Aspergers (high functioning autistic) kid’s anger presents challenges to educators committed to constructive, ethical, and effective youngster guidance. This post explores what we know about the components of Aspergers kid’s anger, factors contributing to understanding and managing anger, and the ways educators can guide kid’s expressions of anger.
Three Components of Anger—
Anger is believed to have three components (Lewis & Michalson, 1983):
The Emotional State of Anger. The first component is the emotion itself, defined as an affective or arousal state, or a feeling experienced when a goal is blocked or needs are frustrated. Fabes and Eisenberg (1992) describe several types of stress-producing anger provocations that young kids face daily in classroom interactions:
Conflict over possessions, which involves someone taking kid’s property or invading their space.
Issues of compliance, which often involve asking or insisting that kids do something that they do not want to do--for instance, wash their hands.
Physical assault, which involves one youngster doing something to another youngster, such as pushing or hitting.
Rejection, which involves a youngster being ignored or not allowed to play with peers.
Verbal conflict, for example, a tease or a taunt.
Expression of Anger—
The second component of anger is its expression. Some kids vent or express anger through facial expressions, crying, sulking, or talking, but do little to try to solve a problem or confront the provocateur. Others actively resist by physically or verbally defending their positions, self-esteem, or possessions in non-aggressive ways. Still other kids express anger with aggressive revenge by physically or verbally retaliating against the provocateur. Some kids express dislike by telling the offender that he or she cannot play or is not liked. Other kids express anger through avoidance or attempts to escape from or evade the provocateur. And some kids use adult seeking, looking for comfort or solutions from a teacher, or telling the teacher about an incident.
Educators can use youngster guidance strategies to help Aspergers students express angry feelings in socially constructive ways. Kids develop ideas about how to express emotions (Michalson & Lewis, 1985; Russel, 1989) primarily through social interaction in their families and later by watching television or movies, playing video games, and reading books (Honig & Wittmer, 1992). Some Aspergers students have learned a negative, aggressive approach to expressing anger (Cummings, 1987; Hennessy et al., 1994) and, when confronted with everyday anger conflicts, resort to using aggression in the classroom (Huesmann, 1988). A major challenge for early childhood educators is to encourage Aspergers students to acknowledge angry feelings and to help them learn to express anger in positive and effective ways.
An Understanding of Anger—
The third component of the anger experience is understanding - interpreting and evaluating - the emotion. Because the ability to regulate the expression of anger is linked to an understanding of the emotion (Zeman & Shipman, 1996), and because kid’s ability to reflect on their anger is somewhat limited, Aspergers students need guidance from educators and parents in understanding and managing their feelings of anger.
Understanding and Managing Anger—
The development of basic cognitive processes undergirds kid’s gradual development of the understanding of anger (Lewis & Saarni, 1985).
Self-Referential and Self-Regulatory Behaviors—Self-referential behaviors include viewing the self as separate from others and as an active, independent, causal agent. Self-regulation refers to controlling impulses, tolerating frustration, and postponing immediate gratification. Initial self-regulation in young kids provides a base for early childhood educators who can develop strategies to nurture kid’s emerging ability to regulate the expression of anger.
Memory—Memory improves substantially during early childhood (Perlmutter, 1986), enabling young kids to better remember aspects of anger-arousing interactions. Aspergers students who have developed unhelpful ideas of how to express anger (Miller & Sperry, 1987) may retrieve the early unhelpful strategy even after educators help them gain a more helpful perspective. This finding implies that educators may have to remind some Aspergers students, sometimes more than once or twice, about the less aggressive ways of expressing anger.
Language—Talking about emotions helps young Aspergers students understand their feelings (Brown & Dunn, 1996). The understanding of emotion in preschool kids is predicted by overall language ability (Denham, Zoller, & Couchoud, 1994). Educators can expect individual differences in the ability to identify and label angry feelings because kid’s families model a variety of approaches in talking about emotions.
Guiding Kid’s Expressions of Anger—
Educators can help Aspergers students deal with anger by guiding their understanding and management of this emotion. The practices described here can help Aspergers students understand and manage angry feelings in a direct and non-aggressive way.
Communicate with Moms and Dads—Some of the same strategies employed to talk with moms and dads about other areas of the curriculum can be used to enlist their assistance in helping Aspergers students learn to express emotions. For example, articles about learning to use words to label anger can be included in a newsletter to moms and dads.
Create a Safe Emotional Climate—A healthy early childhood setting permits kids to acknowledge all feelings, pleasant and unpleasant, and does not shame anger. Healthy classroom systems have clear, firm, and flexible boundaries.
Encourage Kids to Label Feelings of Anger—Educators and parents can help young Aspergers students produce a label for their anger by teaching them that they are having a feeling and that they can use a word to describe their angry feeling. A permanent record (a book or chart) can be made of lists of labels for anger (e.g., mad, irritated, annoyed), and the class can refer to it when discussing angry feelings.
Encourage Kids to Talk About Anger-Arousing Interactions—Preschool kids better understand anger and other emotions when adults explain emotions (Denham, Zoller, &Couchoud, 1994). When Aspergers students are embroiled in an anger-arousing interaction, educators can help by listening without judging, evaluating, or ordering them to feel differently.
Help Kids Develop Self-Regulatory Skills—Educators of infants and toddlers do a lot of self-regulation "work," realizing that the Aspergers students in their care have a very limited ability to regulate their own emotions. As Aspergers students get older, adults can gradually transfer control of the self to kids, so that they can develop self-regulatory skills.
Model Responsible Anger Management—Aspergers students have an impaired ability to understand emotion when adults show a lot of anger (Denham, Zoller, & Couchoud, 1994). Adults who are most effective in helping Aspergers students manage anger model responsible management by acknowledging, accepting, and taking responsibility for their own angry feelings and by expressing anger in direct and non-aggressive ways.
Use Books and Stories about Anger to Help Kids Understand and Manage Anger—Well-presented stories about anger and other emotions validate kid’s feelings and give information about anger (Jalongo, 1986; Marion, 1995). It is important to preview all books about anger because some stories teach irresponsible anger management.
Aspergers students guided toward responsible anger management are more likely to understand and manage angry feelings directly and non aggressively and to avoid the stress often accompanying poor anger management (Eisenberg et al., 1991). Educators can take some of the bumps out of understanding and managing anger by adopting positive guidance strategies.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"I need help FAST with what to do about my teenage son with autism - high functioning, and his out of control rage!!! Please I need advice."
Teens
with Aspergers and High-Functioning Autism (HFA) may be prone to anger, which
can be made worse by difficulty in communicating feelings of
disturbance, anxiety or distress.
Anger may be a common reaction
experienced when coming to terms with problems in employment,
relationships, friendships and other areas in life affected by the disorder.
