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

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.     

Practices and representations of child care and motor development among West Africans in Paris

Massage techniques and postural manipulation used by West African women immigrants in Paris were studied, with the aim of demonstrating that culturally regulated caretaking practices have an influence on infant motor development. Twenty-five infants were observed between the ages of 3 and 12 months and 9 and 15 months. Frequency of massage and its accompanying set of physical exercises were found to be related to age at onset of independent walking. The findings show that infants receiving daily massage walk significantly earlier than infants who do not receive massage, thus confirming other reports that vestibular and postural stimulation have a positive effect on motor development. These results are discussed in relation to the observed frequencey of contact and of physical games with the caregiver for a smaller sample of three infants, and to parental expectations about the age of acquisition of certain cognitive and motor abilities. African immigrant mothers expect their infants to sit and to walk earlier than French mothers. The conclusion emphasizes the contribution of social anthropology, which shows that in all cultures, physical development and body changes elicit symbolic practices and a search for explanation.     

FUNCTIONAL COMMUNICATION TRAINING WITH AND WITHOUT EXTINCTION AND PUNISHMENT

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.     

Health behavior, knowledge and attitudes among Swedish university students

A range of health behaviors was related to beliefs concerning health practices and health knowledge. A questionnaire dealing with health-related practices, health beliefs and knowledge of health risk factors was answered by 166 male and 179 female students aged 18–30 years at Stockholm University. Female students reported engaging in better health behavior than males. Beliefs about the importance of health behaviors were closely related to their frequency of occurrence. There was only a weak relationship between health behaviors and knowledge of specific health matters. It is concluded that health attitudes rather than health knowledge determine health behavior.     

Construct validity and test-retest reliability of a date rape decision-latency measure

In two studies, the construct (convergent and discriminant) validity and test-retest reliability of a date rape decision-latency measure was examined. In Study 1, 174 college men completed measures related to sexual aggression and listened to an audiotaped simulation of a date rape, during which cues of nonconsent and force gradually escalated over time. Participants were instructed to respond, by pressing a button which recorded the latency of their decisions in seconds, if and when they believed the man depicted in the scenario should stop his sexual advances. Results demonstrated positive associations between prolonged decision latencies and sexually aggressive behavior, calloused sexual beliefs, acceptance of interpersonal violence, and sexual promiscuity. In Study 2, initial results were cross-validated in a sample of 102 college men, and discriminant validity was established as decision latencies were unassociated with measures of social desirability, alcohol consumption and drug use. Test-retest reliability assessed over a 2-week interval was .87.The authors wish to thank Alan Gross and Brian Marx for providing the audiotaped stimulus materials, Richard Marsh for writing the decision-latency computer program, Jason Hicks for assisting with programming, and the undergraduate research assistants for serving as experimenters.     

BEHAVIORAL PERSISTENCE AND VARIABILITY DURING EXTINCTION OF SELF-INJURY MAINTAINED BY ESCAPE

The self-injurious escape behavior of a developmentally disabled adult was treated with extinction. Results of a reversal design showed substantial bursts of responding when extinction was introduced and reintroduced: self-injury remained at a variable and elevated rate for some time before stable, low rates were observed. Data on aggression, a nontarget behavior during both baseline and treatment, showed a pattern similar to that seen for self-injury during the extinction conditions.     

Social-Cognitive and Behavioral Correlates of Aggression and Victimization in Boys' Play Groups

A contrived play group procedure was utilized to examine the behavioral and social-cognitive correlates of reactive aggression, proactive aggression, and victimization via peers. Eleven play groups, each of which consisted of six familiar African-American 8-year-old boys, met for 45-min sessions on five consecutive days. Social-cognitive interviews were conducted following the second and fourth sessions. Play group interactions were videotaped and examined by trained observers. High rates of proactive aggression were associated with positive outcome expectancies for aggression/assertion, frequent displays of assertive social behavior, and low rates of submissive behavior. Reactive aggression was associated with hostile attributional tendencies and frequent victimization by peers. Victimization was associated with submissive behavior, hostile attributional bias, reactive aggression, and negative outcome expectations for aggression/assertion. These results demonstrate that there is a theoretically coherent and empirically distinct set of correlates associated with each of the examined aggression subtypes, and with victimization by peers.     

Aggression Observation Scale for Group Psychotherapy

An observational scale to record aggressive behaviors, defenses, and interventions that occur during a psychotherapy group has been developed. Content and process items were included. The content items focus on the spoken material and are on a continuum of increasing group members' awareness of and responsibility for their anger. The process items are directed to underlying psychodynamic issues on a continuum from avoiding anger, to indirect and then expression of anger. Leader interventions (responses) are also included. The development of the scale, the Aggression Observation Scale for Group Psychotherapy (AOSGP), is described including pilot testing and reliability and validity findings.     

Beliefs about stories: Parents' and therapists' explanations of childhood difficulties

Therapists and parents were given vignettes describing the behavioural and emotional difficulties of two nine-year-old children and were asked to rate the importance of a number of possible explanations for such difficulties. Broad agreement was found between parents and therapists, but also there were a number of significant differences. Parents endorsed more child centered explanations and put greater emphasis on physical and developmental factors, while therapists endorsed relationships factors and saw the beliefs of other family members as important. Therapists who were parents showed a pattern of responses that lay between those of parents and non-parent therapists.     

The Del Greco Assertive Behavior Inventory

Previous research in the area of assertiveness training has been examined with respect to the definitions of assertive, aggressive, and nonassertive behavior and the prominent assertion model. Logical inconsistencies have led to a refinement of the definitions of these behaviors, the inclusion of passive aggressive behavior, and the testing of a new two-dimensional model of assertion. The present study has developed a psychometric test to measure assertive, aggressive, nonassertive, and passive aggressive behavior in the college dormitory population. In addition, support was demonstrated for the validity of the two dimensional model of assertion. The instrument development was divided into four phases: item generation, item evaluation and revision, reliability testing and item analysis, and validity testing. Data analysis supported the two-dimensional model of assertion. In addition, an 86-item Del Greco Assertive Behavior Inventory designed for use with college dormitory students has weathered preliminary validity and reliability testing.