Date of Completion

4-20-2017

Embargo Period

4-21-2017

Keywords

Executive Function, Clinical Psychology, Self Regulation, Child Psychiatry

Major Advisor

Marianne Barton, PhD

Associate Advisor

Jeffrey Burke PhD

Associate Advisor

Karen Holler PhD

Field of Study

Psychology

Degree

Doctor of Philosophy

Open Access

Open Access

Abstract

Physical restraints and seclusions (R/S) within a psychiatric inpatient setting remain highly controversial interventions that are used in response to a child’s dysregulated, and unsafe behaviors. Previous studies have identified a range of risk-factors that increase a child’s likelihood of experiencing R/S during their inpatient admission, however no study to date has examined whether a child’s executive functioning (EF) predicts R/S. Thus, the two aims of the current study were 1) to examine the relationship between children’s observable behavior dysregulation (R/S) and performance on formal measures of EF, and 2) to identify which demographic, psychiatric or neurocognitive factors place a child at greater risk for experiencing R/S during his/her inpatient admission. Participants included 271 children who were consecutively given a neuropsychological assessment on the Children’s Inpatient Unit at Emma Pendleton Bradley Children’s Hospital between 2010-2015. The total count of each R/S type (hold, escort, time in seclusion and mechanical restraint) was recorded from the child’s medical record for the current admission. A series of negative binomial regressions predicting each type of R/S were conducted. When EF skills were examined independently from demographic or psychiatric variables, lower scores on the Stroop Color Word task significantly predicted greater holds, escorts, and mechanical restraints. Counter to hypothesis, higher scores on the Wisconsin Card Sorting Task-Categories predicted more holds, escorts, seclusion time and mechanical restraints. However, when significant demographic and psychiatric variables were added to the models, children’s R/S were most predicted by the child’s age, race/ethnicity, history of an out-of-home placement (residential program) and history of aggression. Results are discussed in the theoretical context of the relationship between EF measures and behavior regulation, as well as in the context of inpatient psychiatric treatment.

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