Students: Carina van der Merwe Jacqueline van Druten Janine Herholdt Lucinda Putter Maureen Taylor Monique Chelin Tarina Buitendag

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June Pearson
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1 Students: Carina van der Merwe Jacqueline van Druten Janine Herholdt Lucinda Putter Maureen Taylor Monique Chelin Tarina Buitendag Study leader: Co-study leader: Biostatistician: Mrs. E. Janse van Rensburg Mrs. R. Hattingh Mr. C. van Rooyen

3 Violent acts & aggressive behaviour primary symptom of conduct disorder (Mathias, Stanford et al. 2007:231) Strongest predictor of criminality (Huesmann, Eron and Dubow 2002:204) Conduct Disorder: Diagnosed before 18 years Repetitive and persistent patterns (anti-social & aggressive behaviour)

4 Deal with anger With Conduct Disorder have impaired Difficulty regulating anger Effectively Socio-affective processing Aggressive behaviour Express in socially acceptable manner Cognitive control

Trigger Bandura s YALOM S CURATIVE theory of FACTORS self-efficacy (Bandura 1999 in Brown 2011:332) Catharsis Universality (uninhibited Group Yalom s curative factors (Yalom and Leszcz 2005:1-18)

Environment Drumming Anger Behavioural responses Aggressive behaviour Constructive behaviour Physical aggression Direct verbal aggression Indirect aggression Social change BANDURA S THEORY OF

responsibility Less effective for Conduct Disorder Modelling Emotional regulatory & Social skills Berkowitz 1993:20; Kassinove and Sukhodolsky 1995 in Eckhardt, Norlander and Deffenbacher 2004:20;

5 Trigger Bandura s YALOM S CURATIVE theory of FACTORS self-efficacy (Bandura 1999 in Brown 2011:332) Catharsis Universality (uninhibited Group Yalom s curative factors (Yalom and Leszcz 2005:1-18) Group expression cohesion of emotion) Drumming as an occupation (Reed and Sanderson 1999:38) (Yalom and Leszcz 2005:1-18) (Yalom and Leszcz 2005:1-18) Cognitive process Physiological arousal Environment Drumming Anger Behavioural responses Aggressive behaviour Constructive behaviour Physical aggression Direct verbal aggression Indirect aggression Social change BANDURA S THEORY OF DRUMMING AS AN OCCUPATION Cognitive Behavioural Therapy (CBT): SELF-EFFICACY Increased self awareness Mastery Most common intervention Social Positive persuasion emotional state Sense of responsibility Less effective for Conduct Disorder Modelling Emotional regulatory & Social skills Berkowitz 1993:20; Kassinove and Sukhodolsky 1995 in Eckhardt, Norlander and Deffenbacher 2004:20; O Neill 1995:427; (Vorster 2012:541) (Bandura Eckhardt, 1999 Norlander in in Brown and Defenbacher 2011:332) 2004:20; Grogan, 1991: ; (Reed and Taylor Sanderson 1988:149; 1999:38) Macintosh 2003: and Liu 2006:4

6 This study aimed to determine the short term effect of a group drumming intervention on aggressive behaviour among adolescent girls diagnosed with conduct disorder.

7 Where Permission School in Free State Adolescent girls Diagnosed with Conduct disorder DoE Principal legal guardian (consent) Ethical approval (Faculty of Health Sciences) (Reference no ). Facilitators Researchers attended training program (drumming) Study design Experimental randomized pre-test post-test control group design The Aggression Scale (Orpinas & Frankowski 2001:50) Measurement instrument Standardized self report measure Total aggressive acts

Total population (n=104) Matriculants Diagnosed

Eligible (n=68) Older than 18 (n=23) Epilepsy (n=1)

