Managing Challenging Behaviour in the Adolescent Inpatient Environment

Frontline clinical staff, typically nurses, are routinely faced with the dilemma of managing challenging, defiant and sometimes unsafe behaviours. Structures of ward rules, regulations and ‘behavioural expectations’ are often employed in hospital environments in service of regulating these behaviours and ensuring collective well-being. Adolescent inpatient populations, however, pose unique and particularly complex challenges for managing behavioural expectations, given the unique needs and inherent tempestuousness of this developmental period. This article presents a critical review of the existing literature on behavioural expectations for inpatient units, which is largely bereft of adolescent-specific guidelines. Relevant theoretical perspectives are examined that lend understanding to the management of adolescent behaviour. Finally, drawing from neurodevelopmental, attachment and socio-evolutionary theory, guiding clinical principles and recommendations are derived for best practice in managing challenging adolescent behaviour in hospital settings.