Training Curbs Anger and Aggression in Adolescents With Tourette Syndrome

New Haven, Conn. — In the first study to gauge the benefits of anger control training in adolescents with Tourette syndrome (TS), researchers at the Yale Child Study Center have found that cognitive behavioral therapy is helpful for short-term improvement in anger and aggression. The study is reported in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Children and adolescents with TS, a disorder characterized by tics—involuntary, rapid, sudden movements and vocalizations occurring repeatedly in the same way—should also be evaluated for the presence of disruptive behavior problems, according to lead author Denis Sukhodolsky, associate research scientist in the Yale Child Study Center. “In some cases, these disruptive behavior problems can cause more impairment than tics,” he said. “If disruptive behavior is present, cognitive behavioral interventions such as anger control training could be recommended to reduce the levels of aggression.”

Sukhodolsky and his team studied 26 children and adolescents with TS (24 boys and two girls between the ages and 11 and 15) with moderate to severe levels of oppositional and defiant behavior. They were randomly assigned to a group that received 10 sessions of anger management or to a control group that received their usual treatment for 10 weeks.

When faced with frustrating situations during anger control training, the children role-played appropriate behavior. They were asked to identify and evaluate the consequences of various actions for themselves and others who were involved in hypothetical conflicts. The children were also asked to recall frustrating situations and to problem-solve and role play behavior that would have diffused the problem. They also completed homework to practice “anger coping” skills and share their experiences at the next session.

At the end of treatment, parents reported that disruptive behavior decreased by 52 percent in the anger management group, compared with a decrease of 11 percent in the control group. Clinicians who were unaware of the treatment rated 69 percent of the children who completed anger management training as improved compared with 15 percent in the control group. Sukhodolsky said this improvement was well maintained at a three-month follow-up. He and colleagues plan to conduct larger clinical trials to confirm their results.

The study is part of a clinical research program directed by Professor Lawrence Scahill to develop and test interventions for children and adolescents.

Other authors on the study were Lawrence Vitulano, Deidre H. Carroll, Joseph McGuire, and James Leckman, M.D.

Citation: J. Am, Acad. Child Adolesc. Psychiatry, 48: 4 (April, 2009)