Inpatient psychiatric treatment of the difficult child: Common practices and their ethical implications

This article reviews and discusses the available research literature pertaining to the prevalence of seclusion and restraint procedures in inpatient psychiatric treatment facilities for children and adolescence. The rationales for use, potential effects, and factors found to influence the application of these more extreme clinical interventions are considered. The author suggests that the supposed therapeutic function of these types of practices has not been substantiated and their implementation can vary widely from one setting to another. Results from several studies suggest that clearly defined criteria for use and more observational studies of prevalence and precipitant factors could considerably refine these procedures and reduce potential abuses. The psychopharmacologic approach to the treatment of difficult children is examined as a sophisticated counteraggression strategy which has yet to demonstrate therapeutic efficacy. These clinical procedures, which are utilized in scores of inpatient settings, generate serious ethical questions for the health professional concerned with the legal rights of those minors labeled as deviant members of families or the society at large.