentiating between bullies, assisters, or reinforcers. Specifically, these bullying roles were highly intercorrelated, both concurrently and across school years, and they showed similar correlations with aggression and several characteristics often associated with aggression (i.e., conduct problems, callous-unemotional traits, and positive expectancies about aggression). In contrast, ratings of defending designated a particularly prosocial group of students. Finally, whereas bullying appeared to be very similar in boys and girls, it was somewhat more stable across school years and was related to lower levels of prosocial behavior in boys, both of which could suggest that bullying may be somewhat more related to social group dynamics in girls.

Stability and Change in Patterns of Peer Rejection

Poor school adjustment is a known correlate of peer rejection in childhood. However, the impact of change in sociometric status on children's academic performance over time is unclear. The aim of this study was to determine whether improvement or decline in children's sociometric status would predict corresponding changes in their academic performance trajectories. Two hundred and seventy-two boys and 252 girls in Florence, Italy (mean age at Time 1: 7.42 years) and their teachers participated in this 18-month investigation. Hierarchical linear models indicated that children who were rejected by their peers across the four measurement points of the study demonstrated consistently worse academic performance than did children who were not rejected throughout, whereas children who were regularly accepted by their peers performed better in school than did their peers who were rejected one or more times. A number of children who became rejected exhibited an academic decline, but others who became accepted showed improvement. The implications of these results for children, parents, teachers and school administrators are discussed.

Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features

This paper presents a few perspectives on oppositional defiant disorder (ODD), conduct disorder (CD), and early forms of psychopathy. The developmental changes and stability of each, and the interrelationship between the three conditions are reviewed, and correlates and predictors are highlighted. The paper also examines effective interventions for each of the three conditions and makes recommendations for future research.

Errorless Priming

Reactive aggressive children experience social encoding and interpretation difficulties. Such deficits increase the likelihood that reactive aggressive children perceive the actions of others as provocative and respond in an aggressive manner. Errorless priming was developed as a proactive and success-focused treatment for an 8-year-old boy demonstrating severe reactive aggression (RA). Observations of the child revealed several antecedents that immediately preceded his aggression. This information enabled prediction of aggressive outbursts and development of an intervention that involved providing the child with preparatory information (i.e., priming statements) to moderate his reaction to upcoming stressors. As is characteristic of errorless approaches, a graduated hierarchy was used to systematically fade priming statements. Following treatment, the child was able to tolerate, without problem behavior, antecedent conditions that he found challenging prior to treatment. Errorless priming may have broad potential as a brief and time-efficient intervention for RA.

The Adolescent Coping Process Interview: measuring temporal and affective components of adolescent responses to peer stress

The way in which adolescents cope with stressors in their lives has been established as an important correlate of adjustment. While most theoretical models of coping entail unfolding transactions between coping strategies and emotional arousal, the majority of coping measures tap only trait-level coping styles, ignoring both temporal and affective components of the coping process. The current study fills this gap by establishing the psychometric properties of a newly developed measure, the Adolescent Coping Process Interview (ACPI), that is more in line with transactional and developmental models of coping. Results indicate that the ACPI displays good psychometric properties, captures significant intra-individual variability in coping over the process, and points to emotional arousal as informing several coping-adjustment relationships. Moreover, the ACPI and similar approaches may help promote the development of more adaptive patterns of coping in adolescents by helping to identify specific points within the coping process at which to intervene.

Proximal peer-level effects of a small-group selected prevention on aggression in elementary school children: an investigation of the peer contagion hypothesis

Examined peer contagion in small group, selected prevention programming over one school year. Participants were boys and girls in grades 3 (46 groups, 285 students) and 6 (36 groups, 219 students) attending school in low-resource, inner city communities or moderate resource urban communities. Three-level hierarchical linear modeling (observations within individuals within groups) indicated that individual change in aggression over time related to the average aggression of others in the intervention group. The individual child was "pulled" toward peers' mean level of aggression; so the intervention appeared to reduce aggression for those high on aggression, and to make those low on aggression more aggressive. Effects appeared to be magnified in either direction when the child was more discrepant from his or her peers. From these results we derive a principle of "discrepancy-proportional peer-influence" for small group intervention, and discuss the implications of this for aggregating aggressive children in small group programs.

