Compliance training decreases maladaptive behaviors in two people with developmental disabilities: report of five years' treatment

Compliance training was implemented to decrease non-compliance and avoidance behaviors in two women with severe mental retardation and psychiatric disorders over a five year period. In addition to compliance training, reinforcement schedules and behavioral momentum procedures were also included at various times. The program included training staff at home and at work to ensure generalization across settings and times, direct contact staff were used to assist in implementing compliance procedures at home and vocational trainers were used in the work setting. During baseline, Vanessa had pervasive non-compliant behaviors. Five years later, her non-compliance episodes had decreased by 89%. There were also significant decreases in aggression, self-abusive behaviors, and duration of non-compliance episodes. There were increases in interaction, productivity work, and reduced use of restraint. Annette was a woman with Generalized Anxiety Disorder with panic attacks. She had not left the home for several years. Once anxiety and panic attacks were under control maladaptive behaviors, which formerly functioned to avoid anxiety provoking situations, took on a different function, namely avoidance of work demands. Compliance training resulted in a reduction in non-compliance of 40–80% over a five year period. As a result psychoactive medication and restraint have been reduced and staff interaction and participation in campus and community activities have increased. © 1997 John Wiley & Sons, Ltd.     

Attributional Biases in Sexually Coercive Males1

A social cognitive framework was applied to sexually coercive behavior. Sixty-two male undergraduates completed a self-report measure of sexually coercive behavior, as well as several questionnaires assessing trait aggression, the encoding of sexual behaviors, attributions of hostile intent, and traditional attitudes toward women. Results demonstrate a relationship between the encoding of sexual behaviors and committing sexually coercive behaviors. A tendency to encode ambiguous dating behaviors as admissions of sexual intent related strongly to initiating sexually coercive behavior, while none of the variables examined were strongly related to persisting in sexually coercive behavior. Similar effects were found when controlling for all of the other variables. Implications for intervention designs are discussed.     

Decompressing aggressive inpatients: Breaking the aggression cycle to enhance positive outcome

Prolonged seclusions can result in exacerbation of psychotic symptomatology, self-injurious behavior, and increased likelihood of subsequent aggression. A patient's aggression can be contextualized as an interpersonal and cyclic series of events in which both the staff and the patient can play a contributing role. If this cycle can be interrupted, the likelihood of aggression decreases. The authors describe this aggression cycle and some strategies for interrupting it via a “decompression” treatment modality. Four case examples illustrate the range of outcomes achieved with patients who had been secluded for between 2 to 5 years due to their chronic history of aggression. The authors offer suggestions for developing a decompression treatment program.     

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

We examined the association of callous-unemotional (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.     

Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities

Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint‐reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior‐specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Predicting child behavior problems in maritally violent families

Previous research indicates that children from violent marriages are more likely to suffer from conduct problems and/or anxiety disorders than children from nonviolent, satisfactory marriages. However, knowledge regarding specific factors present in violent marriages relating to child problems is limited. The present study examined the relationships involving interspousal aggression, parent-child aggression, and child behavior problems in a sample of 45 children from maritally violent families. Mothers indicated how often their children witnessed interspousal aggression and were victims of parent-child aggression. Mothers also rated their children's problem behaviors while children reported on their own depressive symptoms. The witnessing of interspousal aggression was highly associated with parental aggression directed toward children. Parent-child aggression related to attention problems, anxiety-withdrawl, motor excess, and conduct problems in children. However, the witnessing of interspousal aggression was not significantly related to child behavior problems. These results are consistent with theoretical predictions linking marital problems to child behavior by virtue of their association with parenting.This research was supported in part by a Grant-in-Aid of Research awarded to the first author by Sigma Xi, the Scientific Research Society, and NIMH Grant No. MH35340 awarded to the third author. The authors wish to thank Martha Wray and her staff at VIBS for their help throughout this project.     

