Aggressive Adolescents in Residential Care: A Selective Review of Treatment Requirements and Models
Knorth, Erik J., Klomp, Martin, Van den Bergh, Peter M., Noom, Marc J., Adolescence
Aggressive adolescents represent a complex problem for residential youth care. Aggressive behavior is often one of the reasons for transferring adolescents from their home environment to placement in a residential unit (Knorth, 1998; Knorth & Van der Ploeg, 1994). However, aggressive behavior often continues to be a problem within the residential unit, and is a regular cause of premature termination of residence (Scholte, 1997). The result is that adolescents who engage in aggressive behavior often get transferred to a different (stricter) therapeutic setting such as secure welfare. Aggressive behavior is a threat to other adolescents in the residential unit. Moreover, this type of behavior evokes feelings of fear, anger or impotence in residential workers.
A crucial question therefore is: What is an adequate approach to the treatment of adolescents who engage in aggressive behavior? The approaches covered in (Anglo-American) literature are largely based on cognitive-behavioral theories (Feindler & Ecton, 1986; Kazdin, 1997; Spence, 1994; Wilde, 1996). Such theories emphasize cognitive restructuring and the need to improve social skills and impulse control in children and adolescents.
Similar approaches are found in the Netherlands (Loeber, Slot, & Sergeant, 2001; Orobio de Castro, 2001). Following an analysis of various approaches to the treatment of aggressive behavior in adolescents, Van der Ploeg and Scholte (1993) conclude that programs based on a cognitive-behavioral approach appear most successful in reducing aggressive behavior (Scholte, 1997). In Dutch institutions for residential care treatment methods based on behavior-therapeutic principles are most common (Kok, Menkehorst, Naayer, & Zandberg, 1991; Slot, 1988; Slot & Renssen, 1994).
This article explores the possibilities of several approaches in the treatment of adolescents who engage in aggressive behavior in residential units, focusing on those with severe behavioral problems who have been placed in strict treatment settings. The investigation was based partly on a literature search in the domains of child psychology, child psychiatry, and youth welfare, and partly on empirical studies in the field of residential youth care. Special attention is paid to findings from The Netherlands.
The term "aggressive behavior" may be interpreted in various ways. In this paper, we follow Van der Ploeg (1997) in defining it as "... injuring other persons, attacking or threatening them with mental and/or physical violence" (p. 263). This definition includes bullying, arguing, fighting, being short-tempered, disobedient and unruly behavior, and irritability. Such behaviors can be found at the top of the list of symptoms indicative of DSM-IV ax-I classifications "conduct disorder" (CD) and "oppositional defiant disorder" (ODD) (APA, 2000).
Main characteristics of a conduct disorder are the following: aggression directed at persons and animals; destroying property; deceitfulness or pilfering; and serious breaches of rules of conduct. An oppositional defiant disorder is defined as "negativist, hostile and openly disobedient behavior," characterized by behaviors such as rages, argumentativeness, and a defiant attitude (APA, 2000). Although a conduct disorder and an oppositional defiant disorder are sometimes thought of as being interchangeable, the two relate to different levels of aggressiveness and social commitment (Lahey, Loeber, Quay, Frick, & Grimm, 1997). In ODD, negative behavior is not as excessive as in CD, with the child or adolescent being more capable of having satisfactory affective relationships with others (Doreleijers, 2000). Children or adolescents with CD exhibit aggressive behavior that seems to be primarily directed against the outside world. Although the adolescents themselves also often suffer as a result of this type of behavior, it is those around them who experience the aggressive behavior as especially disturbing and disagreeable. …