A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management in Children Diagnosed with Asperger Syndrome

Abstract

The purpose of the study described was to evaluate the effectiveness of a cognitive behavioural intervention for anger management with children diagnosed with Asperger syndrome. Forty-five children and their parents were randomly assigned to either intervention or wait-list control conditions. Children in the intervention participated in six 2-h weekly sessions while parents participated in a larger parent group. Parent reports indicated a significant decrease in episodes of anger following intervention and a significant increase in their own confidence in managing anger in their child. Qualitative information gathered from parents and teachers indicated some generalization of strategies learned in the clinic setting to both home and school settings. Limitations of the study and suggestions for future research are also discussed.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Adolphs, R., Sears, L., & Piven, J. (2001). Abnormal processing of social information from faces in autism. Journal of Cognitive Neuroscience, 13, 232–240.

    PubMed  Article  Google Scholar 

  2. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed. (text revision). Washington DC: American Psychiatric Association.

    Google Scholar 

  3. Attwood, T. (1999). Modifications to cognitive Behaviour Therapy to accommodate the cognitive profile of people with Asperger’s Syndrome. Available at: http://www.tonyattwood.com.au/paper2.htm.

  4. Attwood, T. (2004a). Cognitive Behaviour Therapy for children and adults with Asperger’s syndrome. Behaviour Change, 21, 147–161.

    Article  Google Scholar 

  5. Attwood, T. (2004b). Exploring feelings: Cognitive Behaviour Therapy to manage anger (pp. 65–66). Arlington: Future Horizons.

    Google Scholar 

  6. Baron-Cohen, S., Ring, H. A., Wheelwright, S., Bullmore, E. T., Brammer, M. J., Simmons, A., & William, S. C. R. (1999). Social intelligence in the normal autistic brain: An fMRI study. European Journal of Neuroscience, 11, 1891–1898.

    PubMed  Article  Google Scholar 

  7. Bauminger, N. (2002). The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: Intervention outcomes. Journal of Autism and Developmental Disorders, 32, 283–298.

    PubMed  Article  Google Scholar 

  8. Critchley, H. D., Daly, E. M., Bullmore, E. T., Williams, S. C. R., Van Amelsvoort, T., Robertson, D. M., Rowe, A., Phillips, M., McAlonan, G., Howlin, P., & Murphy, D. (2000). The functional neuroanatomy of social behaviour. Brain, 123, 2203–2212.

    PubMed  Article  Google Scholar 

  9. Eisenmajer, R., Prior, M., Leekman, S., Wing, L., Gould, J., Welham, M., & Ong, N. (1996). Comparison of clinical symptoms in autism and Asperger’s syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1523–1531.

    PubMed  Article  Google Scholar 

  10. Ekman, P. (2003). Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. New York: Times Books.

    Google Scholar 

  11. Faupel, P., Henick, G., & Sharp, K. (1998). Anger management. London: David Fulton Publishers.

    Google Scholar 

  12. Fine, C., Lumsden, J., & Blair, R. J. R. (2001). Dissociation between theory of mind and executive functions in a patient with early left amygdala damage. Brain Journal of Neurology, 124, 287–298.

    Google Scholar 

  13. Fitzpatrick, E. (2004). The use of cognitive behavioural strategies in the management of anger in a child with an autistic disorder: An evaluation. Good Autism Practice, 5, 3–17.

    Google Scholar 

  14. Graham, P. (1998). Cognitive Behaviour Therapy for children and families. Cambridge: Cambridge University Press.

    Google Scholar 

  15. Grave, J., & Blissett, J. (2004). Is cognitive behaviour therapy developmentally appropriate for young children? Review of the evidence. Clinical Psychology Review, 24, 399–420.

    PubMed  Article  Google Scholar 

  16. Gray, C. (1998). Social stories and comic strip conversations with students with Asperger syndrome and high functioning autism. In E. Schopler, G. B. Mesibov, & L. J. Kunce (Eds.), Asperger syndrome or high functioning autism. New York: Plenum Press.

    Google Scholar 

  17. Hare, D. J. (1997). The use of Cognitive-Behavioural Therapy with people with Asperger syndrome: A case study. Autism, 1, 215–225.

    Article  Google Scholar 

  18. Hill, E., Berthoz, S., & Frith, U. (2004). Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229–235.

    PubMed  Article  Google Scholar 

  19. Kellner, M., & Tutin, J. (1995). A school-based anger management program for developmentally and emotionally disabled high school students. Adolescence, 30, 813–825.

    PubMed  Google Scholar 

  20. Kendall, P. C. (2000). Child and adolescent therapy: Cognitive behavioural therapy procedures. New York: The Guilford Press.