There
can be an ‘on-off’ quality to this anger, where the teenager may be calm
minutes later after an angry outburst, while those around are stunned
and may feel hurt or shocked for hours, if not days, afterward.
Parents
often struggle to understand these angry outbursts, with resentment and
bitterness often building up over time. Once they understand that their teen has trouble controlling his anger or understanding its effects on
others, they can often begin to respond in ways that will help to manage
these outbursts.
In
some cases, these teens may not acknowledge they have trouble with
their anger, and will blame others for provoking them. Again, this can
create enormous conflict within the family. It may take carefully
phrased feedback and plenty of time for the them to gradually realize
they have a problem with how they express their anger.
The
next step is for the teen to learn anger-management skills. A good
place to start is identifying a pattern in how the outbursts are related
to specific frustrations. Such triggers may originate from the
environment, specific individuals or internal thoughts.
Common causes of anger in Asperger's and HFA teens:
Being swamped by multiple tasks or sensory stimulation
Build up of stress
Difficulties with employment and relationships despite being intelligent in many areas
Having routines and order disrupted
Intolerance of imperfections in others
Other people’s behavior (e.g., insensitive comments, being ignored)
Identifying the cause of anger can be a challenge.
It is important to consider all possible influences relating to:
How well the teenager is treated by peers
The environment (e.g., too much stimulation, lack of structure, change of routine)
The teen’s mental state (e.g., existing frustration, confusion)
The teen’s physical state (e.g., pain, tiredness)
Steps to successful self-management of anger include:
Awareness of situations— The teen becomes more aware of the
situations which are associated with them becoming angry. They may like
to ask other people who know them to describe situations and behaviors
they have noticed.
Becoming motivated— The teen identifies why they would like
to manage anger more successfully. They identify what benefits they
expect in everyday living from improving their anger management.
Develop an anger management record— The teen may keep a diary
or chart of situations that trigger anger. List the situation, the
level of anger on a scale of one to ten and the coping strategies that
help to overcome or reduce feelings of anger.
Levels of anger and coping strategies— As the teen becomes
more aware of situations associated with anger, they can keep a record
of events, triggers and associated levels of anger. Different levels of
anger can be explored (e.g. mildly annoyed, frustrated, irritated and
higher levels of anger).
Self-awareness— The teen becomes more aware of personal
thoughts, behaviors and physical states which are associated with anger.
This awareness is important for the teen in order for them to notice
the early signs of becoming angry. They should be encouraged to write
down a list of changes they notice as they begin to feel angry.
A simple and effective technique for reducing levels of anger is the “Stop – Think” technique:
As the Asperger's or HFA teen notices the thoughts running through his mind...
1. Stop and think before reacting to the situation (are these thoughts accurate or helpful?)
2. Challenge the inaccurate or unhelpful thoughts
3. Create a new thought
A
plan can also be developed to help a teen avoid becoming angry when
they plan to enter into a situation that has a history of triggering
anger. An example of a personal plan is using the “Stop – Think”
technique when approaching a shopping center situation that is known to
trigger anger.
My goal: To improve my ability to cope with anger when I am waiting in long queues.
Typical angry thoughts: ‘The service here is so slack. Why can’t they hurry it up? I'm going to lose my cool any moment now’. Stop thinking this!
New calmer and helpful thoughts: ‘Everyone is probably
frustrated by the long line – even the person serving us. I could come
back another time, or, I can wait here and think about pleasant things
such as going to see a movie’.
Creative destruction or physical activity techniques to reduce anger
Find anger management classes in your area
Relaxation techniques
Self-talk methods
Use visual imagery (jumping into a cool stream takes the heat of anger away)
Coping with extreme anger:
It
is hoped that teens with Asperger's and HFA can make use of these strategies
when they notice themselves becoming angry and therefore avoid feeling
extreme anger. However, this is clearly not always possible. For
situations where teens feel they cannot control their anger, they can
have a personal safety plan.
Possible steps in a personal safety plan:
Avoid situations which are associated with a high risk of becoming angry
Explain to another person how they can be of help to solve the problem
Explore the benefits of using medication with a doctor or psychiatrist
Leave the situation if possible
Make changes to routines and surroundings (e.g., avoid driving in peak hour traffic)
Phone a friend, or a crisis center to talk about the cause of anger
Plan ways to become distracted from the stressful situation (e.g., carry a magazine)
“My 8 y.o. son Cory has a diagnosis of autism (high functioning) and has uncontrollable outbursts and aggression when things don’t go his way. He often becomes so distraught that his suffering is palpable. The emotions vivid on his face. His little body tense with distress. Sometimes he will meltdown, at other times he shuts down. Is this just par for the course with autism? Is there anything that can help reduce the intensity, duration and frequency of these behaviors?”
RE: “Is this just par for the course with autism?”
Yes! Many moms and dads recognize that their high-functioning autistic (Asperger’s) youngster has a problem with anger-control. Many feel that their youngster needs to develop some anger-control skills, or needs to find some kind of counseling that will help him get along better in life (e.g., at school, with a parent, with siblings and classmates, etc.). In some cases, professionals have diagnosed a highly-aggressive youngster on the spectrum with Oppositional Defiant Disorder.
Generally, anger falls into three main categories: 1) Fight, 2) Flight, or 3) Pretend to be “Flighting” (while finding indirect ways to Fight). Most high-functioning autistic kids with anger-control problems will go to either extreme of fight or flight. They tend to become aggressive and hostile, or they withdraw into themselves and become extremely quiet, silently stubborn, and depressed (i.e., a shutdown).
“The Fighters”: Child Anger Turned to Aggression—
The Fighters are pretty simple to recognize. They are aggressive. Many times, the characteristics of high-functioning autistic kids with severe anger-control problems are included in the professional diagnosis for Oppositional Defiant Disorder (ODD). Some of the warning signs in the following list are taken from the criteria for professional diagnosis. Others are additional common signs of anger-control problems for kids that are Fighters.
Uncontrollable fits of rage (usually these tantrums are used as threats to get their way)
Seriously violates rules (e.g., at home, in school, or society in general)
Seems to have “emotional diarrhea” and “lets it all out - all the time”
Physically disruptive (e.g., hitting the parent)
Openly and often defiant of requests
Often feels rules are “stupid” or don’t apply to them
Often demeans or swears directly to parent or others in authority positions
Makes threats
Loud voice and yelling
Initiates fights with others
Has left holes in walls and doors from violent outbursts
Furious temper
Frequently vocalizes anger
Does not follow rules
Difficulty accepting a “no” answer
Destroys property
The “Fighters” have anger-control problems when the problems are creating an unsafe situation for themselves, for others, or for property around them. If parents or siblings are the focus of physical aggression, the problem is extremely critical to address. High-functioning autistic teens who have abused others as kids are at a higher risk of becoming a threat to society than those who have not. Where these warning signs seem to be a part of daily life, intervention is strongly suggested. Intervention can be through anger-control counseling, or through a program dedicated and experienced in working with autistic kids with emotional regulation difficulties.
