Child Psychiatry and Human Development

, Volume 36, Issue 2, pp 177–193 | Cite as

Characterizing Aggressive and Noncompliant Behaviors in a Children’s Psychiatric Inpatient Setting

  • Denis G. Sukhodolsky
  • Laurie Cardona
  • Andrés Martin
Article

Abstract

This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8±2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were rated weekly using the Modified Overt Aggression Scale (MOAS) and the Disruptive Behavior Rating Scale (DBRS) between November 1, 2002 and June 30, 2003. Moderate to high correlations were observed between the four types of aggression (verbal, and physical against self, others, or objects) and noncompliant behavior. In hierarchical regression analyses, only mental retardation emerged as a significant predictor of aggression and noncompliance. Aggression and noncompliance were associated with different characteristics of inpatient treatment. Aggressive behavior was significantly associated with the use of restraints and seclusion, and noncompliant behavior with length of hospitalization and number of psychiatric medications at time of discharge. Modifying milieu interventions for youths with mental retardation, and adapting behavioral interventions empirically proven to target noncompliance may be effective loci for reducing aggression in child psychiatric inpatient units.

Key words

aggression noncompliance inpatient restraint and seclusion children and adolescents 

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References

  1. 1.
    Rice, BJ, Woolston, J, Stewart, E, Kerker, BD, Horwitz, SM 2002Differences in younger, middle, and older children admitted to child psychiatric inpatient servicesChild Psychiatry Human Dev32241261CrossRefGoogle Scholar
  2. 2.
    Pfeffer, CR, Solomon, G, Plutchik, R,  et al. 1985Variables that predict assaultiveness in child psychiatric inpatientsJ Am Acad Child Adolesc Psychiatry24775780Google Scholar
  3. 3.
    Allen, JJ 2000Seclusion and restraint of children: a literature reviewJ Child Adolesc Psychiatric Nurs13159167Google Scholar
  4. 4.
    Brown, RL, Genel, M, Riggs, JA 2000Use of seclusion and restraint in children and adolescents Council on Scientific Affairs, American Medical Association.Arch Pediatr Adolesc Med154653656PubMedGoogle Scholar
  5. 5.
    Millstein, KH, Cotton, N 1990Predictors of the use of seclusion on an inpatient child psychiatric unitJ Am Acad Child Adolesc Psychiatry29256264PubMedGoogle Scholar
  6. 6.
    Sourander, A, Ellilae, H, Vaelimaeki, M 2002Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatmentEur Child Adolesc Psychiatry11162167CrossRefPubMedGoogle Scholar
  7. 7.
    Donovan, A, Plant, R, Peller, A, Siegel, L, Martin, A 2003aTwo-year trends in the use of seclusion and restraint among psychiatrically hospitalized youthsPsychiatr Serv54987993CrossRefGoogle Scholar
  8. 8.
    Donovan, A, Siegel, L, Zera, G, Plant, R, Martin, A 2003bSeclusion and restraint reform: An initiative by a child and adolescent psychiatric hospitalPsychiatr Serv54958959CrossRefGoogle Scholar
  9. 9.
    Masters, KJ, Bellonci, C 2002Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraintJ Am Acad Child Adolesc Psychiatry4013561358Google Scholar
  10. 10.
    Burke, JD, Loeber, R, Birmaher, B 2002Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part IIJ Am Acad Child Adolesc Psychiatry4112751293CrossRefPubMedGoogle Scholar
  11. 11.
    Loeber, R, Burke, JD, Lahey, BB, Winters, A, Zera, M 2000Oppositional defiant and conduct disorder: A review of the past 10 years, Part I.J Am Acad Child Adolesc Psychiatry3914681484CrossRefPubMedGoogle Scholar
  12. 12.
    Collett, BR, Ohan, JL, Myers, KM 2003Ten-year review of rating scales. VI: Scales assessing externalizing behaviorsJ Am Acad Child Adolesc Psychiatry4211431170CrossRefPubMedGoogle Scholar
  13. 13.
    Bowers, L 1999A critical appraisal of violent incident measuresJ Mental Health4339349CrossRefGoogle Scholar
  14. 14.
    Connor, DF, Melloni, RH, Harrison, RJ 1998Overt categorical aggression in referred children and adolescentsJ Am Acad Child Adolesc Psychiatry376673CrossRefPubMedGoogle Scholar
  15. 15.
    Malone, RP, Luebbert, JF, Delaney, MA,  et al. 1997Nonpharmacological response in hospitalized children with conduct disorderJ Am Acad Child Adolesc Psychiatry36242247CrossRefPubMedGoogle Scholar
  16. 16.
    Yudofsky, SC, Silver, JM, Jackson, W 1986The Overt Aggression Scale for the objective rating of verbal and physical aggressionAm J Psychiatry1433539PubMedGoogle Scholar
  17. 17.
    Gabel, S, Shindledecker, R 1991Aggressive behavior in youth: Characteristics, outcome, and psychiatric diagnosesJ Am Acad Child Adolesc Psychiatry30982988PubMedGoogle Scholar
  18. 18.
    Garrison, WT, Ecker, B, Friedman, M, Davidoff, R, Haeberle, K, Wagner, M 1990Aggression and counteraggression during child psychiatric hospitalizationJ Am Acad Child Adolesc Psychiatry29242250PubMedGoogle Scholar
  19. 19.
    Ghuman, HS, Jayaprakash, S, Saidel, DH, Whitmarsh, G 1989Variables predictive of the need for placement in a long-term structured setting for adolescentsPsychiatr Hosp203134PubMedGoogle Scholar
  20. 20.
    Vivona, JM, Ecker, B, Halgin, RP 1995Self- and other-directed aggression in children and adolescent psychiatric inpatientsJ Am Acad Child Adolesc Psychiatry34434444CrossRefPubMedGoogle Scholar
  21. 21.
    Kuczynski, L, Kochanska, G, Radke-Yarrow, M, Girnius-Brown, O 1987A developmental interpretation of young children’s noncomplianceDev Psychol23799806CrossRefGoogle Scholar
  22. 22.
    McMahon, RJ, Forehand, RL 2003Helping the Noncompliant Child: Family-Based Treatment for Oppositional BehaviorGuilfordNew YorkGoogle Scholar
  23. 23.
    Achenbach, TM 1991Manual for the Child Behavior Checklist/4–18 and 1991 profileUniversity of Vermont PressBurlington, VTGoogle Scholar
  24. 24.
    Keenan, K, Wakschlag, LS 2004Are oppositional defiant and conduct disorder symptoms normative behaviors in preschoolers? A comparison of referred and nonreferred childrenAm J Psychiatry161356358CrossRefPubMedGoogle Scholar
  25. 25.
    Benson, AB, Aman, MG 1999