    Google Scholar 

  21. Marks, S., Schrader, C., Levine, M., Hagie, C., Longaker, T., Morales, M., & Peters, I. (1999). Social skills for social ills: Supporting the social skills development of adolescents with Asperger’s syndrome. Teaching Exceptional Children, 32, 56–61.

    Google Scholar 

  22. Myles, B., & Simpson, R. (2001). Effective practices for students with Asperger syndrome. Focus on Exceptional Children, 34, 1–14.

    Google Scholar 

  23. Nelson, W. M., & Finch, A. J. (2000). Children’s Inventory of Anger Manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  24. Nyden, A., Gillberg, C., Hjelmquist, E., & Heiman, M. (1999). Executive function/attention deficits in boys with Asperger syndrome, attention disorder and reading/writing disorder. Autism, 3, 213–228.

    Article  Google Scholar 

  25. Ozonoff, S., South, M., & Miller, J. (2000). DSM-IV defined Asperger syndrome: Cognitive behavioural and early history differentiation from high-functioning autism. Autism, 4, 29–46.

    Google Scholar 

  26. Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry Annual Research Review, 37, 51–87.

    Article  Google Scholar 

  27. Reaven, J., & Hepburn, S. (2003). Cognitive-behavioural treatment of obsessive-compulsive disorder in a child with Asperger syndrome. Autism, 7, 145–164.

    PubMed  Article  Google Scholar 

  28. Safran, S., Safran, J., & Ellis, K. (2003). Intervention ABCs for children with Asperger syndrome. Topics in Language Disorders, 23, 154–165.

    Article  Google Scholar 

  29. Scott, F. J., Baron-Cohen, S., Bolton, P., & Brayne, C. (2002). The CAST (Childhood Asperger Syndrome Test). Preliminary development of a UK screen for mainstream primary school age children. Autism, 6, 9–31.

    PubMed  Article  Google Scholar 

  30. Sofronoff, K. (2003). The children’s inventory of anger – parent version. Unpublished questionnaire. University of Queensland.

  31. Sofronoff, K., & Attwood, T. (2003). A Cognitive Behaviour Therapy intervention for anxiety in children with Asperger’s syndrome. Good Autism Practice, 4, 2–8.

    Google Scholar 

  32. Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46, 1152–1160.

    Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the families who participated in this research and the Apex Autism Trust Foundation who supported the trial with a grant.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kate Sofronoff.

Appendices

Appendix A

Dylan is Being Teased

My friend at school is Dylan. We are in Mrs. Smith’s class. Dylan is a great friend and we like to do the same things at lunch time. Sometimes we play handball, or go to the library and read about volcanoes, and we both like The Simpsons.

There are three boys in our grade who are not our friends. They like to find someone and tease them and get them into trouble. We don’t know why they do it. Sometimes they can be really mean and call you names, which are not true, and want to punch you or push you onto the ground. Dylan and I don’t do that to anyone.

Dylan has been in trouble with the Principal for getting mad at them and hitting them. They start it but he gets in to more trouble then they do. He was suspended for three days last week when they called him a ‘Psycho’. When they said that, he told them to stop, but they didn’t, so he hit one of them on the nose. There was a lot of blood everywhere.

On Friday, at lunchtime, they started to tease him again; calling him chicken and saying he is fat and gay. If he gets mad at them again he will be suspended and have to leave the school forever. He is my only friend.

Tell me what you could do and say to help Dylan keep cool and not get mad with them.

Appendix B

Trainer’s Notes

  • Session 1 Introduction

    • Strengths and Talents

    • Being Happy

    • Feeling Relaxed

  • Session 2 Why we feel anxious

    • Heroes who become angry

    • A time when I have felt angry

    • An emotional tool box

      • physical tools

      • relaxation tools

  • Session 3 Emotional Tool Box

    • Social Tools

    • Thinking Tools

    • Other Tools

    • Inappropriate Tools

  • Session 4 Practice using the tool box

  • Session 5 Social Stories

    • Antidote to poisonous thoughts

  • Session 6 Sharing Strategies

Suggestions for Group Cohesion

Emphasise success and discovery

  • Be careful with idioms

  • Acknowledge intelligence

  • Use the special interest as a metaphor

  • No right or wrong answers

  • Ground rules will need to be established at the start of session 1

  • One person leads the activity. The other person’s function is recording information and maintaining attention

  • Use plenty of games from the list to break up the sessions

  • Incorporate rewards from the reward bank for every child

Session Two

Table 5  
Table 6  

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sofronoff, K., Attwood, T., Hinton, S. et al. A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management in Children Diagnosed with Asperger Syndrome. J Autism Dev Disord 37, 1203–1214 (2007). https://doi.org/10.1007/s10803-006-0262-3

Download citation

Keywords

  • Asperger syndrome
  • Anger management
  • Cognitive Behaviour Therapy