“The Flighters”: Child Anger Turned to Passive Responses—
The Flighters can also be fairly simple to recognize. They are passive. They do not fight back when confronted. Many of their traits may coincide with the diagnosis of depression. Some of the warning signs below are taken from the professional diagnosis for depression, and others are additional common signs of “shutdowns” for Flighters.
Tends to spend a lot of time alone
Seems withdrawn
Seems to hold anger in
Seems to have very little emotion
Seems depressed
Seems “emotionally constipated”
Physical problems may include upset stomach, muscle aches, backaches, frequent headaches, or other physical symptoms from “holding it in”
May simply “go along” with whatever - even when it is a poor decision
May punch holes in walls or kick doors when “the last straw drops”
May have few friends
May blame self unnecessarily
May be seen as a “loner”
Holds anger in, then “blows up” suddenly and violently
Has difficulty expressing emotions
Extremely passive to the point of getting “walked over” by others
Does not engage in much conversation
Deals with difficult emotions by “cutting” the emotions off
The “Flighters” are in danger of destroying themselves emotionally from within. They are like a balloon being constantly blown into with no release valve. When they explode, their anger may be violent, and may lead to harming themselves, harming others, or destroying property. Internalized anger is potentially as destructive to a youngster as aggressive anger.
“The Pretenders”: Child Anger Silently Planning Revenge—
Perhaps the most difficult to detect, the Pretenders follow an anger style that seems to be calm on the surface, but is raging, scheming, and planning underneath. They are passive-aggressive. These kids do not directly confront the anger as a Fighter would do. They will be passive and appear to accept what is said, and then will disregard what is said to do their own thing. They are sneaky. Often, they may be unnoticed. While they are giving a person a hug, they are also stabbing them in the back (so to speak). They lack the courage to be direct, and perfect the skills to be deceitful. They know where the “back door” to revenge is, and will use it often. They will give the appearance of a Flighter. The list of Flighter traits also applies to them. Some additional traits to look for with Pretenders are as follows:
Tends to sabotage
Tends to avoid direct conflict while creating problems in other areas
Sneaky behaviors
Often gets caught in lies
May not admit mistakes
May be very good at blaming others
Inconsistency between what is said and what is done
High-functioning autistic kids who try to manage their anger through the Pretender style are as potentially dangerous to others and themselves as the other styles. Moms and dads tend to underestimate the Pretender style, because the danger does not seem to be as bad as the aggressive Fighter.
The Hostility Cycle—
From an anger-control perspective, an episode of anger can be viewed as consisting of three phases: escalation, explosion, and post-explosion. Together, they make up the hostility cycle. In this process, the escalation phase is characterized by cues that indicate anger is building. These cues can be physical, behavioral, emotional, or cognitive (thoughts). If the escalation phase is allowed to continue, the explosion phase will follow. The explosion phase is marked by uncontrollable anger displayed as verbal or physical aggressiveness. The final stage of the hostility cycle is the post-explosion phase, which is characterized by negative consequences resulting from the verbal or physical aggression displayed during the explosion phase.
The intensity, frequency, and duration of anger in the hostility cycle varies among children. For example, one high-functioning autistic youngster’s anger may escalate rapidly after a provocative event and, within just a few minutes, reach the explosion phase. Another youngster’s anger may escalate slowly but steadily over several hours before reaching the explosion phase. Similarly, one child may experience more episodes of anger and progress through the hostility cycle more often than the other. Despite differences in how quickly the anger escalates and how frequently anger is expressed, the child will undergo all three phases of the hostility cycle.
The intensity of the high-functioning autistic youngster’s anger also may differ. One child may engage in more violent behavior than the other in the explosion phase (e.g., he may assault someone). Another child may express his anger during the explosion phase by shouting at or threatening parents. Regardless of these individual differences, the explosion phase is synonymous with losing control and becoming verbally or physically aggressive.
RE: “Is there anything that can help reduce the intensity, duration and frequency of these behaviors?”
Absolutely! Here are some crucial strategies to help teach your son more constructive ways to deal with anger and frustration:
1. When Cory becomes frustrated, use those incidents as "on-the-spot lessons" to help him learn to calm himself down (rather than always relying on you to calm him down). Every time he acts-out due to low-frustration tolerance, ALWAYS use that moment as a teaching moment. For example, explain to him that we all have little signs that warn us when we’re getting frustrated. We should listen to these signs, because they can help us stay out of trouble. Next, help Cory recognize what specific warning signs he may have that tells him he is starting to get angry (e.g., I talk louder, my cheeks get hot, I clench my fists, my heart starts pounding, my mouth gets dry, I breathe faster, etc.).
2. Use books and social stories about anger to help your son understand and manage it. Well-presented stories about anger and other emotions validate a youngster's feelings and give information about anger. It is important to preview all books about anger, because some stories teach irresponsible anger-control.
3. Use role-playing, puppets, or videos to teach social skills (e.g., how to treat each other, how to work out disagreements, etc.).
4. Use feeling words to help Cory understand the emotions of others (e.g., “Robbie is sitting alone and looks very sad; he may be lonely” …or “When Michael tripped, he looked embarrassed”).
5. Train your son to respond to your "signal" (e.g., a hand motion) to stay calm. Give that signal as soon as he starts "stewing" about something. Alternatively, you can use distraction as soon as you notice him exhibiting an anger sign. If he refuses to be distracted or engaged in dialoguing about his anger and starts yelling, stomping or breaking an object, impose appropriate consequences. But, have these consequences in place ahead of time to serve as a guideline. That means that you have discussed them beforehand and written them out for future reference. Armed with a list of consequences (which preferably consist of withdrawing privileges or charging your son a "penalty"), encourage him to choose such alternatives as doing something else, walking away, or talking about the anger rather than acting it out.
6. Try a "time-in" rather than a "time-out." As a parent, you are Cory's main guide in life. He relies on you to be there with him through his difficult emotional experiences, whatever that may be. Thus, no time-out and no isolation may be the best option on occasion. Instead, try a "time-in." Sit with Cory and incorporate other methods mentioned in this post (e.g., work on breathing with him, ask him questions about his feelings, etc.). The important thing is to be fully present with Cory to help him through his emotions. Remember, you are teaching him social skills to be in relationships with others, rather than acting out alone. When some autistic kids are isolated, they often ruminate and feel guilty for their behavior. This only serves to create low self-esteem, which often cycles back to creating behavioral problems.
