The aggressive child

Acute assessment and management of the aggressive or violent child or adolescent are a challenge for clinicians. Early recognition of signs of impending violence and a clear understanding of the progression of violent behavior are essential to ensure safety of patients and staff. The management of violent and aggressive patients using behavioral interventions tailored to the stage of violence or aggression is critical to reducing the likelihood that the child or adolescent will attack staff or injure self or others. The indications and risks of chemical and physical restraints and hospital standards and guidelines that govern the use of behavioral and experience regarding the prevalence, presentation, and differential diagnosis of psychotic disorders in juveniles. The clinician must rapidly disentangle which elements of the clinical presentation indicate true psychotic thought processes versus elements that represent misunderstood developmentally appropriate phenomena, symptoms of nonpsychotic illnesses, or harbingers of an underlying primary medical illness. A thorough assessment is required before appropriate treatment can begin.