    Disruptive behavior disorders in children with mental retardation

    Quay, HCHogan, AE eds. Handbook of Disruptive Behavior DisordersKluwer Academic/PlenumNew York
    Google Scholar
  26. 26.
    Frick, PJ, Lahey, BB, Loeber, R, Tannenbaum, LE, Horn, Y, Christ, MAG, Hart, EA, Hanson, K 1993Oppositional defiant disorder and conduct disorder: A meta-analytic review of factor analyses and cross-validation in a clinical sampleClin Psychol Rev13319340CrossRefGoogle Scholar
  27. 27.
    Halperin, JM, McKay, KE, Newcorn, JH 2002Development, reliability and validity of the Children’s Aggression Scale-Parent VersionJ Am Acad Child Adolesc Psychiatry41245252CrossRefPubMedGoogle Scholar
  28. 28.
    Kolko, DJ 1988Daily ratings of a child psychiatric unit: psychometric evaluation of the child behavior rating formJ Am Acad Child Adolesc Psychiatry27126132PubMedGoogle Scholar
  29. 29.
    Egeren, LA, Frank, SJ, Paul, JS 1999Daily behavior ratings among child and adolescent inpatients: The abbreviated child behavior rating formJ Am Acad Child Adolesc Psychiatry3814171425CrossRefPubMedGoogle Scholar
  30. 30.
    Weisbrot, DM, Ettinger, AB 2002Aggression and violence in mood disordersChild Adolesc Psychiatr Clin North Am11649672CrossRefGoogle Scholar
  31. 31.
    Kraijer, D 2000Review of adaptive behavior studies in mentally retarded persons with autism/pervasive developmental disorderJ Autism Dev Disord303947CrossRefPubMedGoogle Scholar
  32. 32.
    Mulick, JA, Hammer, D, Dura, JR 1991

