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Anger in Children and Adolescents By Ronald J. Swatzyna, L.M.S.W.-A.C.P.

ANGER AND EMOTIONAL AROUSAL
Anger is an emotion. As with any emotion where intensity can vary, anger can range from slight disturbance to blind rage. The amount of energy generated by anger is proportionate to the intensity of the emotion. If channeled properly, this energy can be used to benefit the individual by, for example, providing a passion to counter life's injustices. On the other hand, if channeled improperly, anger and resentment can threaten the family and future generations.

Intense emotional displays of anger have a long-term impact on both children and parents, often resulting in physical, emotional and spiritual scars. Attention deficit hyperactivity conduct and oppositional defiant disorders are disruptive behaviors that account for the majority of referrals for psychotherapy intervention (Abikoff & Klien, 1992). If at any point in time a family will seek professional help, it is when angry, uncontrollable children are destroying the social fabric of the family.

Many approaches to therapy focus solely on the angry and disruptive child. However, this simplistic approach to treatment has a low rate of success. This article introduces a comprehensive, four-part anger-management therapy that the Tarnow CENTER is implementing to teach children and adolescents how to replace aggressive outbursts with appropriate expressions of anger. Based in part on research by Eva L. Feindler (1995), this multi-modal approach includes arousal-management training, cognitive restructuring, behavioral skills training and family skill development.

AROUSAL-MANAGEMENT TRAINING - CHANGING PHYSICAL RESPONSES
The immediate physiological response to anger increases activity in the endocrine, cardiovascular and skeletal muscular systems. As arousal increases, one experiences such symptoms as diminished blood flow, dry mouth and rapid heartbeat. It is well documented that long-term (chronic) physiological arousal (anger) depletes the immune system and inhibits the body's ability to ward off disease. Children and adolescents with chronic anger often have higher instances of acne, colds and respiratory infections. To counter the uncomfortable nature of chronic hyper-arousal, many adolescents will seek to soothe their emotions by self-medicating with mind-altering substances.

For these reasons, an effective anger-management intervention program must first focus on teaching skills to identify the onset of physiological arousal. Our chosen way to do this at the Tarnow CENTER is through biofeedback. Within a few sessions of this non-invasive process, one can move from awareness of the body's potentially harmful response to growing self-management skills that allow one to remain relatively calm and controlled when faced with conflict. Using biofeedback for relaxation training provides an efficacious way to master physiological arousal in the beginning stage. In doing so, it breaks the destructive cycle of anger before it has an opportunity to gain strength and take control of the individual.

COGNITIVE RESTRUCTURING - CHANGING PERCEPTIONS
The next critical component of a comprehensive anger-management program is concerned with children's perception and appraisal of anger-provoking events. Lochman and Lenhart (1993) refer to children's misperceptions as distortions in social information processing. Several years ago an ABC News special, Teens, What Makes Them Tick, demonstrated how teens perceive facial expressions differently than adults, and the younger the teen, the greater the perceptional difference. Therefore, valuable non-verbal clues that we as adults pick up in our social interactions (sadness, anger, disappointment, fear, etc.), appear incomprehensible or misrepresented in the child's perception.

The cognitive restructuring component of the Tarnow CENTER approach to anger-management includes training to help children and adolescents be more successful in evaluating the feelings and intentions of others as aggressive, non-aggressive, neutral or accidental.

BEHAVIORAL SKILLS TRAINING - CHANGING ACTIONS
Although changing behavior is the focus of many anger-management programs, the reality is that children with disruptive behavior have deficits in specific areas such as assertiveness, communication, problem solving, and other social skills. Their disruptive behavior is a usually successful means to get what they want, but stopping the behavior without self-management skills leaves them defenseless.

The social skills needed to take the place of disruptive behaviors are effective communication, conflict resolution, cooperation with others, decision-making and problem solving according to Goldstein et al. (1987). As part of the team approach to anger- management, the Tarnow CENTER offers numerous groups at both our Galleria and Sugar Land offices for children and teens to develop these skills in a safe environment with their peers. In similar settings, this type of program has shown a reduction in the frequency and intensity of aversive, angry, and aggressive behaviors.

FAMILY INVOLVEMENT - CHANGING RELATIONSHIPS
When combined with the other three components of the Tarnow CENTER model, family involvementis vital tosuccessful treatment of chronic anger in children and adolescents. In their work on aggressive conduct, Patterson and Bank (1989) hypothesized that behavior patterns develop "via a series of social exchanges that are initiated in the home environment". It appears, therefore, that a "family problem" cannot be "fixed" by addressing only one component. The parents and siblings have all participated in creating this "problem" by reinforcing disruptive behavior. Making allowancesfor children's misbehavior (reduction of boundaries) when they are young seems appropriate in light of the guilt parents feel over divorce, long work hours, or a variety of perceived shortcomings. As a child grows in anger and physical size, guilt of the parent is replaced by fear, and disruptive behavior becomes ingrained.

Working for years in an inpatient adolescent psychiatric unit, I found it very interesting how quickly a child's "out-of-control" behavior improved once indoctrinated to the unit's structure, rules and boundaries. Unfortunately, parents who refused to take an active role in treatment (including family therapy) saw their child reverting back to "out-of-control" behavior very soon after being discharged. This resulted in multiple inpatient admissions, usually with an escalation of violence.

THERE IS HOPE
Albert Bandura's social learning theory posits that approximately 80 percent of behavior is learned. The good thing is that it can also be "unlearned." With the multi-modal approach available at the Tarnow CENTER, the treatment of chronic anger in children and teens has the best opportunity to be successful.