7. The thought "It's not fair" is a big anger-arouser for many high-functioning autistic kids. If that is the case, ask your son, "Do you feel you are being treated unfairly?" When he answers the question, listen and don't rush to negate his feelings.
8. Teach Cory to take a time-out from the difficult situation and have some “alone-time” for a few minutes. During the time-out, he can rethink the situation, calm down, and determine what to do next. The length of the time-out is determined by the intensity of the emotion. An autistic youngster who is simply frustrated may just need to take a deep breath. The youngster who is infuriated probably needs to leave the room and settle down. After Cory has calmed down, it’s time to decide on a more appropriate response to the situation. There are at least 3 positive choices: talk about it, get help, or slow down. Simplifying the choices makes the decision process easier. Even autistic kids can learn to respond constructively to frustration when they know there are just a few choices. These choices are skills to be learned. Take time to teach Cory these skills, and practice them as responses to mad feelings.
9. Teach your son to talk about how he feels. Give him a language to express his feelings. If he is too angry to talk or doesn't have the words to express his feelings, ask about the feelings relevant to the specific situation. For example, "Do you feel rejected?" "Hurt?" "Let down?" …etc. When your son expresses the feeling behind his anger (e.g., embarrassment or rejection), suggest some other ways to look at the same event that might not be embarrassing or humiliating.
10. Some high-functioning autistic kids get upset when they know they made a mistake. Instead of admitting their mistake, they act out in anger to deflect the attention off of them. If you realize that this might be the case, it's helpful to say to your son, "Everyone makes mistakes. I am okay with it. Don't feel so bad about it."
11. Stop any and all physically aggressive behaviors! Say something like, "I can't let you hurt each other," or "I can't let you hurt me." Then remove Cory as gently as possible.
12. Sometimes an autistic child’s anger and frustration are caused by very real and inescapable problems in his life. Not all anger is misplaced. Occasionally it's a healthy, natural response to the difficulties that the “special needs” child faces. There is a common belief that every problem has a solution, and it adds to the parent’s frustration to find out that this isn't always the case. Thus, the best attitude to bring to such a circumstance is not to focus on finding the solution, but rather on how you handle the problem as painlessly as possible.
13. Try to establish a home environment that reduces anger and teaches tolerance. For example, you can set a personal example for your son that "big people apologize when they hurt someone” and “it's o.k. to loose and try again.”
14. Simple relaxation tools can help Cory calm down. For example, he can (a) use imagery and visualize a relaxing experience from either his memory or his imagination; (b) slowly repeat a calm word or phrase (e.g., “relax” or “take it easy”) and repeat it to himself; (c) breathe deeply from his diaphragm (however, breathing from the chest won't relax him, so he should picture his breath coming up from the belly).
15. Resist taking Cory’s angry outbursts personally. His motives have more to do with alleviating uncomfortable emotions than with deliberately trying to be “nasty.”
16. One thing that makes many moms and dads angry is to see their youngster challenging their authority and defying them. Sometimes it may appear so, but that may not be the intention of the high-functioning autistic youngster. For example, the child may be too unhappy to be told ‘no’ because he wants something so badly. Of course, you shouldn't give in to your son’s demands, but try to understand what might really be his intention.
17. Many children on the autism spectrum act-out because they simply don’t know how to express their anger any other way. Kicking, screaming, swearing, hitting or throwing things may be the only way they know how to express their emotions. To help Cory express his frustrations appropriately, create an “emotion words” poster together (e.g., "Let’s think of all the words we could use that tell others we’re really frustrated"). Then list his ideas (e.g., angry, mad, annoyed, furious, irritated, etc.). Write them on a chart, hang it up, and practice using them often. When Cory is upset, use the words so he can apply them to real life (e.g., "Looks like you’re really frustrated. Want to talk about it?" …or "You seem really annoyed. Do you need to walk it off?"). Then keep adding new feeling words to the list whenever new ones come up in those "teachable moments" throughout the day.
18. Listen, reflect and validate (without judgment) the feelings Cory expresses. After listening, help him identify the true feeling underlying the anger (e.g., hurt, frustration, sadness, disappointment, fear, etc.). Say something like, "That hurt when your friend was mean to you," or “It was scary to have those boys bully you.”
19. Involve Cory in making a small list of “house rules” (e.g., we work out differences peacefully, we use self-control, we listen to others, we are kind to each other, etc.). Write them down and post them on the refrigerator. Make the rules clear, and follow through with meaningful consequences that are appropriate for Cory’s age when the rules are ignored.
20. Model responsible anger-control yourself. High-functioning autistic kids have an impaired ability to understand emotion when their parents show a lot of anger. Parents who are most effective in helping their kids manage anger model responsible management by acknowledging, accepting, and taking responsibility for their own angry feelings, and by expressing anger in direct and non-aggressive ways.
21. Help Cory to understand that anger is a natural emotion that everyone has. Say something like, "It's normal to feel angry. Everyone feels angry from time to time, but it is not O.K. to hurt others."
22. Help your son develop self-regulatory skills. Parents of kids on the spectrum do a lot of “child-regulation work" (i.e., doing things ‘for’ their child rather than ‘with’ their child). This is because parents know that their child has a very limited ability to regulate emotions. As the high-functioning autistic child gets older, parents can gradually transfer control to their child so that he can develop self-regulatory skills.
23. Facilitate communication and problem solving with Cory by asking questions (e.g., How can I help you? What can you do to help yourself? What do you need? Is your behavior helping you solve your problem? …and so on).
24. Encourage Cory to accept responsibility for his anger and to gain control by asking himself the following questions: Did I do or say anything to create the problem? If so, how can I make things better? How can I keep this issue from happening again?
25. Create a “ways to relax” poster. There are dozens of ways to help autistic kids calm down when they first start to get bent out of shape. Unfortunately, most of these “special needs” children have never been given the opportunity to think of those other possibilities. Thus, they keep getting into trouble because the only behavior they know is inappropriate ways to express their frustration. So, talk with Cory about more acceptable "replacement behaviors.” Make a big poster listing them (e.g., draw pictures, hit a pillow, listen to music, run a lap, shoot baskets, sing a song, talk to someone, think of a peaceful place, walk away, etc.). Once he chooses a replacement behavior, encourage him to use the same strategy each time he starts to get upset.
26. Encourage your son to “label” his emotions. For example, a permanent record (book or chart) can be made of lists of labels for “anger” (furious, mad, hot, irritated, annoyed), and he can refer to it when discussing angry feelings.
