Child or Adolescent Neurobehavioral Unit Admission Criteria

Candidates for admission should meet all of these criteria:

  • 5-17 years of age
  • Primary DSM IV Axis I diagnosis
  • Documented failure in a less structured or restrictive setting
  • Adequate intellectual functioning (IQ>70), vision, hearing
  • English primary language
  • Physical capacity to benefit from, and participate in, therapeutic programming

Plus Indicators for a Possible Brain Disorder:

  • Repetitive rage behavior (Pathological Aggression) with no provocation or gain
  • Impulsivity with impulsive aggression
  • Chronic irritability
  • Poor planning skills (runaway with no plan, no money, nowhere to go)
  • Short attention span & poor memory
  • Laboratory evidence (abnormal CT scan, MRI, EEG)
  • History of neurological disease (seizure disorder, encephalitis)
  • Abnormal Neuropsychological test results
  • Head injury or multiple concussions
  • Exposure by fetus to toxic substances (medications/substance abuse in pregnancy)
  • Lack of prenatal care, difficult pregnancy or childbirth with late development
  • No birth history or early developmental history available due to adoption

Behavioral history includes one or more of the following:

  • Previous psychiatric treatment failures
  • Repeated impulsive aggression, out of proportion to provocation
  • Early onset of substance abuse (before age 13)
  • Failure to plan ahead, to remain on task, or to complete tasks
  • Failure to learn from punishments or consider consequences before acting
  • Significant learning disability or deficit in executive cognition

Description of a typical Neuropsychiatric patient

A child or adolescent with a suspected Neuropsychiatric disorder may be described as impulsive, short-tempered, disorganized, learning impaired and socially unskilled or immature.

These relatively mild brain problems (as compared to Traumatic Brain Injuries) occur in patients with normal intellect and few if any obvious neurological symptoms (e.g., they may be clumsy but show no paralysis). The problems are not due to acute or progressive neurological diseases (e.g.: traumatic head injury, brain tumor), but tend to be mild disorders of brain function caused by complications during pregnancy or delivery. Some cases may have a family history of a similar “explosive temper”, that may be genetic in origin (intermittent Explosive Disorder or Bipolar Disorder). Typically, there may be very subtle brain disorders, many of which have never been identified. However, they are not trivial. They make the child or adolescent vulnerable to maladaptive behavior and to the development of psychiatric disorders (worsened if they grow up in chaotic or abusive families). The combination of brain vulnerability and later development of psychiatric impairment is the definition of a neuropsychiatric disorder.

Sophisticated neuropharmacologic treatment is an essential factor in stabilizing brain function and providing adequate control of explosive aggression and impulsivity. It is the goal of the treatment program to remove or overcome the neurological barriers to successful treatment of these psychiatric disorders, and to do so in a secure environment with Neuropsychiatrically trained nursing staff.

The milieu is also modified to take into account the fact that children with neurodevelopment disorders are easily over stimulated. The milieu is quieter and slower paced, with many rest periods built into the schedule. Limit setting is accomplished without confrontations that can lead to rage behavior. It is a nurturing, rather than authoritarian milieu, with emphasis on:

1) Redirection
2) Having the patient go to a quiet place and calm down
3) Positive praise when control is achieved

There is a concerted effort to avoid a punitive program, and all negative behavioral consequences are kept brief (15 minutes to 24 hours at a maximum). Social skill training and anger management is an integral part of all nursing plans. However, all training, including schoolwork, is modified to take into account the patient’s neuropsychological limitations as identified on initial assessments.