Reducing reactive aggression by lowering coping demands and boosting regulation: five key staff behaviors

Lowering the incidence of reactive aggression on inpatient child/adolescent psychiatric units by creating a milieu that reduces coping demands and augments children's self- regulation capabilities.

This article elaborates on specific staff approaches that have the potential to reduce occurrences of reactive aggression and behavioral eruptions frequently displayed by children and adolescents during inpatient psychiatric treatment. Identified are key staff behaviors along with explanations on how they dampen the kindling of reactive aggression and create an enhanced milieu. Accompanying each staff behavior is an explanation of the neuroscience and theory that supports the intervention.

Published literature and clinical examples.

Children hospitalized on inpatient psychiatric units frequently have poor self-regulation skills and diffuse the negative affects they experience via behaviors such as tantrums, venting, and aggression. Staff can reduce this reactive aggression by tempering the way they set expectations, by providing structure, and by decreasing threat via sensible rules that encourage choice. Staff must also create and maintain relationships with the patients that set a particular tone, thereby creating an enhanced milieu populated with adults who are positive and able to attune to a child's changing affect level.