27. Be sure to VALUE what Cory is experiencing. For example, if he is hurt and crying, never say, "Stop crying." Instead, validate his experience by saying something like, "I’m sure that hurts. That would make me cry too." This makes an ally out of you, rather than a target for free-floating anger. As an ally, Cory learns to trust you, realizing you are there for him no matter what. If he can trust you, he can learn to trust himself and the outer world.
28. Acknowledge strong emotions, helping Cory to save face (e.g., say, "It must be hard to get a low score after you tried so hard").
29. All of us exhibit some "signs" just as we begin to get angry. So, it’s actually fairly easy to identify the “anger signs” in a youngster with high-Functioning Autism. For example, you may detect a certain look in the eye, a tone of voice, or a tightness in your child’s body. Thus, your first course of action is to help him observe these signs right at the onset of anger. Once he can identify the early signs of his anger, he can also learn to diffuse it by self-soothing techniques (e.g., walking away, taking full and vigorous breaths, etc.).
30. Lastly, help Cory understand that he can “choose” how to react when he feels angry or frustrated. Teach him self-control and positive ways to cope with negative impulses (e.g., write about feelings, tense body and then relax, tell someone how you feel, play music or sing, look at books or read, hug a pet or a stuffed animal, find a quiet place or sit alone, exercise, draw or play with clay, count slowly, calm self by breathing deeply, etc.).
By using a few of the ideas listed above, you can help strengthen your relationship with your high-functioning autistic youngster and give him the tools he needs to cope effectively with frustration and anger.
Resources for parents of children and teens on the autism spectrum:
More articles for parents of children and teens on the autism spectrum:
Social rejection has devastating effects in many areas of functioning.
Because the ASD child tends to internalize how others treat him,
rejection damages self-esteem and often causes anxiety and depression.
As the child feels worse about himself and becomes more anxious and
depressed – he performs worse, socially and intellectually.
Meltdowns are not a pretty sight. They are somewhat like overblown
temper tantrums, but unlike tantrums, meltdowns can last anywhere from
ten minutes to over an hour. When it starts, the Asperger's or HFA child
is totally out-of-control. When it ends, both you and your child are
totally exhausted. But... don’t breathe a sigh of relief yet. At the
least provocation, for the remainder of that day -- and sometimes into
the next - the meltdown can return in full force.
Although Aspergers [high-functioning autism] is at the milder end of the
autism spectrum, the challenges parents face when disciplining a
teenager on the spectrum are more difficult than they would be with an
average teen. Complicated by defiant behavior, the teen is at risk for
even greater difficulties on multiple levels – unless the parents’
disciplinary techniques are tailored to their child's special needs.
Your older teenager or young “adult child” isn’t sure what to do, and
he is asking you for money every few days. How do you cut the purse
strings and teach him to be independent? Parents of teens with ASD face
many problems that other parents do not. Time is running out for
teaching their adolescent how to become an independent adult. As one
mother put it, "There's so little time, yet so much left to do." Click here to read the full article…
Two traits often found in kids with High-Functioning Autism are
“mind-blindness” (i.e., the inability to predict the beliefs and
intentions of others) and “alexithymia” (i.e., the inability to
identify and interpret emotional signals in others). These two traits
reduce the youngster’s ability to empathize with peers. As a result, he
or she may be perceived by adults and other children as selfish,
insensitive and uncaring. Click here to read the full article...
Become an expert in helping your child cope with his or her
“out-of-control” emotions, inability to make and keep friends, stress,
anger, thinking errors, and resistance to change.
A child with High-Functioning Autism (HFA) can have
difficulty in school because, since he fits in so well, many adults
may miss the fact that he has a diagnosis. When these children display
symptoms of their disorder, they may be seen as defiant or disruptive.
"Is it common for children with high functioning autism to be highly explosive? My daughter can fly off the handle in a heartbeat for what seems to be rather trivial matters (to me anyway)."
Children with High-Functioning Autism (HFA) often have a difficult time controlling their anger as compared to “typical” children, which is due to the fact that they have problems understanding their emotions and their impact on others.
In addition, they aren’t living in a void in which they don’t understand that they’re different from other kids. Often teased and rejected by their peers, they can have emerging anger they don’t understand and can’t easily control.
Helping these children with anger problems requires direct communication about the effect of their anger on others as well as methods of improving their low self-esteem and poor sense of self-worth, which is often at the root of the youngster’s anger.
Anger that’s acted-out badly needs to be treated like any other unwanted behavior. Some form of reasonable consequence directed at getting the point across that the behavior is wrong needs to be combined with a pragmatic discussion of the meaning behind the anger and other ways to control it. Remember that effective discipline for the HFA child can be much different from the discipline that works for other children.
If the anger seems to be a part of your daughter’s frustration over how she is being treated by others or from depressive feelings, finding better avenues to discuss what is really going on can help her deal with the issues without using anger as an outlet. Most children on the spectrum are of greater than average intelligence and have the resources to understand the relationship between their anger and the underlying social issues their dealing with.
Creating an Anger-Management Plan—
The basic idea in developing an anger-management plan for kids on the autism spectrum is to try many different strategies and find the management techniques that work best for them. This is an ongoing process. As working strategies are identified, they can be added to the anger-management plans and used when the youngster starts to feel angry.
Children on the spectrum should be encouraged to refer to their anger-management plans as their “toolbox” and the specific strategies they use to manage their anger as their “tools.” This analogy can be very helpful. You can take this even further by creating a physical box for your HFA daughter to put the strategies in (i.e., written on pieces of paper).
You could be really creative and have the pieces of paper shaped like various tools. Also, discuss how different tools should be used for different situations (e.g., point out how a screwdriver can be very useful, but not for pounding in nails).
Again, it’s important to identify the specific strategies that work best for your daughter. These strategies should be put down in a formal anger-management plan for referral when your daughter encounters an anger-provoking event. It’s also important to explore how different techniques may be used at different times.
For example, your daughter may feel better after running around in the yard, but this may not be possible when she is getting angry at something in the classroom. Strategies need to be in place to handle the different situations that may arise.
An effective strategy that many kids on the spectrum use is to talk about their feelings with someone that they can trust (e.g., parent or other family member). By discussing anger, they can begin to identify the primary emotions that underlie it and determine whether the thinking and expectations in response to the anger-provoking event are rational.
Often an outsider can see the event from a different point of view, and offer some guiding words of wisdom. HFA kids can sometimes view an event as un-winable or un-escapable when there is a very simple solution which can be reached.
