The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

Goren, Suzanne; Singh, Nirbhay N.; Best, Al M.

doi:10.1007/bf01321301

Cited by 74 publications

(64 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adding to the literature to date that has utilized clinic-referred and community samples, children hospitalized for inpatient psychiatric treatment were evaluated in the present studies to maximize the inclusion of youth with severe psychopathology. The exacerbation and attenuation hypotheses for aggression among psychiatrically hospitalized children have implications for treatment decisions, hospitalization duration, and aftercare recommendations (e.g., Goren et al 1993).…”

Section: The Present Studiesmentioning

confidence: 99%

Aggression Among Children with ADHD, Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Becker

Luebbe

Stoppelbein

et al. 2011

J Abnorm Child Psychol

View full text Add to dashboard Cite

Competing hypotheses for explaining the role of anxiety in the relation between attention-deficit/hyperactivity disorder (ADHD) symptoms and childhood aggression were evaluated. Two studies tested whether anxiety exacerbated, attenuated, or had no effect on the relation between ADHD and aggression subtypes among psychiatrically hospitalized children. In Study 1 (N = 99), children who scored above clinical cut-off levels for anxiety only, ADHD only, and co-occurring ADHD and anxiety were compared on aggression subtypes (i.e., reactive, proactive, overt, and relational aggression). In Study 2, the moderating role of anxiety on the relation between ADHD and aggression subtypes was examined with a larger sample (N = 265) and with continuous variables. No support was found for either the attenuation or exacerbation hypothesis, and results remained consistent when separately examining hyperactivity/impulsivity and inattention symptoms of ADHD. Although ADHD symptoms were significantly associated with all aggression subtypes, this association did not remain when including symptoms of oppositional defiant disorder.

show abstract

Section: The Present Studiesmentioning

confidence: 99%

Aggression Among Children with ADHD, Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Becker

Luebbe

Stoppelbein

et al. 2011

J Abnorm Child Psychol

View full text Add to dashboard Cite

show abstract

“…For example, Goren et al (1993) express the concern that psychiatric facilities are too often ''organized around coercion and control'' (p. 71) and therefore cannot be expected to promote non-coercive behavior. Goren et al advocate for the empowering of child psychiatric patients by the promotion of shared (i.e., staff/patient) decision making, the reduction of excessive rules and behavioral demands, and encouragement of patient ownership of behavior.…”

Section: Discussionmentioning

confidence: 97%

“…Developing treatment regimens for aggressive youth with C/U traits is challenging prospect, but there is an emerging set of collaborative, non-confrontational treatment philosophies, strategies, and techniques that can be utilized for this task (e.g., Feldstein and Ginsburg 2006;Goren et al 1993;Greene and Albon 2006;. For example, conducting a motivational interview at the time of the hospital admission can immediately establish that clinical staff are empathetic but expect the patient to take personal responsibility for behavior change (Feldstein and Ginsburg 2006).…”

Section: Discussionmentioning

confidence: 98%

“…This is unfortunate, because the accurate identification of the child factors associated with physically restrictive treatment measures has the potential to guide future inpatient intervention efforts. Factors that have been found to be significant in some-but not all-of the extant literature include younger age (Goren et al 1993), low intellectual and/or verbal abilities (Becker et al 1996), a history of maltreatment (Millstein and Cotton 1990) a diagnosis of conduct disorder or an oppositional defiant disorder (CD/ODD; Atkins and Ricciuti 1992), male gender (Persi and Pasquali 1999;Goren et al 1993), and ethnic minority status (Atkins and Ricciuti 1992).…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients

Stellwagen

Kerig

2009

J Child Fam Stud

View full text Add to dashboard Cite

We examined the association of callousunemotional (C/U) traits with the rates of seclusion and restraint among a sample of child psychiatric inpatients (N = 101). Analyses focused on the incremental value of C/U traits as a predictor over and above the influence of other risk factors for physically restrictive treatment measures found in previous research, including gender, age, verbal intelligence, ethnicity, the diagnosis of a conduct disorder or an oppositional defiant disorder, maltreatment history, and the other dimensions of psychopathy (i.e., narcissism and impulsivity). Results of hierarchical multiple regressions indicated that younger age and C/U traits predicted seclusion rates, whereas only C/U traits predicted restraint rates. The discussion of these findings focuses on the necessity of developing effective intervention programs for inpatient children with prominent C/U traits, to help forestall the physically dangerous behavior that necessitates a seclusion or restraint.

show abstract

“…There is a growing body of literature discussing the dangers and unintended consequences associated with use (Mohr et al 2003;Nunno et al 2006). Research literature also suggests that despite training protocols, staff members' actions are often antecedent to violent episodes requiring the use of restraints (Garrison et al 1990;Goren et al 1993;Natta et al 1990). …”

Section: The Elements Of Informed Consentmentioning

confidence: 97%

Black Boxing Restraints: The Need for Full Disclosure and Consent

Mohr

Nunno

2010

J Child Fam Stud

View full text Add to dashboard Cite

In this article we discuss the necessity of fully informing patients and their families of what constitutes physical interventions and their attendant risks under the established principles and obligations of informed consent. After a brief review of the elements of informed consent and the nature of the duty to advise patients and their families of treatment risks, we argue that physical interventions are an unvalidated treatment for aggressive and violent behavior and should be used only as a safety intervention. We focus our discussion on the informed consent issues for school aged children, adolescents, and emancipated minors and contend that if restraints are used they must pose less risk than the behavior they are trying to alleviate. We also opine that if restraints are misused by mental health or child welfare treatment settings, then their misuse may be considered a subject of a patient maltreatment, abuse, criminal or civil action. A central thesis of the article is that informed consent must be seen as an integral and dynamic process of treatment. We recommend strategies that gain parental permission and child assent, that view informed consent as a dynamic and individualized process that aids and supports the therapeutic relationship, and that stress the importance of simplicity and clarity.

show abstract

The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

Cited by 74 publications

References 18 publications

Aggression Among Children with ADHD, Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Aggression Among Children with ADHD, Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients

Black Boxing Restraints: The Need for Full Disclosure and Consent

Contact Info

Product

Resources

About