Study participant participant (n=32) Control Control

sport Control Experimental group: group (Atay(n=8)

group with (n=8) daily Randomized Intervention

Intervention (n=16) between hostels Drumming

aims Checklist: Control Hawthorne group: 3 weeks 2

between 3 effect drumming sessions (McCambridge,

8 Total population (n=104) Matriculants Diagnosed (n=10) Pre-test with conduct Mid-year disorder exams Eligible (n=68) Older than 18 (n=23) Epilepsy (n=1) No assent (n=2) Matching Sampling Criteria Study Study participant participant (n=32) Control Control group Pre-test Experimental (n=16) Scores Type of sport Control Experimental group: group (Atay(n=8) 2013:169) (n=16) Stratified Participants Continued group with (n=8) daily Randomized Intervention (n=32) activities Experimental 3 researchers moved Intervention (n=16) between hostels Drumming Program: 10 Drumming limit Theory-based Free time aims Checklist: Control Hawthorne group: 3 weeks 2 Facilitators Ensure sessions Post-test consistency between 3 effect drumming sessions (McCambridge, Witton and Piloted on matriculants 2 drumming groups Ethical Elbourne 2014:267) reasons

9 Age range years Median = 15,8 years Racial distribution 15% 39% 46% Black (n=12) Coloured (n=10) White (n=4)

10 CONTROL GROUP EXPERIMENTAL GROUP 95% CI [ -16 ; 6 ] BEFORE INTERVENTION Median Median % CI [ -13 ; 5 ] 95% CI [ -11 ; 18 ] AFTER INTERVENTION Median 21 95% CI [ -28 ;-3 ] Median 7

11 Percentages Decreased Aggression Scores 76,92% (n=10) 30,77% (n=4) 0 Experimental Groups Control

12 UFS OT IV, Group Drumming (2015) Med Diff betw C&I at post-test p= Med Diff betw I at pre & post-test p=0.15 Bittman Dickson & Coddington (2009) Significant decrease. Decrease in total Anger p=0.031 Decrease in instrumental anger p=0.002 Currie & Startup (2012) Significant decrease in aggression p< 0.01

13 Group Drumming Physical aggression Trigger Cognitive process Aggressive behaviour Direct verbal aggression (Threat, change etc.) Physiological arousal Environment Anger Behavioural responses Constructive behaviour Indirect aggression Social change Berkowitz 1993:20; Kassinove and Sukhodolsky 1995 in Eckhardt, Norlander and Deffenbacher 2004:20; O Neill 1995:427; Eckhardt, Norlander and Defenbacher 2004:20; Grogan, 1991: ; Taylor 1988:149; Macintosh 2003: and Liu 2006:4

14 Experimental Group Small initial sample size Control Group Resources Drop out (n=4) Matching (n=2) Availability Facilitators

15 Larger initial sample size Long term effects of group drumming Conduct As an evidence based qualitative research underlying intervention mechanisms SA context Explore effect of group drumming on other Maintained long term occupational Aggression: performance areas Strongest predictor of Implications targeting at risk Investigate criminality therapeutic relationship Diagnosis (Huesmann et al. 2002:204) Short term results youth

16 Promising results Occupational Therapy Group Drumming Further investigate Aggression in: mental health Adolescent girls community Conduct Disorder school based settings

ATAY, I. (2013). Impact of Sports and Social Activities Participation on Aggression Level. International Journal of Academic Research, vol. 5, no. 5, pp. 169-173. BANDURA, A. (1973).

