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

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.

Violence Exposure Among Children with Disabilities

“…That is, children exhibit aggressive behavior and are restrained for doing so and, in turn, display aggressive behavior after the restraint has ended. This association was found among mentally retarded children in psychiatric inpatient facilities (Sukholdolsky et al 2005). Similarly, in an extensive study of aggression among psychiatrically hospitalized youth, Boxer (2007) reported that youth becoming involved in seclusion and restraint because of aggressive behavior have histories of various types of aggression prior to hospitalization.…”

Rages—What Are They and Who Has Them?

“…Diagnostically, the outbursts, sometimes called ''rages,'' have been increasingly associated with mania (Mick et al 2005) and ''severe mood dysregulation'' (Leibenluft et al 2003), but they may occur in many other psychiatric illnesses (Budman et al 2000;Campbell et al 1992;Kessler et al 2006) or are associated with domestic violence (Connor et al 2003) or compromised language and cognitive function (Gilmour et al 2004;Sukhodolsky et al 2005;Nigg and Nikolas 2008). Indeed, generic emotion dysregulation (Cole and Hall, 2008) and affective=overt=hot=reactive=impulsive aggression may be a dimension that cuts across a number of diagnoses, including attention-deficit=hyperactivity disorder (ADHD), autism, posttraumatic stress disorder, and bipolar disorder (BPD) ( Jensen et al 2007).…”

“…Inpatient studies addressing S=R have described the frequency and course of outbursts or the targets of aggression (Garrison et al 1990;Vivona et al 1995;Sukhodolsky et al 2005) but not diagnosis. Outpatient studies (e.g., Bambauer and Connor 2005;Connor and McLaughlin 2006) address a less impaired population, give no indication of how outbursts were managed, and rely on caregivers or teachers as informants rather than using direct observation.…”

Videogame Assisted Emotional Regulation Training: An ACT with RAGE-Control Case Illustration

“…Social skills are addressed in this therapy because elevated levels of anger are frequently the result of an inability to articulate feelings, resulting in dysregulation and aggression toward others (Sukhodolsky et al 2005). Additionally, the identification of supportive people in Sara's life and attention given to her experience of feeling better after talking with such people will encourage her to continue engaging with these supports in the future.…”

“…Anger and aggression are among the most common reasons for psychiatrically hospitalizing children and adolescents (Rice et al 2002;Sukhodolsky et al 2005). These patients often display dramatic problems with self-regulation that interfere with global adaptive functioning (Berenbaum et al 2003).…”