As one mother of a child with Asperger’s stated:
“My son struggled with anger problems throughout elementary and most of middle school. He is now 15, and through many talks, discussions and maturity, he seems to be controlling his anger/frustration rather well. I have always been open and honest with him about how others can be, why they can be that way, and how he is ‘different’ than most kids his age. In time, he grew into his own, better understood himself and his own actions - and I'm so proud of him. I would explain to him why things would affect him the way they do, but he was never to use having Aspergers as an excuse to not be in control of his own actions and emotions. We have an open relationship and he knows he can talk to me about anything. That has been our biggest tool I think. He also did receive consequences when he would misbehave. I don't treat him differently just because he has Aspergers. They get treated differently enough as it is.”
Resources for parents of children and teens on the autism spectrum:
Many moms and dads recognize that their Aspergers or high functioning autistic (HFA) child has a problem with anger management. They feel their child needs to develop anger management skills, or needs to find some kind of anger management counseling that will help them get along better in life -- in school, at work, with a parent, with siblings, and others. In some cases, professionals may have diagnosed the Aspergers or HFA child with a “conduct disorder”, or “oppositional defiant disorder”.
Types of Anger—
The natural response to fear is to fight it or avoid it. When confronted with fear, animals and humans both go into “fight or flight”, “violence or silence”, or “gun or run”. They engage in the conflict, or they withdraw. Though many moms and dads may equate “child anger management” with the “fight-violence-gun,” uncontrollable rage, parents must also recognize that anger may be “turned inwards” in the “flight-silence-run” mode, which can often times be as dangerous, if not more so, than expressed anger.
Generally, anger falls into three main categories: 1) Fight, 2) Flight, or 3) Pretend to be “Flighting”, while finding indirect ways to Fight. Most children on the autism spectrum who have anger management problems will go to either extreme of fight or flight. They tend to become aggressive, mean, and hostile, or they withdraw into themselves and become extremely silent, silently stubborn, and depressed.
“The fighters” are pretty simple to recognize. They are aggressive. Many times, the characteristics of Aspergers and HFA children with anger management problems are included in the professional diagnosis for “Conduct Disorder” or an “Oppositional Defiant Disorder (ODD)”. Some of the warning signs in the following list are taken from the criteria for professional diagnosis. Others are additional common signs of anger management problems for children that are “fighters”.
Destroys property
Difficulty accepting a “No” answer
Does not follow rules
Frequently vocalizes anger
Furious temper
Has left holes in walls and doors from violent outbursts
Initiates fights with others
Loud and yelling
Makes threats
Often demeans or swears directly to parent or others in authority positions
Often feels rules are “stupid”, or don’t apply
Openly and often defiant of requests
Physically cruel to animals
Physically cruel to people
Seems to have “emotional diarrhea”, and “lets it all out, all the time”
Seriously violates rules (at home, in school, or society in general)
Uncontrollable fits of rage (usually these “temper tantrums” are used as threats to get their way)
This list does not list every possible warning sign for the “fighters”. The child “Fighters” have anger management problems when the problems are creating an unsafe situation for themselves, for others, or for property around them. If animals and/or people are the focus of the anger and aggression, the problem is extremely critical to address. Aspergers and HFA teenagers who have abused animals or people as kids are at a higher risk of becoming a threat to society than those who have not. Where these warning signs seem to be a part of daily life, intervention is strongly suggested. Intervention can be through anger management counseling, an anger management program, or a program dedicated and experienced in working with special needs children with anger management problems.
“The Flighters”: Child Anger Turned to Passive Responses—
The “Flighters” can also be fairly simple to recognize. They are passive. They do not fight back when confronted. Many of their characteristics may coincide with the diagnosis of depression. Some of these warning signs are taken from the professional diagnosis for depression, and others are taken from learning, observations and experience.
Deals with difficult emotions by “cutting” the emotions off
Does not engage in much conversation
Extremely passive, to the point of getting “walked over” by others
Has difficulty expressing emotions
Holds anger in, then “blows up” suddenly and violently
May blame self unnecessarily
May have few friends
May punch holes in walls or kick doors, when “the last straw drops”
May be seen as a “loner”
May simply “go along” with whatever, even when it is a poor decision
Physical problems may include upset stomach, muscle aches, backaches, frequent headaches, or other physical symptoms from “holding it in”.
Seems “emotionally constipated”
Seems depressed
Seems to have very little emotion
Seems to hold anger in
Seems withdrawn
Tends to spend a lot of time alone
The “flighters” are in danger of destroying themselves emotionally from within. The “flighters” are like a balloon being constantly blown into, with no release valve. When they explode, their anger may be violent, and may lead to harming themselves, harming others, or destroying property. Internalized anger is potentially as destructive to a child as aggressive anger.
“The Pretenders”: Child Anger Silently Planning Revenge—
Perhaps the most difficult to detect, the “Pretenders” follow an anger style that seems to be calm on the surface, but is raging, scheming, and planning underneath. They are passive-aggressive. These children do not directly confront the anger as a “Fighter” would do. They will be passive and appear to accept what is said, and then will disregard what is said to do their own thing. They are sneaky. Often, they may be unnoticed. While they are giving a person a hug, they are also stabbing them in the back (so to speak). They lack the courage to be direct, and perfect the skills to be deceitful. They know where the “back door” to revenge is, and will use it often.
They will give the appearance of a “Flighter”. The list of “flighter” characteristics also applies to them. Additional items to look for with “Pretenders” are on the following list.
Inconsistency between what is said and what is done
May be very good at blaming others
May not admit mistakes
Often gets caught in lies
Sneaky behaviors
Tends to avoid direct conflict, while creating problems in other areas
Tends to sabotage
These warning signs are a few to look for the “Pretenders”. Aspergers and HFA children who try to manage their anger through the “Pretender” style are as potentially dangerous to others and themselves as the other style. Moms and dads cannot underestimate the “Pretender” style because the danger does not seem to be that of the aggressive “Fighter”.
As has been shown, anger comes in three main styles -- Fighter, Flighter, and Pretender -- and each style has the potential to create big problems for the Aspergers or HFA child, families, and society in general. This post has offered specific warning signs that may indicate if a child on the spectrum has an anger management problem more significant than what is to normally be expected. When necessary, professional and competent intervention is recommended.
Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders? Sign-up for Online Parent Coaching today.
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10 comments:
Anonymous said...
I have a question, is a child with asperger's able to kill an animal, such as a cat????
he was asked if it bothered him and he laughed and said, it made it little sister cry. And would they do these things because of jealousy of the sibling?
Thank you for your response.
Anonymous said...
if this were my child I would bring him in to his psychologist. I don't think its typical for any child of any ability to be harming animals...without a proper evaluation there is no way anyone here can answer this question...we would all be speculating. Ask a professional.
Anonymous said...
