Different Factors Influence Self-Reports and Third-Party Reports of Anger by Adults with Intellectual Disabilities
John Rose
School of Psychology, University of Birmingham, Birmingham, UK
Black Country Foundation Partnership Trust, Stourbridge, UK
Search for more papers by this authorCorresponding Author
Paul Willner
Psychology Department, College of Human and Health Sciences, Swansea University, Swansea, UK
Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath, UK
Correspondence
Any correspondence should be directed to Professor Paul Willner, Psychology Dept, Swansea University, Singleton Park, Swansea SA2 8PP, UK (e-mail: [email protected]).
Search for more papers by this authorJennifer Shead
Black Country Foundation Partnership Trust, Stourbridge, UK
Search for more papers by this authorAndrew Jahoda
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Search for more papers by this authorDavid Gillespie
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorJulia Townson
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorClaire Lammie
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Search for more papers by this authorChristopher Woodgate
Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath, UK
Search for more papers by this authorBiza Stenfert Kroese
School of Psychology, University of Birmingham, Birmingham, UK
Search for more papers by this authorDavid Felce
Psychological Medicine and Neurology, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorPamela MacMahon
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Search for more papers by this authorNikki Rose
Black Country Foundation Partnership Trust, Stourbridge, UK
Search for more papers by this authorAimee Stimpson
Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath, UK
Search for more papers by this authorJacqueline Nuttall
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorKerenza Hood
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorJohn Rose
School of Psychology, University of Birmingham, Birmingham, UK
Black Country Foundation Partnership Trust, Stourbridge, UK
Search for more papers by this authorCorresponding Author
Paul Willner
Psychology Department, College of Human and Health Sciences, Swansea University, Swansea, UK
Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath, UK
Correspondence
Any correspondence should be directed to Professor Paul Willner, Psychology Dept, Swansea University, Singleton Park, Swansea SA2 8PP, UK (e-mail: [email protected]).
Search for more papers by this authorJennifer Shead
Black Country Foundation Partnership Trust, Stourbridge, UK
Search for more papers by this authorAndrew Jahoda
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Search for more papers by this authorDavid Gillespie
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorJulia Townson
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorClaire Lammie
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Search for more papers by this authorChristopher Woodgate
Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath, UK
Search for more papers by this authorBiza Stenfert Kroese
School of Psychology, University of Birmingham, Birmingham, UK
Search for more papers by this authorDavid Felce
Psychological Medicine and Neurology, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorPamela MacMahon
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
Search for more papers by this authorNikki Rose
Black Country Foundation Partnership Trust, Stourbridge, UK
Search for more papers by this authorAimee Stimpson
Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath, UK
Search for more papers by this authorJacqueline Nuttall
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorKerenza Hood
South East Wales Trials Unit, Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
Search for more papers by this authorAbstract
Background
Many people with intellectual disabilities display high levels of anger, and cognitive-behavioural anger management interventions are used routinely. However, for these methods to be used optimally, a better understanding is needed of different forms of anger assessment. The aim of this study was to investigate the relationship of a range of measures to self- and carer reports of anger expression, including instruments used to assess mental health and challenging behaviour.
Method
Adults with intellectual disabilities, who had been identified as having problems with anger control, their key-workers and home carers all rated the service users’ trait anger, using parallel versions of the same instrument (the Provocation Inventory). In addition, service users completed a battery of mental health assessments (the Glasgow Depression Scale, Glasgow Anxiety Scale and Rosenberg Self-Esteem Scale), and both groups of carers completed a battery of challenging behaviour measures (the Hyperactivity and Irritability domains of the Aberrant Behavior Checklist and the Modified Overt Anger Scale).
Results
Participants had high levels of mental health problems (depression: 34%; anxiety: 73%) and severe challenging behaviour (26%). Hierarchical linear regression analysis was used to explore the extent to which anger ratings by the three groups of respondents were predicted by demographic factors, mental health measures and challenging behaviour measures. Older service users rated themselves as less angry and were also rated as less angry by home carers, but not by key-workers. More intellectually able service users were rated as more angry by both sets of carers, but not by the service users themselves. Significantly, mental health status (but not challenging behaviour) predicted service users’ self-ratings of anger, whereas challenging behaviour (but not mental health status) predicted carers’ ratings of service users’ anger.
Conclusions
Service users and their carers appear to use different information when rating the service users’ anger. Service users’ self-ratings reflect their internal emotional state and mental health, as reflected by their ratings of anxiety and depression, whereas staff rate service users’ anger on the basis of overt behaviours, as measured by challenging behaviour scales.
References
- Allen D., Lowe K., Brophy S. & Moore K. (2007) Predictors, costs and characteristics of out of area placements for people with intellectual disability and challenging behaviour. Journal of Intellectual Disability Research 51, 409–416.
