William T. Garrison

Aggression and Counteraggression during Child Psychiatric Hospitalization

The article reports on a 1-year descriptive study of aggressive incidents and staff counteraggressive strategies within a child psychiatry inpatient unit. Ninety-nine child/adolescent patients produced a total of 887 reportable aggressive incidents during the 12-month study period. Seclusion, activity restriction, physical restraint, and administration of p.r.n. medication were studied in relation to patient aggression. Results of the study confirm the hypotheses that (1) much patient aggression within defined clinical contexts conforms to patterns of prediction directly related to person and environmental variables, and (2) the primary value of counteraggression strategies such as seclusion and restraint resides in the acute management of aggressive children and not in long-term therapeutic functions. The article offers some recommendations for new research in this general area as well as suggestions for clinical applications of these methods.

The Child Behavior Checklist as a Screening Instrument for Young Children

The authors report a pilot study which investigated the screening utility of the Child Behavior Checklist within a normal population sample of young children. Reports of behavior problems from mothers, fathers, and teachers were compared with findings from a concurrent, blind clinical assessment of these children. Results suggest good agreement between parents exists for those children perceived to be atypically problematic. However, paired-rater agreement was relatively low for parent-teacher, parent-clinician, and teacher-clinician case selection. The authors discuss shortcomings in the checklist approach and possible methods which can improve the screening utility of various approaches to the measurement of child psychopathology.

Aggressive Behavior, Seclusion and Physical Restraint in an Inpatient Child Population

The use of seclusion and physical restraint in response to child aggressive behavior was examined within an inpatient psychiatric facility. Results indicate that both seclusion and physical restraint are used at moderate levels as the clinical response to child aggression. Several environmental variables were noted to precipitate seclusion and physical restraint in a child psychiatric setting. The need to refine our understanding and implementation of these more extreme clinical measures is discussed.

The boston Naming Test: norm data and cue utilization in a sample of normal 6- and 7-year-old children

Abstract The object-naming abilities of 83 normal children were examined using the Boston Naming Test developed by E. Kaplan, H. Goodglass, and S. Weintraub (1976, The Boston Naming Test (experimental edition), unpublished test, Veterans Hospital, Boston, Massachusetts). There is currently a lack of available norms for this instrument, especially for populations of younger children. Cue utilization in this sample is explored and attention is focused upon possible gender differences in naming performance and cue strategies. Seven summary scores derived from the test are presented in this report. Results indicate that the Boston Naming Test can discriminate within a normal population sample of young children and provides a relatively normal distribution for six of seven derived scores. Boys were found to have a significantly greater number of items correctly named but no gender differences in cue utilization were evident. A major proportion of the children in this sample of 6- and 7-year-olds used phonological cues almost exclusively, rather than semantic cues also provided. Cue use was not related to age or spontaneously given responses, and none of the children were found to be highly proficient at using both types of cues.

An application of the pictorial scale of perceived competence and acceptance within an epidemiological survey.

The Perceived Competence and Acceptance Scale for Younger Children (PCS) was examined in the course of an epidemiological survey of psychological disorders in children. Eighty-three children, aged 6 and 7 years, were administered several measures including the WISC-R, the WRAT, the Lie Scale for Children, and the PCS. Teachers provided ratings from a parallel version of the PCS and reported on the behavioral and social development of each child through the Child Behavior Checklist. Investigation of the psychometric characteristics of the PCS substantially replicates findings reported by its developers. The size and direction of correlations among the cognitive competence subscale of the PCS, achievement measures, and the Lie Scale indicate that children tend to more accurately report about this domain than others included in the PCS. Children who reported atypically high or low PCS levels were not found to differ from the remainder of the sample on two clinical indices. Children who tended to exaggerate PCS levels, as compared to teacher ratings, had significantly more behavior problems in school and were seen by two observers as more apt to be currently maladjusted.

Inpatient psychiatric treatment of the difficult child: Common practices and their ethical implications

This article reviews and discusses the available research literature pertaining to the prevalence of seclusion and restraint procedures in inpatient psychiatric treatment facilities for children and adolescence. The rationales for use, potential effects, and factors found to influence the application of these more extreme clinical interventions are considered. The author suggests that the supposed therapeutic function of these types of practices has not been substantiated and their implementation can vary widely from one setting to another. Results from several studies suggest that clearly defined criteria for use and more observational studies of prevalence and precipitant factors could considerably refine these procedures and reduce potential abuses. The psychopharmacologic approach to the treatment of difficult children is examined as a sophisticated counteraggression strategy which has yet to demonstrate therapeutic efficacy. These clinical procedures, which are utilized in scores of inpatient settings, generate serious ethical questions for the health professional concerned with the legal rights of those minors labeled as deviant members of families or the society at large.

