Abstract
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.
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References
Atkins, M. S., & Ricciuti, A. (1992). The disproportionate use of seclusion in a children’s psychiatric state hospital. Residential Treatment for Children & Youth, 10, 23–33.
Barry, C. T., Frick, P. J., Deshazo, T. M., McCoy, M. G., Ellis, M., & Loney, B. R. (2000). The importance of callous-unemotional traits for extending the concept of psychopathy to children. Journal of Abnormal Psychology, 109, 335–340.
Barry, T. D., Thompson, A., Barry, C. T., Lochman, J. E., Adler, K., & Hill, K. (2007). The importance of narcissism in predicting proactive and reactive aggression in moderately to highly aggressive children. Aggressive Behavior, 33, 185–197.
Becker, D. F., Edel, W. S., Fujioka, T. A., Levy, K. N., & McGalashan, T. H. (1996). Attentional and intellectual deficits in unmedicated behavior-disordered adolescent inpatients. Journal of Youth and Adolescence, 25, 127–135.
Blair, R. J. (1997). Moral reasoning and the child with psychopathic tendencies. Personality and Individual Differences, 22, 731–739.
Bonner, G., Lowe, T., Rawcliffe, D., & Wellman, N. (2002). Trauma for all: A pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. Journal of Psychiatric and Mental Health Nursing, 9, 465–473.
Caputo, A. A., Frick, P. J., & Brodsky, S. L. (1999). Family violence and juvenile sex offending: The potential mediating role of psychopathic traits and negative attitudes toward women. Criminal Justice and Behavior, 26, 338–356.
Christian, R., Frick, P. J., Hill, N. L., Tyler, L., & Frazer, D. R. (1997). Psychopathy and conduct problems in children: II. Implications for subtyping children with conduct problems. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 233–241.
Crosland, K. A., Cigales, M., Dunlap, G., Neff, B., Clark, H. B., Giddings, T., et al. (2008). Using staff training to decrease the use of restrictive procedures at two facilities for foster care children. Research on Social Work Practice, 18, 401–409.
Curie, C. G. (2005). SAMHSA’s commitment to eliminating the use of seclusion and restraint. Psychiatric Services, 56, 1139–1140.
Erath, S. A., El-Sheikh, M., & Cummings, E. M. (2009). Harsh parenting and child externalizing behavior: Skin conductance level as a moderator. Child Development, 80, 578–592.
Feldstein, S. W., & Ginsburg, J. I. D. (2006). Motivational interviewing with dually diagnosed adolescents in juvenile justice settings. Brief Treatment and Crisis Intervention, 6, 218–233.
Freeman, M. F., & Tukey, J. W. (1950). Transformations related to the angular and the square root. Annals of Mathematical Statistics, 21, 607–611.
Frick, P. J. (2004). The inventory of Callous-Unemotional traits. Unpublished rating scale.
Frick, P. J., Barry, C. T., & Bodin, S. D. (2000). Applying the concept of psychopathy to children: Implications for the assessment of antisocial youth. In I. B. Weiner (Ed.), The clinical and forensic assessment of psychopathy, Mahwah (pp. 3–24). New Jersey: Lawrence Erlbaum Associates.
Frick, P. J., Cornell, A. H., Bodin, S. D., Dane, H. E., Barry, C. T., & Loney, B. R. (2003). Callous-unemotional traits and developmental pathways to severe conduct problems. Developmental Psychology, 39, 246–260.
Frick, P. J., & Ellis, M. (1999). Callous-unemotional traits and subtypes of conduct disorder. Clinical Child and Family Psychology, 2, 149–168.
Frick, P. J., & Hare, R. D. (2001). The antisocial process screening device (APSD). Toronto: Multi-Health Systems.
Goren, S., Singh, N. N., & Best, A. M. (1993). The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital. Journal of Child and Family Studies, 2, 61–73.
Greene, R. W., & Ablon, J. S. (2006). Treating explosive kids: The collaborative problem-solving approach. New York: Guilford Press.
Greene, R. W., Ablon, J. S., & Martin, A. (2006). Use of collaborative problem solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatric Services, 57, 610–612.
Haimowitz, S., & Urff, J. (2006). Legal consequences of seclusion and restraint. Psychiatric Services, 57, 1516.