The impact of first-grade "friendship group" experiences on child social outcomes in the fast track program

Many interventions for children's behavior problems successfully utilize a group format for social skills training, providing opportunities for practice and performance feedback from peers. Recent studies however, suggest that grouping aggressive children together may reduce intervention effectiveness or even increase risk. The present study examined the relative impact of children's own behavior and their experiences with peers in the first-grade "friendship groups" of Fast Track, a multi-component preventive intervention program. Two-hundred sixty-six children (56% minority, 29% female) participated in 55 friendship groups. Children's own positive and negative behavior in friendship groups was related to relative improvements in social cognitive skills, prosocial behavior, and aggression, assessed through child interviews, teacher ratings, and peer sociometric nominations. Results from hierarchical linear models also revealed that the amount of peer escalation children received for their disruptive behavior during sessions impeded some intervention gains, whereas mere exposure to other children's positive or negative behavior was rarely related to outcomes.

Psychosocial group prevention and intervention programs for children and adolescents

Psychosocial group interventions provide a potent venue for promoting children's social competencies, self-regulation, and problem solving in a natural peer group context. Three exemplary prevention and intervention group programs were described that are empirically supported, theoretically rich, and flexible for application in residential care settings. Special considerations are offered for designing and implementing groups with this population.

The role of chronic peer difficulties in the development of children's psychological adjustment problems

A longitudinal investigation was conducted to explicate how the confluence of early behavioral dispositions, relational histories, and cognitive representations of the self and others contributes to internalizing problems, externalizing problems, and loneliness. One-hundred and ninety three girls, and 206 boys were assessed annually from age 5 (kindergarten) to age 10 (Grade 4). Early aggressive behavior was related to Grade 4 maladjustment directly and indirectly through subsequent relational stressors. Significant associations emerged between chronic friendlessness and rejection and later adaptation not accounted for by concurrent relational difficulties. Self- and peer beliefs partially mediated the relation between peer difficulties and internalizing problems and loneliness. The results highlight the utility of child-by-environment models as a guide for the investigation of processes that antecede psychosocial maladjustment.

Negative feelings exacerbate hostile attributions of intent in highly aggressive boys

Tested the hypothesis that aggressive boys' tendency to attribute hostile intentions to peers is exacerbated in a negative emotional state. Twenty-nine highly aggressive boys in special education, 12 moderately aggressive boys in regular education, and 16 nonaggressive boys in regular education inferred peers' intentions in 8 vignettes concerning ambiguous provocation by peers. Mild negative emotions were induced by unjust loss of a manipulated computer game. Half the vignettes were completed in this negative emotional state. After completion of all vignettes, the game was played again and won to reinduce positive feelings. Self-ratings of feelings obtained throughout the study showed the manipulations consecutively induced negative and positive feelings. Negative feelings increased hostile attribution of intent in the highly aggressive group. Highly and moderately aggressive boys responded more aggressively than nonaggressive boys.

Translating emotion theory and research into preventive interventions

Scientific advances in the field of emotions suggest a framework for conceptualizing the emotion-related aspects of prevention programs that aim to enhance children's socioemotional competence and prevent the emergence of behavior problems and psychopathology. A conception of emotions as inherently adaptive and motivational and the related empirical evidence from several disciplines and specialities suggest 7 principles for developing preventive interventions: the utilization of positive and negative emotions, emotion modulation as a mediator of emotion utilization, emotion patterns in states and traits, different processes of emotion activation, emotion communication in early life, and the development of connections for the modular and relatively independent emotions and cognitive systems. Each principle's practical implications and application in current prevention programs are discussed.

