A review of the assessment and treatment of anger and aggression in offenders with intellectual disability

Abstract

Rates of aggression amongst people with intellectual disability (ID) have been found to be high in studies conducted on several continents across a number of service settings. Aggression is the primary reason for people with ID to be admitted or re-admitted to institutional settings, and it is also the main reason for individuals in this client group to be prescribed behaviour-control drugs. Anger is a significant activator of aggression, but little is known about the emotional aspects of the lives of people with ID. There are many reasons for this, but a lack of reliable and validated assessment measures is chief among them. The present review found that very little work has been conducted to date concerning the development of robust tools for assessing anger and aggression in this population. A narrative review of interventions for reducing aggression and anger in people with ID showed that there is virtually no evidence to support the use of psychotropic medications. Research has shown that behavioural interventions can be effective; however, they are intrusive and have not been tested in naturalistic settings with higher-functioning clients and low-frequency aggression. More recently, cognitive-behavioural interventions have shown promise, but the mechanisms for effective change have yet to be delineated. Priority research questions relating to assessment, treatment and therapeutic skills in working with anger and aggression problems are offered by the present review.

Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients

“…37,[66][67][68][69] Similarly, comorbid substance abuse increases the risk of violence in patients with mental retardation. 70 Furthermore, violent mentally retarded adults have been shown to have larger brain ventricles than their non-violent counterparts, as well as a higher frequency of abnormal EEGs, yet no increased prevalence of seizure disorders (as for schizophrenia). 27,47,71,72 In addition to schizophrenia and mental retardation (with or without comorbidity), the personality disorders as independent primary diagnoses -in particular antisocial and other cluster B personality disorders -are associated with violent behaviour.…”

Assessment and treatment of offenders with intellectual and developmental disabilities

“…In a series of waiting list controlled studies, Taylor et al (2002Taylor et al ( , 2004 have evaluated individual cognitive behavioural anger treatment with detained male patients who have mild-borderline ID and significant violent histories. Taylor et al (2002) reported a pilot study involving 20 detained male patients using an 18 session cognitive behavioural treatment comprising of six sessions of a psycho-educational and motivational preparatory phase, followed by a 12 session treatment phase based on individual formulation of each participant's anger problems and needs that followed the cognitive behavioural stages of cognitive preparation, skills acquisition, skills rehearsal and practice in vivo. Participant's self-report of anger intensity to provocation was significantly lower following the intervention in a treatment condition when compared with a waiting list control.…”

A selective review of research on offenders with developmental disabilities: assessment and treatment

“…Despite the consequences that anger and aggression problems have for people with DD directly, and for others around them, including direct care staff and systems concerned with their care and rehabilitation, there is little in the literature concerning the development of reliable and valid measures of these phenomena in this population (Novaco & Taylor, 2004;Taylor, 2002). Studies by Benson and Ivins (1992) and Rose and West (1999) have indicated that modified self-assessment measures of anger reactivity can have some limited reliability and validity with people with DD.…”

“…This approach incorporates the stress inoculation paradigm (Meichenbaum, (2005) 1985) and has cognitive re-structuring, arousal reduction and behavioural skills training as its core components. Taylor (2002) and Taylor and Novaco (in press) have reviewed numerous case and case-series studies, and a small number of uncontrolled group studies involving individual and group therapy formats incorporating combinations of cognitive-behavioural techniques including selfmonitoring, relaxation and skills training that have yielded reductions in levels of anger and aggression that were maintained at follow-up. In addition there have now been three outcome trials that have established the effectiveness of group cognitive-behavioural anger treatment over waitlist controlled conditions with clients with DD and anger and aggression problems living in community settings (Lindsay et al, 2004a;Rose, West, & Clifford, 2000;Willner, Jones, Tams, & Green, 2002).…”

“…However, we aim to give the reader an overview of the scope of these recent developments, and the extent to which they are moving to the forefront of work on offenders and violence in general. Taylor (2002) and reviewed studies of the prevalence of aggression in populations of people with DD conducted across three continents. They indicate prevalence rates for aggression of between 11 and 27% in centralized service provider surveys (Harris, 1993;Sigafoos, Elkins, Kerr, & Attwood, 1994) and direct carer interview studies (Deb, Thomas, & Bright, 2001;Hill & Bruininks, 1984;Smith, Branford, Collacott, Cooper, & McGrother, 1996).…”