18 ATAY, I. (2013). Impact of Sports and Social Activities Participation on Aggression Level. International Journal of Academic Research, vol. 5, no. 5, pp BANDURA, A. (1973). Aggression: A social learning analysis. Englewood Cliffs, NJ: Prentice-Hall, pp. 58. BERKOWITZ, L. (1993). Aggression: Its Causes, Consequences, and Control. New York: McGraw-Hill, pp BITTMAN, B., L. DICKSON and K. CODDINGTON (2009). Creative musical expression as a catalyst for quality of life improvement in inner city adolescents placed in a court referred residential treatment program. Advances, vol. 24, no. 1, pp BROWN, C. (2011). Motivation. In C. BROWN and V.C. STOFFEL (Eds). Occupational Therapy in Mental Health: A Vision for Participation, chap. 23, Philadelphia: Davis Company, pp BURTON, P. and L. LEOSCHUT (2013). School Violence in South Africa: Results of the 2012 National School Violence Study. Centre for Justice and Crime Prevention, vol. 12, pp CURRIE, M. and M. STARTUP (2012). Doing Anger Differently: Two controlled trials of percussion group psychotherapy for adolescent reactive aggression. Journal of adolescence, vol. 35, pp DONSON, H. (2008). A profile of fatal injuries in South Africa Tygerberg: Medical Research Council-UNISA Crime, Violence and Injury Lead Programme. [Available online at: on 10 February 2015]. ECKHARDT, C., B. NORLANDER and J. DEFFENBACHER (2004). The Assessment of Anger and Hostility: A Critical Review. Aggression and Violent Behavior, vol. 9, pp GROGAN, G. (1991). Anger management: A perspective for Occupational Therapy (Part 1 & 2). Occupational Therapy in Mental Health, vol. 11, no. 2/3, pp HUESMANN, L.R., L.D. ERON and E.F. DUBOW. (2002). Childhood predictors of adult criminality: are all risk factors reflected in childhood aggressiveness?. Criminal Behaviour and Mental Health, vol. 12, pp LIU, J. (2006). Concept Analysis: Aggression. Issues Mental Health Nursing, vol. 25, no. 7, pp MACINTOSH, H.B. (2003). Sounds of healing: music in group work with survivors of sexual abuse. The Arts of Psychotherapy, vol. 30, pp MATHIAS C.W., M.S. STANFORD, D.M. MARSH, P.J. FRICK, F.G. MOELLER, A.C. SWANN and D.M. DOUGHERTY. (2007). Characterizing aggressive behavior with the Impulsive/Premeditated Aggression Scale among adolescents with conduct disorder. Psychiatry Research, vol. 151, no. 3, pp MAXWELL, J.P. (2004). Anger rumination: an antecedent of athlete aggression?. Psychology of Sport and Exercise, vol. 5, no. 3, pp MCCAMBRIDGE, J., J. WITTON and D.R. ELBOURNE. (2014). Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. Journal of Clinical Epidemiology, vol. 67, pp O NEILL, H. (1995). Anger: the Assessment and Treatment of Problematic Anger, Part 1. British Journal of Occupational Therapy, vol. 58, no. 11, pp ORPINAS, P. and R. FRANKOWSKI (2001). The Aggression Scale: A Self-Report Measure of Aggressive Behaviour for Young Adolescents. Journal of Early Adolescents, vol. 21, no. 1, pp REED, K.L. and S.N. SANDERSON (1999). Concepts of Occupational Therapy (4th edition). Pennsylvania: Lippincott Williams & Wilkins, pp TAYLOR, E. (1988). Anger Intervention. The American Journal of Occupational Therapy, vol. 42, no. 3, pp YALOM, I., and M. LESZCZ (2005). The therapeutic factors The theory and practice of group psychotherapy (5th edition), chap. 1. New York, NY: Basic Books, pp WORLD HEALTH ORGANISATION (2002). World report on Violence and Health- Summary. [Available online at on 10 February 2015].

19 Thank You Mrs. E. Janse van Rensburg Mrs. R. Hattingh Mr. C. van Rooyen Mr. A. Mocke School where study was performed Department of Education Ms. P. Orpinas CSU for the drums

The short term effect of a group drumming intervention on aggressive behaviour among adolescent girls diagnosed with conduct disorder

Doi: http://dx.doi.org/10.17159/2310-3833/2016/v46n2a4 South African Journal of Occupational Therapy, 2016; 46(2): 16-22. ISSN On-line 2310-3833 The short term effect of a group drumming intervention on