This study evaluates efficacy and effectiveness of ‘Doing Anger Differently’ (DAD), a group treatment for reactively aggressive 12–15 year old males. DAD uses percussion exercises to aid treatment. Study 1 compared a ten-week treatment with a waitlist control at pre, post and 6 month (treatment group only) follow-up. Study 2 replicated Study 1, but also followed up controls at 6 months. In study 1 (N = 54) the treatment resulted in lowered trait anger (Cohen’s d = −1.3), aggression-reports (d = −1.0) and depression (d = −0.6), and increased self-esteem (d = 0.6), all maintained at six months. In study 2 (N = 65), aggression-reports fell to one fifth of pre-treatment levels at nine months follow-up (d = −1.2), with lowered trait anger (d = −0.4) and anger expression (d = −0.3) post-treatment.
High anger and aggression in early adolescence are linked with crimes, violence, low educational achievement, and physical and mental ill health in adolescence and maturity (Colder and Stice, 1998, Colman et al., 2009, Lacourse et al., 2010, Loeber, 1990, Reef et al., 2009 and Roeser et al., 1998). There is also a male vulnerability to these problems (Australian Institute of Criminology, 2001, Canter, 1982 and Loeber, 1990).
Early adolescence is an optimum age to intervene because difficulties with anger and aggression at this age are highly predictive of later morbidity (Loeber, 1990, Loeber and Schmaling, 1985 and Reef et al., 2009). Both mild and severe symptoms of externalizing behaviour in adolescence are associated with adult negative outcomes (Colman et al., 2009). Also, early adolescence is a developmental turning point. Harnessing the changes of rapid increases in cognitive abilities (Moshman, 1998), a relatively fluid identity and the increase in the social influence of peers (Steiner et al., 1997), provides an opportunity for intervention prior to the establishment of rigid sets of aggressive, anti-social ideas and identity. After adult–like criminal offending commences, interventions are less successful (Australian Institute of Criminology, 2001, Dodge, 2008 and Weisz and Hawley, 2002).
Cognitive Behavioural treatment for these problems has had some success with children (Larson and Lochman, 2002 and Sukhodolsky et al., 2004) and adults (DiGuiseppe & Tafrate, 2003), but provides only modest and short-term outcomes with early adolescents (e.g. Deffenbacher, Lynch, Oetting, & Kemper, 1996) and no gains maintained at six months follow-up or longer. A review of secondary prevention interventions for child and adolescent violence (Fields and McNamara, 2003) found that most treatment programs had at least one statistically significant positive outcome but that, typically, changes in children (including adolescents) were modest and short-term. Another review (Greenberg, Domitrovich, & Bumbarger, 2001) found positive changes in observed aggressive behaviours for programs treating children under 12, but no similar findings for adolescents. A third recent review found that school-based secondary prevention programs can curb aggressive behaviours (Mytton, DiGuiseppi, Gough, Taylor, & Logan, 2006), finding evidence for efficacy with adolescents as well as children, but called for further research on the maintenance of treatment gains.
Long-term change in aggressive behaviour (i.e. six months or longer) in early adolescents remains an elusive goal of preventive intervention (Feindler, 1990, Fields and McNamara, 2003 and Tolan and Guerra, 1994), though few long-term follow-up studies have been published so far. Experts have called for further research, particularly within the high school setting (Larson, 1998) and for innovative treatments which may be part of a comprehensive school-based approach (Dodge, 2008).
We report here two studies evaluating Doing Anger Differently (DAD), an innovative program which uses structured Latin American percussion exercises to explicate and treat reactive aggression in adolescent males. We defined reactive aggression as aggression where there is anger present, is aimed at causing harm to others and is commonly impulsive (cf Connor, 2002). The dominant treatment procedures on which the DAD program is based are summarized in the design section, below.
