To examine how health care professionals attempt to manage acutely aggressive behaviours exhibited by children and adolescents in various hospital settings.
Method
A review of the literature examining management techniques on child psychiatric and pediatric wards is presented. Techniques reviewed include pharmacotherapy, psychotherapy, seclusion, restraint and the use of pro re nata (prn) medications.
Results
Effects of various management techniques are presented, where available.
Conclusion
There is little evidence for the effectiveness of most presently used acute management techniques in containing aggressive child behaviours over the long term. Suggestions for improved evaluation of management techniques are made.
References
1.
GarrisonW.T., EckeB., FriedmanM.Aggression and counteraggression during child psychiatric hospitalization.J Am Acad Child Adolesc Psychiatry1990; 29: 242–250.
2.
MillsteinK.H., CottonN.S.Predictors on the use of seclusion on an inpatient child psychiatric unit.J Am Acad Child Adolesc Psychiatry1990; 29: 256–264.
3.
CottonN.The developmental-clinical rationale for the use of seclusion in the psychiatric treatment of children.Am J Orthopsychiatry1989; 59: 442–450.
4.
McGuffinP.W.The effect of timeout duration on frequency of aggression in hospitalized children with' conduct disorders.Behav Resident Treat1991; 6: 279–288.
5.
FasslerD., CottonN.A national survey on the use of seclusion in the psychiatric treatment of children.Hosp Commun Psychiatry1992; 43: 370–374.
6.
VitielloB., RicciutiA J., BeharD.Prn medications in child state hospital inpatients.J Clin Psychiatry1987; 48: 351–354.
7.
VitielloB., HillJ.L., EliaJ.Prn medications in child psychiatric patients: a pilot placebo-controlled study.J Clin Psychiatry1991; 52: 499–501.
8.
WerryJ.S., AmanM.G.Practitioner's guide to psychoactive drugs in children and adolescents.New York: Plenum Publishing Corporation,1993.
9.
EichelraanB.Toward a rational pharmacotherapy for aggressive and violent behaviour.Hosp Commun Psychiatry1988; 39: 31–39.
10.
StewartJ.T., MyersW.C., BurketR.C.A review of the pharmacotherapy of aggression in children and adolescents.J Am Acad Child Adolesc Psychiatry1990; 29: 269–277.
11.
CampbellM., GonzalezN.M., SilvaR.R.The pharmacologic treatment of conduct disorders and rage outbursts.Psychiatr Clin North Am1992; 15: 69–85.
12.
MercerM.Closing the barn door: the prevention of institutional abuse through standards.Child Youth Serv1982; 4: 127–132.
13.
KaplanS.L., BusnerJ., KupietzS.Effects of methylphenidate on adolescents with aggressive conduct disorder and ADDH: a preliminary report.J Am Acad Child Adolesc Psychiatry1990; 29: 719–723.
14.
CampbellM., SmallA.M., GreenW.H.Behavioral efficacy of haloperidol and lithium carbonate: a comparison in hospitalized aggressive children with conduct disorder.Arch Gen Psychiatry1984; 41: 650–656.
15.
AlessiN., NaylorM.W., GhaziuddinM.Update on lithium carbonate therapy in children and adolescents.J Am Acad Child Adolesc Psychiatry1994; 33: 291–304.
16.
ConnorD.F.Beta blockers for aggression: a review of the pediatric experience.J Child Adolesc Psychopharmacol1993; 3: 99–114.
17.
EvansR.W., ClayT.H., GualtieriT.C.Carbamazepine in pediatric psychiatry.J Am Acad Child Adolesc Psychiatry1987; 26: 2–8.
18.
KazdinA.E.Treatment of conduct disorder: progress and directions in psychotherapy research.Dev Psychopathol1993; 5: 277–310.
19.
KendallP.C.Cognitive-behavioral therapies with youth: guiding theory, current status, and emerging developments.J Consult Clin Psychol1993; 61: 235–247.
20.
MarohnR.C.Management of the assaultive adolescent.Hosp Commun Psychiatry1992; 43: 622–624.
21.
KusterT., RowlandG., SchaffnerT.Strategies for the prevention of physical assault among emotionally disturbed youths (PAARR.).Child Youth Serv1987; 10: 85–101.
MillerD.E.The management of misbehavior by seclusion.Milieu Ther1985; 4: 13–18.
24.
KalfusG.R., RazzanoK.M.Maternal acceptability of treatments for child withdrawal and aggression.Child Fam Behav Ther1992; 14: 11–22.
25.
KazdinA.E.Acceptability of aversive procedures and medications as treatment alternatives for deviant child behavior.J Abnorm Child Psychol1984; 12: 289–301.
26.
CadmanD., BoyleM., SzatmarP.Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study.Pediatrics1987; 79: 805–813.
27.
EiserC.Psychological effects of chronic disease.J Child Psychol Psychiatry1990; 31: 85–98.
28.
TaylorD.C.Psychological aspects of chronic sickness. In: Child and adolescent psychiatry: a comprehensive textbook.LewisM., editor. Baltimore MD: Williams and Wilkins1991:614–623.
29.
SovnerR., HurleyA.D.Managing aggressive behavior: a psychiatric approach.Psychiatr Aspects Ment Retard Rev1986; 5(4).
30.
KupfersmidJ., MazzarinsH., BenjaminR.Programming as a means of assault prevention.Child Youth Serv1987; 10: 49–85.