Anger management for adolescents: efficacy of brief group therapy

OBJECTIVES

To investigate the efficacy of a brief, manual-based group therapy for adolescents with poor anger control. A previously developed anger management treatment package of 10 to 12 sessions was condensed to a 4-session package to be given within 2 weeks. Immediate effectiveness and the transfer of skills were investigated; anger management skills not only had to be acquired, they also had to be used in the adolescents' natural social interactions.

METHOD

Fifty adolescent psychiatric inpatients were selected for high levels of anger and randomly assigned to treatment or control conditions. Pre- and posttreatment measures were administered to subjects and adults who rated the subjects' behaviors.

RESULTS

Pre/post self-report measures, as well as behavior ratings by adults, indicated that the patients who went through the anger management series exhibited significantly improved skills.

CONCLUSIONS

These results suggested that the intervention for adolescents was effective even though it was condensed, but it should not be further abbreviated.

The relationship between aggression in children and locus of control beliefs

Gender differences are evident in the etiology and maintenance of aggressive behavior (which is on the increase for both male and female youths), but the explanatory models that have been proposed, including social learning theory and information processing models, are more appropriate for boys than for girls. In an attempt to elucidate processes underlying aggression, particularly for girls, the authors explored locus of control as a cognitive variable possibly related to aggressive behavior. The relationships between teacher-reported aggression and 3 types of locus of control (internal, powerful other, and unknown) for success and failure experiences were investigated. For girls, aggressive behavior was positively related to internal and unknown locus of control. In contrast, boys' aggressive behavior was unrelated to internal locus of control beliefs and negatively related to external locus of control beliefs. Possible explanatory mechanisms for the relationship between locus of control beliefs and aggression are discussed. The present study contributes to the understanding of aggression in girls and points to different processes underlying girls' and boys' aggression.

Criterion validity and the utility of reactive and proactive aggression: comparisons to attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and other measures of functioning

Examined the criterion validity and the utility of Dodge and Coie's (1987) measure of reactive and proactive aggression. Participants were 405 children in kindergarten through 5th grade attending an urban elementary school. Examined criterion validity by testing whether reactive aggression or proactive aggression was significantly correlated with criterion measures of overall impairment as measured by the Impairment Rating Scale (Pelham, Gnagy, et al., 1996), classroom behavior as measured by a frequency count of classroom rule violations, and peer adjustment as measured by teacher ratings of peer behavior on the Pittsburgh Modified IOWA Conners (Pelham, Milich, Murphy, & Murphy, 1989). Examined utility by testing whether reactive aggression or proactive aggression was significantly correlated with criterion measures after controlling for each other and after controlling for attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder as measured by the Disruptive Behavior Disorder Rating Scales (Pelham, Gnagy, Greenslade, & Milich, 1992). Results showed good evidence of criterion validity for both reactive and proactive aggression, but mixed evidence for their utility.

Empirically supported psychosocial treatments for attention deficit hyperactivity disorder

Reviews and evaluates psychosocial treatments for attention deficit hyperactivity disorder (ADHD) in children and adolescents according to Task Force Criteria (Lonigan, Elbert, & Johnson, this issue). It is concluded that behavioral parent training and behavioral interventions in the classroom meet criteria for well-established treatments. Cognitive interventions do not meet criteria for well-established or probably efficacious treatments. Issues regarding the evaluative process are discussed and future directions for psychosocial treatment for ADHD are outlined.

Residential behavior therapy for children with conduct disorders

Children with conduct disorders are often referred to residential treatment centers (RTCs). RTCs shorten the length of treatment and thus feel they need to reconceptualize the purpose and process of treatment. Two intervention strategies have been found to affect conduct disorder in outpatient settings: parent training programs that are based on operant learning principles and cognitive-behavioral programs that focus on the relation between cognition and behavior. These strategies should not be transferred to the RTC but adapted to the characteristics of residentially treated conduct disordered children and their parents. These methods should be used together to integrate and strengthen the various learning processes that residential treatment can foster. An outline is given of a comprehensive and integrated residential treatment program based on behavioral methods that have been proven to affect conduct disorder.