RUN to a professional, and if you don't think you found the right one for your child and family, keep looking. Abuse to animals is very serious, and often does not stop there. At this point, you might not know if your child did this out of frustration, anger, etc, or if he enjoys watching reactions (without any real malintent). Whatever the case, intervention is needed ASAP. If you are truly unsure he did it, you are at least acknowledging the possibility, so please don't get scared and back off. Even if he is not the culprit here, his reaction to the situation is not one you should be comfortable with. Blessings and good luck.
Anonymous said...
I agree with the above comments. I have an Asperger's son who has plenty of anger/aggressiveness issues, but he is always kind and loving to animals. He also gets very irritated with his younger siblings but is never cruel (he might yell at them, etc. if they are "bugging" him). I can't imagine him purposely doing something to make someone cry (unintentionally maybe). I think your child might have something going on besides Asperger's. Early intervention can help--I'd get started quickly!
Anonymous said...
I certainly wouldn't call this typical aspie behavior... I agree with Megan, RUN to a professional.
Anonymous said...
I found that although my daughter does not appear to connect with people emotionally, inherently she displays a lot of compassion for others. It might be an “Aspie like” trait to say something to a person unwittingly hurting the person’s feelings however I also found that strong emotional responses such as crying, laughing or yelling make an immediate impression on my daughter. If your son is displaying pleasure in seeing such a negative response that is something entirely different. Trait’s of Asperger’s is that the person does not identify with others feelings and/or does not know how to respond. Your son had a pleasurable response. Good luck.
Anonymous said...
cruelty to animals is a MAJOR red flag, part of the homicidal triad. RUN to a psychologist!!!
Anonymous said...
Did any of you even read the article that proceeds the comments? Hostility toward animals is a common problem with Aspie's, especially those who are "fighters". If you have an Aspie child, you should already be seeing a professional, so that's not the issue. The issue is understanding -- REALLY understanding -- the challenges your child is facing so that you can help him respond appropriately. To the OP: Whether your child killed the cat or not doesn't have to be determined. If he is a Pretender, he may pretend he did it even if he didn't. If he is a Fighter, maybe he did. Whatever. The point now is to give him every possible advantage by educating yourself and then teaching him HOW to better respond to his complex emotions. He doesn't feel or think the way you feel or think; don't expect him to. Ever. But DO expect him to LEARN appropriate, safe modes of expression. It takes time, patience, and persistence. In the meantime, don't add pets to your household. Your child needs CONSTANT supervision, and may always need it. My son turned 21 today, and I still spend 99% of my time "dealing" with the issues that result from being the parent of an Aspie. It's a commitment unlike anything you could ever even imagine, so buck up, educate yourself, and get down to the hard job of teaching this child what he needs to learn to survive in our cruel world. And DON'T rely on message boards as your source of information. Rely on the experts.
Anonymous said...
I actually am the one with AS and I was just looking at websites to better understand myself and my behaviors especially when I was little. I am a girl with AS who is now in her teenage years but when I was younger I was defiantly both a "fighter" and a " pretender". I still am in some ways but I have found that my temper is getting better as I am getting older.
Anonymous said...
I have a 15 year old with aspirers and lately he has been very fascinated with poronography. He ordered over $500 with of porno on his cell phone ( which has since been taken away) and ordered $600 of porno movies on my tv. Last night we got home and he had tries to rent another porno and he I told him no that is no acceptable and he hit me in the cheat very hard and left a bruise. I don't know what to do for him.
My Aspergers son has anger problems. How can I help him understand what his real emotions are?
Answer
For kids with Aspergers (high functioning autism), anger can be a major challenge. Many people do not realize the strong connection between Aspergers and behavioral issues like anger, anxiety, and depression. The very characteristics of Aspergers lead to these behavioral issues. Some of these characteristics are:
Gross and fine motor problems
Inflexible thinking
Lack of language skills, especially social language, gestures and cues
Narrow interests
Sensory issues
Social skills weaknesses
Understanding anger in Aspergers children is quite simple. Nearly all of your son’s anger stems from frustration. The characteristics of Aspergers listed above (plus others) create a confusing and uncomfortable social environment. The natural reaction is frustration, and the natural escalation of frustration is anxiety, then anger. Helping an Aspergers child understand his anger and other emotions, however, can be quite difficult. You must help your son understand the cause of his emotions, and then develop a plan to avoid the negative emotions that stem from frustration. There are several options available for the mother/father searching for anger-management for their Aspergers children. Here are a couple of those options:
1. Home Solutions— Not everyone with Aspergers anger issues choose private therapy. For some people, these therapies are not covered by insurance or are simply not available. Others choose to handle therapy and learning situations at home, in their own way. This is perfectly acceptable, and in all honesty, quite helpful for the child even if you do choose private therapy. Support at home will increase progress. Some examples of home solutions are:
Five point scale assessments teach a youngster how to recognize his anger or anxiety and prepare to control their emotional responses.
Parenting discipline programs teach parents how to use proper discipline techniques, which in turn, may diffuse some of the youngster’s anxiety and anger.
Play therapy/activities make learning emotional control fun.
Social stories can be written for specific behavioral problems and situations. These stories can put your youngster’s feelings into words and offer him simple solutions.
2. Cognitive-Behavioral Therapy— Many people with Aspergers anger choose to try cognitive-behavioral therapy. This therapy is highly recommended for kids with Aspergers. Cognitive-behavioral therapy is individual therapy designed around the idea that a child’s emotions and thought processes are what control that child’s outward feelings and behaviors. Most people tend to blame the situation or other people. This therapy places the focus on a child’s internal thoughts. In other words, if we think a certain way, even though the situation makes us feel the opposite, we can begin to feel better about that situation.
For your Aspergers child, anger can get in the way of learning, playing, and life. Perhaps you can use some of the above suggestions to help him handle his anger and better understand his emotions.
"I'm in desperate need of some strategies to deal with my Aspergers (high-functioning) son's anger. When he starts to stew about something, it's not long before all hell breaks loose. Any suggestions?!"
• American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Health
Disorders. 4th ed. Washington, DC: American Psychiatric Association. 1994.
• Anger Management for Substance Abuse and Mental Health Clients
• Barkley, R.A. (1997). Defiant Children: A Clinician’s Manual for Assessment and Parent
Training. 2nd ed. New York: Guilford Press.
• Beck, R., and Fernandez, E. (1998). Cognitive behavioral therapy in the treatment of anger: A
meta-analysis. Cognitive Therapy and Research, 22, 63-74.
• Berkowitz, L. (1970). Experimental investigations of hostility catharsis. Journal of Consulting
and Clinical Psychology, 35, 1-7.
• Carroll, K.M.; Rounsaville, B.J.; and Gawin, F.H. (1991). A comparative trial of psychotherapies
for ambulatory cocaine abusers: Relapse prevention and interpersonal psychotherapy.
American Journal of Drug and Alcohol Abuse, 17, 229-247.