Sex,race, and experiences of aggression

Most previous research on sex differences in experienced aggression has confounded the sex of the aggressor and of the target by considering married or dating couples. In the present study, black and white male and female college students were asked about specific acts of aggression which they had received from or directed toward a male or female. As predicted, males were likely to have both received and exhibited more forms of aggressive behavior, although females were somewhat more likely to have been honked at, to have been forced by a male to have sex, and to have slapped someone. Few racial differences were found, but it appeared that blacks might have been relatively more likely to exhibit physical aggression and whites to exhibit nonphysical aggression. Some differences were found in specific behaviors directed toward and received from males and females, but in general subjects said that they received more aggressive behaviors than they directed toward others. © 1992 Wiley-Liss, Inc.     

Risk Factors for Attempting Suicide in Prisoners

We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history of suicidal behavior, convictions for violent crime, had exhibited aggressive behavior in jail, and had higher BGLHA aggression scores. A similar pattern of risk factors was found for prisoners with suicidal ideation. A lifetime history of attempting suicide, or of having suicidal ideation, is frequent in prisoners. Risk factors include family, developmental, aggression, personality, psychiatric, and substance abuse factors.     

Social Identity and Youth Aggressive and Delinquent Behaviors in a Context of Political Violence

The goal of the current study was to examine the moderating role of in‐group social identity on relations between youth exposure to sectarian antisocial behavior in the community and aggressive behaviors. Participants included 770 mother‐child dyads living in interfaced neighborhoods of Belfast. Youth answered questions about aggressive and delinquent behaviors as well as the extent to which they targeted their behaviors toward members of the other group. Structural equation modeling results show that youth exposure to sectarian antisocial behavior is linked with increases in both general and sectarian aggression and delinquency over one year. Reflecting the positive and negative effects of social identity, in‐group social identity moderated this link, strengthening the relationship between exposure to sectarian antisocial behavior in the community and aggression and delinquency towards the out‐group. However, social identity weakened the effect for exposure to sectarian antisocial behavior in the community on general aggressive behaviors. Gender differences also emerged; the relation between exposure to sectarian antisocial behavior and sectarian aggression was stronger for boys. The results have implications for understanding the complex role of social identity in intergroup relations for youth in post‐accord societies.     

Psychiatric Symptoms as a Predictor of Sexual Aggression among Male College Students

The goal of this investigation was to examine psychiatric symptoms as predictors of the frequency and severity of sexually aggressive behaviors that had been perpetrated by college-aged men in the past year. Over 400 undergraduate males completed an assessment of sexual aggression, athletic involvement, fraternity affiliation, alcohol and drug use, mistrust of women, depression, and social anxiety. More than 40% of the undergraduate men reported having participated in some form of sexual aggression within the past 12 months, 6% of whom reported having attempted or completed rape. Sexually aggressive behavior (both frequency and severity) was predicted by alcohol use, mistrust of women, and social anxiety. Results are the first to indicate that psychiatric symptoms might contribute to sexual aggression among college men.     

Short-term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management

The current article aims to examine the performance of two brief, dynamic risk measures – the Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV (eHARM-FV)] – scored at regular clinical case conferences for forensic psychiatric patients in two different settings. The eHARM represents a first-in-class dynamic risk assessment tool using data analytics. Two studies are presented from two forensic psychiatric hospitals in Ontario, Canada. The first study compared the HARM-FV, scored by trained research staff, with the BRC4, scored concurrently by clinical teams, on 36 forensic inpatients. In the second study, trained research staff scored both the BRC4 and the eHARM-FV on 55 forensic inpatients. Both studies demonstrated that the BRC4 and both HARM-FV tools were moderately and positively correlated with each other, with higher agreement for similar domains and items. In both samples, the risk measures performed better at identifying individuals who engaged in repeated or more serious problematic behavior. The HARM-FV and eHARM-FV produced higher area under the curve values for subsequent behavior compared with the BRC4. All three tools were effective at detecting future aggression and adverse incidents. We did not directly compare the HARM-FV and eHARM-FV.     

Aggression and sexuality in relation to toddler attachment: Implications for the caregiving system

Sexuality and aggression emerge in the second year of life as important motivational systems that organize substantial aspects of the toddler's behavior, affecting the operation of the attachment system and transforming the parents' perceptions and behaviors toward the child. The interconnection between different motivational systems in the parent and child is discussed as an important dimension in broadening our understanding of attachment in the context of the caregiving system. Normative and clinical examples are presented to illustrate how aggression and sexuality affect attachment and caregiving behaviors and representations in toddlerhood.     

