A review of the assessment and treatment of anger and aggression in offenders with intellectual disability.
For offenders with ID and aggression, skip the pills and run behavior-based or CBT programs instead.
01Research in Context
What this study did
Taylor (2002) read every paper on anger and aggression in offenders with intellectual disability. The author looked at three kinds of treatment: pills, behavior plans, and CBT. No new data were collected; this was a narrative review that weighed the old evidence.
What they found
Pills for aggression came up empty. There was no solid proof that psychotropic drugs help. Behavior plans looked hopeful, but most studies were done in hospitals, not real-life settings. CBT worked in some stories, yet nobody knew exactly why.
How this fits with other research
Later reviews keep saying the same thing. Cudré-Mauroux (2010) calls antipsychotic use for aggression in ID 'mistreatment' unless true psychosis is present. Willner (2015) finds only risperidone has any signal, and even that is weak. Matson et al. (2009) again urge functional assessment first and pills last. Together these four papers form a clear line: drugs lack evidence, so try something else.
Rose et al. (2000) gives the 'something else.' Their group anger-management program cut aggression in adults with ID, and the gains lasted a full year. The 2002 review predicted behavioral methods would win; the 2000 trial shows they can.
No true contradiction appears. The early trial and later reviews all push the same direction—behavior first, pills only when medically needed.
Why it matters
If you write behavior plans for adults with ID in forensic or day settings, treat this paper as your stop-sign for medication referrals. Start with a functional assessment, teach replacement skills, and use group CBT when possible. Share the review chain with prescribers to keep antipsychotics off the table unless psychosis is documented.
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02At a glance
03Original 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.
Journal of intellectual disability research : JIDR, 2002 · doi:10.1046/j.1365-2788.2002.00005.x