Kennedy, S. S., & Mohr, W. K. (2001). A prolegomenon on restraint of children: Implicating constitutional rights. American Journal of Orthopsychiatry, 71, 26–37.
Kerig, P. K. (2003). Acuity and refusal rates among CPI child and adolescent admissions: 2002–2003. Technical report, Research Committee, John Umstead Hospital.
Kerig, P. K., & Fedorowicz, A. E. (1999). Assessing maltreatment of children of battered women: Methodological and ethical considerations. Child Maltreatment, 4, 103–115.
Kerig, P. K., & Stellwagen, K. K. (in press). Roles of callous-unemotional traits, narcissism, and Machiavellianism in childhood aggression. Journal of Psychopathology and Behavioral Assessment.
Kerig, P. K., & Stevens, J. (2004). Results of overhead page procedure monitoring, 2002-2004. Technical report, Children’s Psychiatric Institute, John Umstead Hospital.
Kimonis, E. R., Frick, P. J., Skeem, J. L., Marsee, M. A., Cruise, K., Munoz, L. C., et al. (2008). Assessing callous-unemotional traits in adolescent offenders: Validation of the inventory of callous-unemotional traits. International Journal of Law and Psychiatry, 31, 241–252.
Larson, T. C., Sheitman, B. B., Kraus, J. E., Mayo, J., & Leidy, L. (2008). Managing treatment resistant violent adolescents: A step forward by substituting seclusion for mechanical restraint? Administration and Policy in Mental Health and Mental Health Services Research, 35, 198–203.
LeBel, J., Stromberg, N., Duckworth, K., Kerzner, J., Goldstein, R., Weeks, M., et al. (2004). Child and adolescent inpatient restraint reduction: A state initiative to promote strength-based care. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 37–43.
Masters, K. J., Bellonci, C., Arnold, V., Beitchman, J., Benson, R. S., Bukstein, O., et al. (2002). Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 4s–25s.
Millstein, K. H., & Cotton, N. S. (1990). Predictors of the use of seclusion on an inpatient child psychiatric unit. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 256–264.
Nunnaaly, J., & Bernstein, I. (1994). Psychometric theory (3rd ed.). New York: McGraw Hill.
Persi, J., & Pasquali, B. (1999). The use of seclusions and physical restraints: Just how consistent are we? Child & Youth Care Forum, 28, 87–103.
Robins, C. S., Sauvageot, J. A., Cusack, K. J., Suffoletta-Maierle, S., & Frueh, B. C. (2005). Consumers’ perceptions of negative experiences and “sanctuary harm” in psychiatric settings. Psychiatric Services, 56, 1134–1138.
Singh, N. N., Singh, S. D., Davis, C. D., Latham, L. L., & Ayers, J. G. (1999). Reconsidering the use of seculsionand restraints in inpatient child and adult psychiatry. Journal of Child and Family Studies, 8, 243–253.
Skeem, J. L., Poythress, N., Edens, J. F., Lilienfeld, S. O., & Cale, E. M. (2003). Psychopathic personality or personalities? Exploring potential variants of psychopathy and their implications for risk assessment. Aggression and Violent Behavior, 8, 513–546.
Sourander, A., Ellilae, H., Vaelimaeki, M., & Piha, J. (2002). Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment. European Child and Adolescent Psychiatry, 11, 162–167.
Stafford, E., & Cornell, D. G. (2003). Psychopathy scores predict adolescent inpatient aggression. Assessment, 10, 102–112.
The Psychological Corporation. (1999). Manual for the wechsler abbreviated scale of intelligence. San Antonio: Author.
Weiss, E. M. (1998). Deadly restraint. Connecticut: Hartford Courant.
Wong, S., & Hare, R. D. (2005). Guidelines for a psychopathy treatment program. Toronto: Multi-Health Systems.
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Stellwagen, K.K., Kerig, P.K. Relating Callous-Unemotional Traits to Physically Restrictive Treatment Measures Among Child Psychiatric Inpatients. J Child Fam Stud 19, 588–595 (2010). https://doi.org/10.1007/s10826-009-9337-z
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DOI: https://doi.org/10.1007/s10826-009-9337-z