Keeping Control of Anger

Youth with mild intellectual disabilities and borderline intellectual functioning (hereby referred to as Mild to Borderline Intellectual Disabilities, or MBID; youth with an IQ between 50 and 85 and deficits in adaptive behavior) display more behavior problems (e.g., oppositional defiant and aggressive behavior) than children without MBID, and these behavior problems are more likely to persist later in life. However, research into interventions specifically for youth with MBID is limited. Such specific interventions are needed, because standard intervention protocols may be less suitable for youth with MBID and behavior problems, due to their limited cognitive abilities and other social and psychological risk factors. Therefore, a new school-based targeted prevention program called Keeping Control of Anger, designed specifically for youth (between 9 and 14 years old) with MBID and behavior problems, has been developed, based on an evidence based intervention for children without MBID.

The study is a randomized controlled trial with two conditions and four repeated measures. Schools are randomly assigned to either the intervention condition or the control condition (care-as-usual). Participants are youth with limited cognitive functioning, congruent with MBID and elevated behavior problems between 9 and 14 years old.

The first aim of this study is to test the effectiveness of the school-based targeted prevention program for youth with mild intellectual disabilities and behavior problems (e.g., aggressive and oppositional defiant behavior) at reducing behavior problems. It is expected that the intervention is effective in reducing behavior problems, compared to a care-as-usual control group.

The second aim is to examine mediating variables. It is expected that social information processing and emotion regulation mediate the intervention effectiveness.

The third aim is to investigate moderating variables. It is expected that variables such as demographic variables, IQ, initial level of problems, and therapy factors (i.e., treatment integrity, therapeutic alliance, client comprehension, client motivation, and client involvement) moderate the intervention effectiveness.

Four: pre-intervention, during the intervention, post-intervention, 4 to 6 month follow-up

Keeping Control of Anger consists of one individual session and ten group sessions (3-5 youth per group) led by a trainer (mental health professional either employed by or working at the special education school) and a co-trainer ([remedial] teacher at the school). The targeted prevention program uses CBT-techniques such as cognitive restructuring, emotion-education, role playing, and modeling. Specific adaptions have been made to tailor the program to the needs of youth with MBID (e.g., set session structure, pictorial aids, limited and easy text, repetition of learned skills, and use of videos to make hypothetical situations more life-like and to limit the amount of reading). Homework exercises are given after most sessions and these are discussed in the following session. A month after the tenth session, a booster session is given.