• Clark, H.W.; Reilly, P.M.; Shopshire, M.S.; and Campbell, T.A. (1996). Anger management treat
ment in culturally diverse substance abuse patients. In: NIDA Research Monograph: Problems
of Drug Dependence, Proceedings of the 58th Annual Scientific Meeting, College on Problems
of Drug Dependence. Rockville, MD: National Institute on Drug Abuse.
• Deffenbacher, J.L. (1996). Cognitive behavioral approaches to anger reduction. In: Dobson,
K.S., and Craig, K.D. (Eds.), Advances in Cognitive Behavioral Therapy (pp. 31-62). Thousand
Oaks, CA: Sage Publications.
• Deffenbacher, J.L. (August 1999). Anger reduction interventions as empirically supported inter
vention programs. Paper presented at the 107th Annual Convention of the American
Psychological Association, Boston.
• Dobson, K.S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression.
Journal of Consulting and Clinical Psychology, 57, 414-419.
• Ducharme, J.M.; Atkinson, L.; and Poulton, L. (2000). Success-based, noncoercive treatment of
oppositional behavior in children from violent homes. Journal of the American Academy of
Child and Adolescent Psychiatry, 39(8), 995-1004.
• Edmondson, C.B., and Conger, J.C. (1996). A review of treatment efficacy for individuals with
anger problems: Conceptual, assessment, and methodological issues. Clinical Psychology
Review, 10, 251-275.
• Ellis, A. (1979). Rational-emotive therapy. In: Corsini, R. (Ed.), Current Psychotherapies (pp.
185-229). Itasca, Il: Peacock Publishers.
• Ellis, A., and Harper, R.A. (1975). A New Guide to Rational Living. N. Hollywood, CA: Wilshire
Books.
• Heimberg, R.G., and Juster, H.R. (1994). Treatment of social phobia in cognitive behavioral
groups. Journal of Clinical Psychology, 55, 38-46.
• Hoyt, M.F. (1993). Group therapy in an HMO. HMO Practice, 7, 127-132.
• Juster, H.R., and Heimberg, R.G. (1995). Social phobia: Longitudinal course and long-term out
come of cognitive behavioral treatment. Psychiatric Clinics of North America, 18, 821-842.
• Maude-Griffin, P.M.; Hohenstein, J.M.; Humfleet, G.L.; Reilly, P.M.; Tusel, D.J.; and Hall, S.M.
(1998). Superior efficacy of cognitive behavioral therapy for urban crack cocaine abusers: Main
and matching effects. Journal of Consulting and Clinical Psychology, 66, 832-837.
• Murray, E. (1985). Coping and anger. In: Field, T., McCabe, P., and Schneiderman, N. (Eds.),
Stress and Coping (pp. 243-261). Hillsdale, NJ: Erlbaum.
• Piper, W.E., and Joyce, A.S. (1996). A consideration of factors influencing the utilization of time-
limited, short-term group therapy. International Journal of Group Psychotherapy, 46, 311-328.
• Reilly, P.M., and Grusznski, R. (1984). A structured didactic model for men for controlling family
violence. International Journal of Offender Therapy and Comparative Criminology, 28, 223-235.
• Reilly, P.M., and Shopshire, M.S. (2000). Anger management group treatment for cocaine
dependence: Preliminary outcomes. American Journal of Drug and Alcohol Abuse, 26(2),
161-177.
• Reilly, P.M.; Clark, H.W.; Shopshire, M.S.; and Delucchi, K.L. (1995). Anger management, post-
traumatic stress disorder, and substance abuse. In: NIDA Research Monograph: Problems of
Drug Dependence, Proceedings of the 57th Annual Scientific Meeting (p. 322), College on
Problems of Drug Dependence. Rockville, MD: National Institute on Drug Abuse
• Reilly, P.M.; Shopshire, M.S.; and Clark, H.W. (1999). Anger management treatment for cocaine
dependent clients. In: NIDA Research Monograph: Problems of Drug Dependence, Proceedings
of the 60th Annual Scientific Meeting (p. 167), College on Problems of Drug Dependence.
Rockville, MD: National Institute on Drug Abuse.
• Reilly, P.M.; Shopshire, M.S.; Clark, H.W.; Campbell, T.A.; Ouaou, R.H.; and Llanes, S. (1996).
Substance use associated with decreased anger across a 12-week cognitive-behavioral anger
management treatment. In: NIDA Research Monograph: Problems of Drug Dependence,
Proceedings of the 58th Annual Scientific Meeting, College on Problems of Drug Dependence.
Rockville, MD: National Institute on Drug Abuse.
• Reilly, P.M.; Shopshire, M.S.; Durazzo, T.C.; and Campbell, T.A. (2002). Anger Management for
Substance Abuse and Mental Health Clients: Participant Workbook. Rockville, MD: Center for
Substance Abuse Treatment.
• Shopshire, M.S.; Reilly, P.M.; and Ouaou, R.H. (1996). Anger management strategies associat
ed with decreased anger in substance abuse clients. In: NIDA Research Monograph: Problems
of Drug Dependence, Proceedings of the 58th Annual Scientific Meeting (p. 226), College on
Problems of Drug Dependence. Rockville, MD: National Institute on Drug Abuse.
• Smokowski, P.R., and Wodarski, J.S. (1996). Cognitive behavioral group and family treatment of
cocaine addiction. In: The Hatherleigh Guide to Treating Substance Abuse, Part 1. (pp. 171-
189). New York: Hatherleigh Press.
• Straus, M.; Gelles, R.; and Steinmetz, S. (1980). Behind Closed Doors: Violence in the
American Family. Garden City, NY: Doubleday.
• Trafate, R.C. (1995). Evaluation of treatment strategies for adult anger disorders. In:
Kassinove, H. (Ed.), Anger Disorders: Definition, Diagnosis, and Treatment (pp. 109-130).
Washington, DC: Taylor and Francis.
• Van Balkom, A.J.L.M.; Van Oppen, P.; Vermeulen, A.W.A.; Van Dyck, R.; Nauta, M.C.E.; and Vorst,
H.C.M. (1994). A meta-analysis on the treatment of obsessive compulsive disorder: A compari
son of antidepressants, behavior, and cognitive therapy. Clinical Psychology Review, 14, 359-
381.
• Walker, L. (1979). The Battered Woman. New York: Harper & Row.
• Webster-Stratton, C., and Hammond, M. (1997). Treating children with early-onset conduct
problems: A comparison of child and parent training interventions. Journal of Consulting and
Clinical Psychology, 65(1), 93-109.
• Yalom, I.D. (1995). The Theory and Practice of Group Psychotherapy. 4th ed. New York: Basic
Books, Inc.