- Aman M. G., Singh N. N., Stewart A. W. & Field C. J. (1985) The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. American Journal on Mental Deficiency 89, 485–491.
- Balsamo M. (2010) Anger and depression: evidence of a possible mediating role for rumination. Psychological Reports 106, 3–12.
- Benson B. A. & Brooks W. (2008) Aggressive challenging behaviour and intellectual disability. Current Opinion in Psychiatry 21, 454–458.
- Benson B. A. & Ivins J. (1992) Anger, depression and self-concept in adults with mental retardation. Journal of Intellectual and Developmental Disability 36, 169–175.
- Borthwick-Duffy S. A. (1994a) Epidemiology and prevalence of psychopathology in people with mental retardation. Journal of Consulting and Clinical Psychology 62, 17–27.
- Borthwick-Duffy S. A. (1994b) Prevalence of destructive behaviors. In: Destructive Behavior in Developmental Disabilities: Diagnosis and Treatment (eds T. Thompson & D. B. Gray), pp 3–23. Sage, Thousand Oaks, CA, USA.
- Bramston P. & Fogarty G. (2000) The assessment of emotional distress experienced by people with an intellectual disability: a study of different methodologies. Research in Developmental Disabilities 21, 487–500.
- Crocker A. G., Mercier C., Lachapelle Y., Brunet A., Morin D. & Roy M.-E. (2006) Prevalence and types of aggressive behaviour among adults with intellectual disabilities. Journal of Intellectual Disability Research 50, 652–661.
- Cuthill F. M., Espie C. A. & Cooper S.-A. (2003) Development and psychometric properties of the Glasgow Depression Scale for people with a learning disability: individual and carer supplement versions. British Journal of Psychiatry 182, 347–353.
- Dagnan D. & Sandhu S. (1999) Social comparison, self-esteem and depression in people with intellectual disability. Journal of Intellectual Disability Research 43, 372–379.
- Dagnan D., Grant F. & McDonnell A. (2004) Understanding challenging behaviour in older people: the development of the controllability beliefs scale. Behavioural and Cognitive Psychotherapy 32, 501–506.
- Davis J. P., Judd F. K. & Herrman H. (1997) Depression in adults with intellectual disability. Part 1: A review. Australian and New Zealand Journal of Psychiatry 31, 232–242.
- Deb S., Thomas M. & Bright C. (2001) Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. Journal of Intellectual Disability Research 45, 495–505.
- Dilworth J., Phillips N. & Rose J. (2011) Factors relating to staff attributions of control over challenging behaviour. Journal of Applied Research in Intellectual Disabilities 24, 29–38.
- Eaton L. F. & Menolascino F. J. (1982) Psychiatric disorders in the mentally retarded: types, problems and challenges. American Journal of Psychiatry 139, 1297–1303.
- Emerson E., Robertson J., Dorr H., Russell P., Spencer K., Davies I., Felce D., Allen D., Churchill J., Rose S., Maguire S., Hatton C., Madden P., Mills R., McIntosh B. & Congdon D. (2008) Commissioning Person Centred, Cost Effective. Local Support for People with Learning Difficulties, Social Care Institute for Excellence, London.
- Felce D. & Kerr M. (2012) Investigating low adaptive behaviour and presence of the triad of impairments as indicators of risk for challenging behaviour among adults with intellectual disabilities. Journal of Intellectual Disability Research 57, 128–138.
- Felce D., Kerr M. & Hastings R. P. (2009) A general practice based study of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities. Journal of Intellectual Disability Research 53, 243–254.
- Felce D., Perry J., Lowe K. & Jones E. (2011) The impact of autism or severe challenging behaviour on lifestyle outcome in community housing. Journal of Applied Research in Intellectual Disabilities 24, 95–104.
- Ghazinour M. & Richter J. (2009) Anger related to psychopathology, temperament, and character in healthy individuals – an explorative study. Social Behavior and Personality 37, 1197–1212.
- Gross J. J., Carstensen L. L., Pasupathi M., Tsai J., Skorpen C. G. & Hsu A. Y. C. (1997) Emotion and aging: experience, expression, and control. Psychology and Aging 12, 590–599.
- Hagiliassis N., Gulbenkoglu H., Di Marco M., Young S. & Hudson A. (2005) The anger management project: a group intervention for anger in people with physical and multiple disabilities. Journal of Intellectual and Developmental Disability 30, 86–96.
- Hatton C., Emerson E., Robertson J., Gregory N., Kessissoglou S., Perry J., Felce D., Lowe K., Walsh P. N., Linehan C. & Hillery J. (2001) The adaptive behavior scale – residential and community (Part I) – development of a short form. Research in Developmental Disabilities 22, 273–288.
