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PubMed2002

Contending with "problem behaviors" in the nursing home.

Despite the pervasiveness of challenging resident behaviors in U.S. nursing homes, the staff who work in these facilities typically have little training in mental health or behavior management. This article, based on ethnographic research in a U.S. nursing home that served a predominantly psychiatrically disabled clientele, explores how staff conceptualized and dealt with difficult resident behaviors. It investigates formal and informal strategies used by staff to contend with problematic resident behavior, as well as the obstacles--both internal and external--to effective behavior management in this context.

Adult↗
PubMed1991

Managing the care of patients with dementia. How to maximize level of functioning and minimize behavior problems.

Effective treatment of patients with dementia involves supporting and educating the primary caregiver, uncovering and correcting the underlying cause of any decompensation that may occur, and deciding when drug therapy is appropriate. Caregivers must be taught how to cope with the patient's denial and how to modify the patient's environment so that it is safe and easy to understand. Pharmacologic therapy for depression accompanying dementia can improve a patient's quality of life and independence considerably; drugs may also be of help in dealing with patients who resist care. Psychotic symptoms usually do not require pharmacologic treatment, and hypnotics should, if possible, be avoided as a solution to sleep problems.

Adaptation, Psychological↗
PubMed1993

Psychological distress, problem behaviors, and family functioning of sexually abused adolescent inpatients.

OBJECTIVE: By studying children and adolescents who have been sexually abused, improvements in identifying and treating emerging pathology can be gleaned before personality structures become more rigidly defined and less amenable to therapeutic interventions. It is through studying and comparing subgroups of victims and controls that clinical researchers can additionally elucidate abuse-related manifestations that contribute to the development of psychopathology. METHOD: A group of sexually abused adolescent psychiatric inpatients was compared with a control group of inpatient counterparts on measures of social competence, self-esteem, depression, substance abuse, and perceptions of family characteristics and functioning. Consecutive admissions to an adolescent inpatient psychiatric unit (N = 423) were carefully screened for a history of sexual abuse, then divided into two groups, each with 87 subjects, after matching on key variables including age, race, gender, socioeconomic status, and psychiatric diagnosis. RESULTS: Sexually abused and control group inpatient adolescents were similar on standardized measures of psychological distress and family functioning. Statistically significant differences were found between groups on substance abuse measures. CONCLUSION: The phenomenology of the relationship between sexual abuse and substance abuse and the implications for inpatient treatment are summarized.

Adolescent↗
PubMed2000

Cross-setting consistency in early adolescent psychopathology: deviant friendships and problem behavior sequelae.

This study examines adult reports of externalizing and internalizing psychopathology at home and school in a sample of 224 high-risk adolescent boys and girls (average age 12 years). Four groups of young adolescents were defined, based on the consistency of the teacher and parent Child Behavior Checklist reports: normal, internalizing, externalizing only, and comorbid. Group comparisons revealed the comorbid and externalizing groups were more engaged in a deviant peer group and were observed in higher levels of deviancy training with their friends, compared to other young adolescent groups. In general, elevated levels of arrest, drug use, and sexual promiscuity were associated with cross-setting consistency in externalizing disorders. Comorbid youth, however, showed the highest levels of sexual promiscuity in middle adolescence, compared to all other groups. These findings are consistent with a developmental account of adolescent maladjustment and suggest that emotional disturbance in early adolescence might exacerbate youth vulnerability, especially to deviancy training within friendships.

Adolescent↗
PubMed2001

Using parental ratings to study the etiology of 3-year-old twins' problem behaviors: different views or rater bias?

Child Behavior Checklist questionnaires (Achenbach, 1992), filled in separately by mothers and fathers, were collected for an effective sample of 3,501 Dutch 3-year-old twin pairs. To disentangle the child's phenotype from that of the rater, two contrasting models were fitted to the data. One model, called a Rater Bias model, is based on the assumption that both parents assess exactly the same behaviors in the child. A weaker alternative of this model, called a Psychometric model, assumes that apart from these common behavioral views, each parent also assesses a unique aspect of the child's behavior. A Psychometric model fitted the data of both Internalizing and Externalizing scales significantly better than a Rater Bias model. This implied that each parent provided unique information from his or her own perspective, apart from the common behavioral view. Using this best fitting model, the etiology of both the Internalizing and Externalizing scales was studied. Common factors (influencing behaviors similarly assessed by both parents) were more important than unique factors (influencing behaviors uniquely assessed by one parent). Common genetic factors explained about 50% of the variance of both scales, indicating a possible inborn vulnerability to childhood psychopathology. Common environmental factors not shared between twins (free of unreliability and error) explained around 14% of both scales, suggesting the importance of pure idiosyncratic experiences even for children as young as 3 years. Common environmental factors shared between twins (unconfounded by rater bias) were only found for the Externalizing scale, explaining 18% of the variance. Rater bias and unreliability, if present in the data, were included in the estimates of the unique factors. Unique genetic, shared, and nonshared environmental factors each explained around 8% of the variance for both scales. These small effects could be detected because of the large sample of twin pairs used.

Adult↗