A school-based anger management program for developmentally and emotionally disabled high school students

Adolescence, Winter, 1995 by Millicent H. Kellner, Judith Tutin

Since Novaco (1975) developed a cognitive-behavioral conceptualization of anger, several practitioners (Feindler, Marriott, & Iwata, 1984; Feindler & Ecton, 1986; Feindler, 1991; Goldstein & Glick, 1987) have made use of a cognitive-behavioral approach for effectively intervening with aggressive youth. These approaches are based on Novaco's model of anger as a stress reaction in which the cognitive, behavioral, and physiological responses are each of importance in intervention. Given society's present concern about violence (Koop & Lundberg, 1992) and increasing concern with the violent and antisocial activities of young people in particular (APA, 1993), this approach, which places emphasis on assisting adolescents and young adults to develop new skills and strategies for managing anger, appears to have a valuable role among the efforts to reduce violence.

Scant attention, however, has been paid to using a cognitive-behavioral approach with young people whose cognitive, emotional, and behavioral limitations appear to preclude them from making use of such a model. While Feindler and Ecton (1986), for example, do suggest that a one-to-one approach might be useful with adolescents of below average intellectual functioning, they neither develop a specific model of intervention for this population nor consider using the group therapy approach they have devised for other adolescents. On the other hand, Benson (1992) offers an impressionistic report of success with an anger-management program for mentally retarded adults at an outpatient mental health center, and research is emerging to demonstrate the advantages of cognitive-behavioral interventions for helping mentally retarded children and adolescents develop a wide range of skills (Whitman, Scherzinger, & Sommer, 1991). Thus, although these young people may be limited in their potential to benefit from traditional, insight-oriented therapies, they do appear to be good candidates for the structured, concrete approach of a skill-building model.

Further, there are serious negative consequences for developmentally and emotionally disabled people who lack the skills to manage anger. Since members of this vulnerable population may live out their lives in a variety of protective settings, possessing these skills may help ensure successful adjustment to these settings and prevent more restrictive placements. Moreover, mastery of these skills may increase the likelihood that some individuals will gain partial or full entry into the mainstream.

Given the promise of anger-management treatment with a cognitive-behavioral basis, a pilot program was undertaken at a special school for older adolescents and young adults with diagnoses such as pervasive developmental delays, mental retardation, and autism. The pilot program made use of the major elements of the anger-management model described by others (Feindler & Ecton, 1986; Goldstein & Glick, 1987), but modified the model to meet the learning needs of the participants. Further modifications were made to integrate the program into this specific, multidisciplinary setting. After making several changes in the pilot format, the model was employed in a more extended program involving additional participants. Both the pilot program and the final version of the model are described here.

Setting

The special day school in which the programs were conducted has 110 students ranging in age from 13-21 years, each with a history of severe emotional and learning problems. A multidisciplinary team approach is used with a team comprised of teachers, clinical social workers, and speech/language clinicians, all of whom work with a particular student on a regular basis. Individual, group, and family therapy are also part of the program, in addition to the specialized academic and recreation programs. In the high school grades, the average class size is 12, with most classes having one teacher and two aides. There is a crisis room which students use for a time out before or after aggressive behavior problems occur.

Participants

One female and three male students, who scored within the borderline range of intellectual functioning and who ranged in age from 15 to 18 years, were chosen by the multidisciplinary classroom team to participate in the pilot program. These students were selected because their inability to cope with their anger, as exhibited through aggressive acting out or severe withdrawal, led to frequent interruptions in their school program. Their diagnoses included attention deficit disorder, pervasive developmental delays, autism, mental retardation, and depressive disorder. All of these students were classified by their home school districts as emotionally disturbed. These students were also classified as learning disabled and neurologically impaired. Two students were taking medication, which included Ritalin, Norpramin, and Trilafon.

Format

Meetings were held weekly over the course of five weeks and each lasted for forty-five minutes. This framework was chosen to provide sufficient time to introduce the major concepts of anger management and hold the attention of the students, an important consideration when working with a population with attentional deficits.