Psychopathy scores predict adolescent inpatient aggression

This prospective study found that psychopathy scores predicted aggressive behavior among 72 adolescent psychiatric inpatients, even after controlling for age, sex, socioeconomic status, length of hospital stay, and independent self-report measures of impulsivity and conduct problems. Psychopathy was assessed within 3 days of hospital admission by clinical raters trained in the use of Hare's Psychopathy Checklist-Revised. Aggressive behavior was recorded by clinical staff members who were unaware of psychopathy ratings. Adolescents rated higher in psychopathy exhibited higher frequencies of both reactive and instrumental aggressive behavior than adolescents rated lower in psychopathy. Post hoc regression analyses revealed that psychopathy had incremental validity in predicting aggression beyond the contribution of clinical diagnosis or scores on the Millon Adolescent Clinical Inventory.     

Behavioral assessment and analysis of mechanical restraint utilization on a psychiatric,child and adolescent inpatient setting

A behavioral assessment and analysis of mechanical restraint utilization on a child and adolescent psychiatric inpatient unit was performed to identify contextual variables associated with implementation. The most frequent antecedent conditions correlated with restraint were when staff initiated physical contact towards a patient and when a patient refused to go to, or remain in, the “quiet room” when instructed. These interactions were seen as staff-initiated encounters that elicited aggressive responses from patients and increased the likelihood of restraint because the physical intervention and “quiet room” procedures were implemented in the absence of a comprehensive treatment formulation, and without reference to behavior-specific guidelines. Recommendations to reduce the use of mechanical restraint with child and adolescent inpatients by isolating functionally controlling variables are presented. © 1998 John Wiley & Sons, Ltd.     

Multilevel Correlates of Childhood Physical Aggression and Prosocial Behavior

The study identified independent individual, family, and neighborhood correlates of children's physical aggression and prosocial behavior. Participants were 2,745 2–11-year olds nested in 1,982 families, which were themselves nested in 96 Canadian neighborhoods. Hierarchical linear modeling showed that the total variation explained by the three-level model was 28.03% for physical aggression and 17.57% for prosocial behavior. For both childhood behaviors, approximately 66% of this explained variance was between individuals and up to 30% was between families. The smallest amount of observed variation was between neighborhoods. Significant individual-level predictors common to both childhood behaviors were child's sex and maternal hostility toward the target child. Specifically, boys had more mother-reported physical aggression and less prosocial behavior. Children who experienced greater-than-average maternal hostility (compared to siblings) were more physically aggressive and less prosocial. At the family level, significant common predictors were mother depressed mood and punitive parenting. Children had higher levels of physical aggression and lower levels of prosocial behavior in families where mothers had greater depressed mood and used more punitive parenting practices. At the neighborhood level, greater perceived problems and lower poverty level were associated with higher levels of physical aggression. Results are discussed with reference to past and future studies of multilevel effects on children's socialization.     

Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities

The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff‐reported injury prediction that could be obtained from the staff‐completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self‐injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff‐reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal‐directed activities in human aggression. Aggr. Behav. 29:31–40, 2003. © 2003 Wiley‐Liss, Inc.     

Sectioned offenders presenting with enduring mental illness: a study exploring behaviors indicative of bullying

Logit and logistic regression analyses were employed to explore the nature, extent and predictors of behaviors indicative of "being bullied" and of "bullying others" in a sample of 125 adult male offender-patients sectioned for enduring mental illness and detained within a high-secure psychiatric hospital. The study addresses the lack of research into this specialized population to date, with a subsidiary aim of comparing the results directly with a previous study conducted with a population of adult male personality-disordered offender-patients (n = 53). Participants were required to complete a self-report behavioral checklist (Direct and Indirect Patient behavior Checklist-Hospital version Revised). The prediction that indirect (subtle) aggression would be reported more frequently than direct aggression was supported in relation to perpetration estimates, with evidence such aggression was also more prevalent among personality-disordered than mentally ill offender-patients. As predicted verbal aggression was the most commonly reported direct behavior. Although it was predicted that those perpetrating aggression would present with increased experience with secure settings this was only supported with regard to bully-victims. Contrary to the prediction made, those victimized did not present with less experience of secure settings. Consistent with the hypothesis, bully/victims were predicted by increased negative behavior toward staff and hospital rules. The results are discussed in relation to the environment in which the aggression is taking place with the implications for practice and future research outlined.     