- Holden B. & Gitlesen J. P. (2006) A total population study of challenging behaviour in the county of Hedmark, Norway: prevalence and risk markers. Research in Developmental Disabilities 27, 456–465.
- Hull L., Farrin L., Unwun C., Everitt B., Wykes T. & David A. S. (2003) Anger, psychopathology and cognitive inhibition: a study of UK servicemen. Personality and Individual Differences 35, 1211–1226.
- Hurley A. D. (2008) Depression in adults with intellectual disability: symptoms and challenging behaviour. Journal of Intellectual Disability Research 52, 905–916.
- Jenkins R., Rose J. & Lovell C. (1997) Psychological well-being of staff working with people who have challenging behaviour. Journal of Intellectual Disability Research 41, 502–511.
- King N., Lancaster N., Wynne G., Nettleton N. & Davies R. (1999) Cognitive-behavioural anger management training for adults with mild intellectual disability. Scandinavian Journal of Behaviour Therapy 28, 19–22.
10.1080/028457199440098 Google Scholar
- Lindsay W. R., Allan R., Parry C., MacLeod F., Cottrell J., Overend H. & Smith A. H. W. (2004) Anger and aggression in people with intellectual disabilities: treatment and follow-up of consecutive referrals and a waiting list comparison. Clinical Psychology and Psychotherapy 11, 255–264.
- Lowe K., Allen D., Jones E., Brophy S., Moore K. & James W. (2007) Challenging behaviours: prevalence and topographies. Journal of intellectual Disability Research 51, 625–636.
- MacKinlay L. & Langdon P. E. (2009) Staff attributions towards men with intellectual disability who have a history of sexual offending and challenging behaviour. Journal of Intellectual Disability Research 53, 807–815.
- Mahon N. E., Yarcheski A., Yarcheski T. J. & Hanks M. M. (2010) A meta-analytic study of predictors of anger in adolescents. Nursing Research 59, 178–184.
- McClintock K., Hall S. & Oliver C. (2003) Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study. Journal of intellectual Disability Research 47, 405–416.
- McConatha J. T., Leone F. M. & Armstrong J. M. (1997) Emotional control in adulthood. Psychological Reports 80, 499–507.
- Meins W. (1995) Symptoms of major depression in mentally retarded adults. Journal of Intellectual Disability Research 39, 41–45.
- Mental Health Foundation (2008) Boiling Point. Available at: www.mentalhealth.org.uk (accessed on 13 Feburary 2013).
- Mills S. & Rose J. (2011) The relationship between challenging behaviour, burnout and cognitive variables in staff working with people who have intellectual disabilities. Journal of Intellectual Disability Research 55, 844–857.
- Mindham J. & Espie C. A. (2003) Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability. Journal of Intellectual Disability Research 47, 22–30.
- Moss S., Emerson E., Kiernan C., Turner S., Hatton C. & Alborz A. (2000) Psychiatric symptoms in adults with learning disability and challenging behaviour. The British Journal of Psychiatry 177, 452–456.
- Novaco R. W. (1994) Anger as a risk factor for violence among the mentally disordered. In: Violence and Disorder: developments in Risk Assessment (eds J. Monahan & H. J. Streadman), pp 21–59. University of Chicago Press, Chicago.
- Novaco R. W. (2003) Anger and Psychopathology. In: International Handbook of Anger (eds M. Potegal & G. Stemmler), pp 465–497. Springer, New York.
- Oliver P. C., Crawford M. J., Rao B., Reece B. & Tyrer P. (2007) Modified Overt Aggression Scale (MOAS) for people with intellectual disability and aggressive challenging behaviour: a reliability study. Journal of Applied Research in Intellectual Disabilities 20, 368–372.
- Painuly N., Sharan P. & Mattoo S. K. (2005) Relationship of anger and anger attacks with depression: a brief review. European Archives of Psychiatry and Clinical Neuroscience 255, 215–222.
- Phillips L. H., Henry J. D., Hosie J. A. & Milne A. B. (2006) Age, anger regulation and well-being. Aging and Mental Health 10, 250–256.
- Riediger M., Voelkle M. C., Ebner N. C. & Lindenberger U. (2011) Beyond “happy, angry, or sad?”: age-of-poser and age-of-rater effects on multi-dimensional emotion perception. Cognition and Emotion 25, 968–982.
- Robertson J., Emerson E., Pinkney L., Caesar E., Felce D., Meek A., Carr D., Lowe K., Knapp M. & Hallam A. (2004) Quality and costs of community-based residential supports for people with mental retardation and challenging behavior. American Journal on Mental Retardation 109, 332–344.
- Rose J. (2010) Carer reports of the efficacy of cognitive behavioural interventions for anger. Research in Developmental Disabilities 31, 1502–1508.
- Rose J. & Gerson D. F. (2009) Assessing anger in people with intellectual disabilities. Journal of Intellectual and Developmental Disabilities 34, 116–122.