    Assessment and management of antisocial and hyperactive behavior

    Matson, JLMulick, JA. eds. Handbook of Mental RetardationPergamon PressNew York
    Google Scholar
  33. 33.
    Pfeffer, CR, Plutchik, R, Mizruchi, MS, Lipkins, R 1987Assaultive behavior in child psychiatric inpatients, outpatients, and nonpatientsJ Am Acad Child Adolesc Psychiatry26256261PubMedGoogle Scholar
  34. 34.
    Kay, SR, Wolkenfeld, F, Murrill, LM 1988Profiles of aggression among psychiatric patients I: Nature and prevalenceJ Nerv Ment Dis176539546PubMedGoogle Scholar
  35. 35.
    Silver, JM, Yudofsky, SC 1991The Overt Aggression Scale: Overview and guiding principlesJ Neuropsychiatry Clinical Neurosci3S22S29Google Scholar
  36. 36.
    Barkley, RA 1997Defiant Children: A Clinician’s Manual for Assessment and Parent TrainingGuilford PressNew YorkGoogle Scholar
  37. 37.
    Kazdin, AE 2003

    Problem-solving skills training and parent management training for conduct disorder

    Kazdin, AE. eds. Evidence-based psychotherapies for children and adolescentsGuilford PressNew York
    Google Scholar
  38. 38.
    Sukhodolsky, DG, Kassinove, H, Gorman, B 2004Cognitive behavioral therapy for anger in children and Adolescents: A meta-AnalysisAggr Violent Beh9247269CrossRefGoogle Scholar
  39. 39.
    Delga, I, Heinssen, RK, Fritsch, RC, Goodrich, W, Yates, BT 1989Psychosis, aggression, and self-destructive behavior in hospitalized adolescentsAm J Psychiatry146521525PubMedGoogle Scholar
  40. 40.
    Connor, DF, Steingard, RJ, Anderson, JJ, Melloni, RH,Jr 2003Gender differences in reactive and proactive aggressionChild Psychiatry Human Dev33279294CrossRefGoogle Scholar
  41. 41.
    Underwood, MK, Galen, BR, Paquette, JA 2001Top ten challenges for understanding gender and aggression in children: Why can’t we all just get along?Soc Dev10248266Google Scholar
  42. 42.
    Reynolds, CR, Kamphaus, RW 1992Behavior Assessment System for Children (BASC): ManualAmerican Guidance ServiceCircle Pines, MHGoogle Scholar
  43. 43.
    Greene, RW, Biederman, J, Zerwas, S, Monuteaux, M, Goring, JC, Faraone, SV 2002Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorderAm J Psychiatry15912141224CrossRefPubMedGoogle Scholar
  44. 44.
    Gillberg, C, Persson, E, Grufman, N, Themner, U 1986Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: Epidemiological aspectsBr J Psychiatry1466874Google Scholar
  45. 45.
    Fidura, JG, Lindsy, ER, Walker, GR 1987A special behavior unit for treatment of behavior problems of persons who are mentally retardedMent Retard25107111PubMedGoogle Scholar
  46. 46.
    Angold, A, Costello, EJ 1993Depressive comorbidity in children and adolescents: Empirical, theoretical, and methodological issuesAm J Psychiatry15017791791PubMedGoogle Scholar
  47. 47.
    Kim-Cohen, J, Caspi, A, Moffitt, TE, Harrington, H, Milne, BJ, Poulton, R 2003Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohortArch Gen Psychiatry60709717CrossRefPubMedGoogle Scholar
  48. 48.
    Leibenluft, E, Blair, RJ, Charney, DS, Pine, DS 2003Irritability in pediatric mania and other childhood psychopathologyAnn N Y Acad Sci100820118CrossRefPubMedGoogle Scholar
  49. 49.
    Dodge, KA, Lochman, JE, Harnish, JD, Bates, JE, Pettit, GS 1997Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youthJ Abnorm Psychol1063751CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Denis G. Sukhodolsky
    • 1
    • 2
  • Laurie Cardona
    • 1
    • 2
  • Andrés Martin
    • 1
    • 2
  1. 1.Child Study CenterYale University School of MedicineUSA
  2. 2.Children’s Psychiatric Inpatient ServiceYale New-Haven HospitalUSA

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