Legitimized aggression and sexual coercion: Individual differences in cultural spillover

Correlations between aggressive attitudes and sexual coercion have consistently been found in numerous empirical studies across social science disciplines. Extrapolating from sociological research linking indices of legitimate aggression by state to statewide frequencies of rape, we have extended the investigation of legitimate aggression and coercive sexuality to the individual level. The specific purposes of this research were to index the breadth and level of endorsement of legitimized aggression at the individual level and to measure the association between such an index and coercive sexual behavior. These purposes were achieved across the course of three studies in which we created a new dispositional measure, the Proclivity for Legitimized Aggression Questionnaire (PLAQ), and replicated a sociocultural level correlation with coercive sexual behavior (Study 1); assessed the individual differences level construct validity of the PLAQ (Study 2); and tested whether endorsement of items on the PLAQ were related to content‐relevant behaviors (Study 3). The PLAQ was internally consistent, modestly but significantly correlated with a measure of self‐reported coercive sexual behavior, and characterized by promising construct validity. Aggr. Behav. 27:26–43, 2001. © 2001 Wiley‐Liss, Inc.     

Antecedents of sexual and non-sexual aggression in young Singaporean men

This study investigated factors that have previously been implicated in male sexual aggression towards women, using a structural equation modelling approach to assess their relative influence on sexually coercive behaviours in young Singaporean men. Variables were classified under three major headings: childhood experience, personality, and attitudes facilitating violence. Non-sexual aggression against women was included in order to investigate its relationship to sexual aggression as well as its own causal antecedents. Results suggest that sexual and non-sexual aggression have different antecedents, and confirm the primacy of sexual variables (sexual experience, child sexual abuse) as antecedents to sexual aggression. Contrary to the hypothesis that sexual aggression is primarily aggressive in motivation, belligerence exerted only indirect effects on sexual aggression. Attitudinal variables (e.g. attitudes supportive of sexual aggression) contributed modestly to sexual but not to non-sexual aggression. Antisociality exerted indirect effects on both sexual aggression (via sexual experience and acceptance of interpersonal violence) and on non-sexual aggression (via belligerence). Parental violence contributed exclusively to non-sexual aggression. Finally, some cross-cultural differences in sexually coercive behaviour are highlighted.     

Children’s Attitudes toward Aggression: Associations with Depression,Aggression, and Perceived Maternal/Peer Responses to Anger

Little is known about factors that influence children’s attitudes toward aggression, despite evidence that these attitudes are influential in promoting violent behaviors. The purpose of the present research was to examine the relation of self, peer, and parent social factors to school-age children’s maladaptive attitudes toward aggression. Specifically, symptoms of depression, peer overt aggression behaviors, and perceptions of maternal and peer responses to anger were evaluated as important factors associated with the use of aggression. These factors were examined separately for boys and girls, as research has consistently documented gender differences in the form and use of aggression. Hierarchical regression models were computed separately for boys and girls in grades three through five (N?=?167), with child-reported depression, peer-nominated overt aggression, and child-reported maternal and best friend responses to anger examined as predictors of maladaptive attitudes toward aggression. For girls, depressive symptoms positively predicted maladaptive attitudes toward aggression. For boys, the extent of peer-reported overt aggression (positively) and child-reported supportive maternal responses to the child’s anger (negatively) predicted maladaptive attitudes toward aggression. The value of examining social factors that relate to attitudes toward aggression is discussed as well as consideration of gender differences in these relations. In addition, discussion includes how these results highlight important targets for interventions that may be especially relevant for school-age girls and boys.