- Rose J., Jones F. & Fletcher B. (1998) Investigating the relationship between stress and worker behaviour. Journal of Intellectual Disability Research 42, 163–172.
- Rose J., West C. & Clifford D. (2000) Group interventions for anger in people with intellectual disabilities. Research in Developmental Disabilities 21, 171–181.
- Rose J., Loftus M., Flint B. & Carey L. (2005) Factors associated with the efficacy of a group intervention for anger in people with intellectual disabilities. British Journal of Clinical Psychology 44, 305–317.
- Rose J., Dodd L. & Rose N. (2008) Individual cognitive behavioural intervention for anger. Journal of Mental Health Research in Intellectual Disabilities 1, 97–108.
- Rose J., O'Brien A. & Rose D. (2009) Group and individual cognitive behavioural interventions for anger. Advances in Mental Health and Learning Disabilities 3, 45–50
10.1108/17530180200900039 Google Scholar
- Schieman S. (1999) Age and anger. Journal of Health and Social Behavior 40, 273–289.
- Schieman S. (2010) The sociological study of anger: basic social patterns and contexts. In: International Handbook of Anger: Constituent and Concomitant Biological, Psychological, and Social Processes (eds M. Potegal, G. Stemmler & C. Spielberger), pp 329–348. Springer, New York.
- Stenfert Kroese B., Jahoda A., Pert C., Trower P., Dagnan D. & Selkirk M. (2013) Staff expectations and views of cognitive behaviour therapy (CBT) for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities (in press).
- Tangney J. P., Hill-Barlow D., Wagner P. E., Marshall D. E., Borenstein J. K., Sanftner J., Borenstein T. & Gramzow R. (1996) Assessing individual differences in constructive versus destructive responses to anger across the life-span. Journal of Personality and Social Psychology 70, 780–796.
- Taylor J. L., Novaco R. W., Gillmer B. & Thorne I. (2002) Cognitive-behavioural treatment of anger intensity among offenders with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities 15, 151–165.
- Taylor J. L., Novaco R. W., Guinan C. & Street N. (2004) Development of an imaginal provocation test to evaluate treatment for anger problems in people with intellectual disabilities. Clinical Psychology and Psychotherapy 11, 233–246.
- Taylor J. L., Novaco R. W., Gillmer B. T., Robertson A. & Thorne I. (2005) Individual cognitive-behavioural anger treatment for people with mild-borderline intellectual disabilities and histories of aggression: a controlled trial. British Journal of Clinical Psychology 44, 367–382.
- Taylor J. L., Lindsay W. R. & Willner P. (2008) CBT for people with intellectual disabilities: emerging evidence, cognitive ability and IQ effects. Behavioural and Cognitive Psychotherapy 36, 723–734.
- Thomas S. P. (1995) Women's anger: causes, manifestations, and correlates. In: Stress and Emotion: Anxiety, Anger, and Curiosity (eds C. D. Spielberger & I. G. Sarason), pp 53–74. Taylor & Francis, Washington, DC.
- Thomas S. P. (2002) Age differences in anger frequency, intensity, and expression. Psychiatr Nurses Association 8, 44–50.
10.1067/mpn.2002.124412 Google Scholar
- Tynan H. & Allen D. (2002) The impact of service user cognitive level on carer attributions for aggressive behaviour. Journal of Applied Research in Intellectual Disabilities 15, 213–223.
- Tyrer C. W., McGrother C. F., Thorp M., Donaldson S., Bhaumik J. M., Watson J. M. & Hollin C. (2006) Physical aggression towards others in adults with learning disabilities: prevalence and associated factors. Journal of Intellectual Disability Research 50, 295–304.
- Voelker S. K., Shore D. L., Brown-Moore C., Hill L. C., Miller L. T. & Perry J. (1990) Validity of self-report of adaptive behaviour skills by adults with mental retardation. Mental Retardation 28, 305–309.
- Willner P. (2007) CBT for people with intellectual disabilities: focus on anger. Advances in Mental Health and Learning Disabilities 1, 14–21.
10.1108/17530180200700015 Google Scholar
- Willner P., Jones J., Tams R. & Green G. (2002) A randomised controlled trial of the efficacy of a cognitive-behavioural anger management group for adults with learning disabilities. Journal of Applied Research in Intellectual Disabilities 15, 224–235.
- Willner P., Brace N. & Phillips J. (2005) Assessment of anger coping skills in individuals with intellectual disabilities. Journal of Intellectual Disability Research 49, 329–339.
- Willner P., Jahoda A., Rose J., Stenfert-Kroese B., Hood K., Townson J., Nuttall J., Gillespie D. & Felce D. (2011) Anger management for people with mild to moderate learning disabilities: study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff. Trials 12, 36.
