Re: Evaluation of a Children's Temper-Taming Program

Abstract

We are prompted to write a response to the recently published article by Williams and others (1). These authors describe a brief cognitive-behavioural intervention for young children with anger control difficulties (called kNOw Problem Pathway). This program consists of 8 weekly 1-hour sessions for the children and 3 sessions for their parents. Although the research design used in this study did not include random assignment, the authors were nonetheless able to offer convincing, statistically significant, pre- to posttest changes in the relevant measures. The methods used in the kNOw Problem Pathway are very similar to a program that has been in place for nearly 20 years at the Child Development Institute (CDI, formerly Earlscourt Child and Family Centre). Our program is named Stop Now and Plan (SNAP(TM), 2). Both programs rely heavily on, first, making children cognitively and physiologically aware of their emotional responses to situations that may trigger aggressive behaviour and, second, training them to respond effectively by making choices that will reduce their problems. Williams and others refer to this as choosing it over losing it. In SNAP(TM) this is referred to as the critical moment when children have the choice of making their problems smaller or bigger. In recent years, ongoing research at CDI has led us to conclude that better treatment effects can be demonstrated with sex-specific interventions. As such, we currently offer the Under 12 Outreach Program for boys in conflict with the law and the Girls Connection for girls with disruptive behaviour problems. We recognize that, although there are many similarities in the development of boyhood and girlhood aggression, differences that warrant our clinical and research attention also exist (see 3). Using standardized measures (for example, the Child Behavior Checklist; 4), we have been able to demonstrate significant pre- to posttreatment improvements for these multifaceted, family-focused interventions, with medium to large effect sizes (for example, 5 and 6). As well, our programs are manualized (for example, SNAP(tm) Children's Group Manual; 7) and monitored for integrity of treatment delivery. Williams and others are correct to point out that longer term follow-up would help determine whether the reduction in anger and aggression is sustainable over time (1, p 611). When we followed some 447 of our former boys and girls into adolescence and adulthood, we discovered that, our efforts notwithstanding, 41% were subsequently found guilty of a crime 10 years after completing the program. Unfortunately, we do not know what proportion of individuals subsequently received care in the civil or forensic mental health systems. Williams and others' paper adds impetus to the challenge of evaluating the effectiveness of these kinds of interventions over the long term (1). What is encouraging is that impulse-control programs like the kNOw Problem Pathway and SNAP(TM) are now sufficiently well-defined to be researched. Continuous evaluation and rigorous research on the risk factors that predict antisocial outcomes will assist in the targeting of children and families who will most likely benefit from these and other interventions.