Attachment to a special object at the age of three years: Behavior and temperament characteristics

This study attempts to estimate the prevalence rate of attachment to a special object in a total population sample of three-year-olds drawn from an ongoing epidemiologic survey. The significance of object attachment at age three for the development of behavioral disturbance is assessed through two separate measures. Data from parental reports of temperament characteristics and observational codings of play sessions in the home setting are also presented. While the authors conclude that attachment to a special object is not related to behavioral disturbance, certain temperamental and play behavior characteristics were found to be significant.

Predicting violent behavior in psychiatrically hospitalized boys.

A naturalistic study of violent behavior in a sample of 100 boys residing within an inpatient psychiatric facility is reported. Over 1000 recorded incidents of interpersonal aggression were used to explore patterns of male violence in a contextually defined setting. Findings include a proportionately greater incidence of violence in younger boys. Staff members, particularly males, were more likely to be the victims of interpersonal violence, but peers and staff were equally likely to be the target of aggressive behavior in general. Observable provocation in the social context, the age of the child, and choice of victim (staff vs. peer) were found to be important predictors within a logistic regression model of violence. An estimate of the predictive utility of a logistic model for the occurrence of violence was found to be too low for clinical purposes. An application of a descriptive statistical method to collections of incidents for five highly aggressive boys yielded idiopathic models of violent behavior. Predictive accuracy estimates from these models suggest that multivariate description of behavioral data can be a clinically useful tool in understanding and possibly preventing violence within defined contexts such as residential psychiatric facilities.

Young children's subjective reports about their diabetes mellitus: a validation of the Diabetes Pictorial Scale.

The authors report on a validation study using the Diabetes Pictorial Scale (DPS), a measure of disease-related attitudes, behaviors, and knowledge specifi cally designed for use with younger children with insulin dependent diabetes mellitus (IDDM). Results of this study, based on the responses of 39 children ages 4 to 10, suggest that the DPS demonstrates sufficient variation between and within patients to merit further field- testing of the technique. Pre selected DPS items hypothesized to affect metabolic control in IDDM were examined in this study and compared with glycosy lated hemoglobin (HbA1) values collected concurrently. Childrens reports concerning adherence to their dietary plan, the regularity of insulin injections, and the regularity ofmealslsnacks were related to glycemic control. Broader issues pertinent to the utility, reliability, and validity of childrens subjective reports are briefly discussed within the context of demand characteristics in the IDDM provider-patient interaction.

Life Events and Social Supports in Families With a Two- Year-Old: Methods and Preliminary Findings

C ONCEPTUALIZATIONS of stress and its impact on families and children have been widely studied in sociology,1*2 clinical medicine? and social epidemiology.6,7 Although the literature regarding stress in families has burgeoned during the past 20 yrs,8,9 much of this work has been of a theoretical nature. Consequently, empirical research has appeared far less frequently. Two major reasons account for this situation: (1) theoretical models of the stressful experiences that are encountered by individuals, as well as whole families, have lacked sufficient specificity to engender operational definitions upon which empirical work could be based and (2) the few instruments that are designed to measure stress have suffered from serious methodological and conceptual flaws.‘s13 Although it is generally conceded that a high level of stress in families is undesirable and potentially harmful, the study of the unique impact of stress on the development of the child in the early and middle years has only recently emerged in child psychology and psychiatry. I4 There is little data on the frequency of life events and life changes in normal families. Because life events occur in all families, this lack of normative data has made it difficult to draw an association between life events and behavior or developmental problems. Concurrent with the development of research on stressful events in family life is the importance of various mediators of stress. Marital status,15quality of marriage,16 and the availability of a confidante have each been suggested as key stress-buffering agents for adults. “Jo Research has also indicated that sociocultural variables, including social status and income levels, 19~20 societal attitudes toward health,21 and the homogeneity of social groupsZ2can also act as stress-buffering factors. Personal characteristics involved in the processes of individual coping,23 perceived control of behavior,24 past experience, and intelligence levels have also been mentioned as mediators of stress.25 The most widely researched mediator of stress in families is social support.26.27 Although this concept is broad, it is possible to trace the sources of social support to kinship, friendship, and community level sources of help. The numbers of relatives, friends, and neighbors can be used as indices of social support availability,27 even though one study has cautioned that availability and quantity of contact with others may not be so influential as the quality of interaction within such systems.28 As an example, Garrison and Earls29 report that frequent contact with relatives can be associated with negative outcomes in young children.