In the US, ‘tough-love’ military-style boot camps are advertised as a panacea for teenagers with problem behaviours such as substance abuse and aggression. Although little evidence exists that harsh techniques work, parents can choose from hundreds of ‘emotional-growth’ boarding schools, ‘extreme-survival’ camps and anti-drug programmes, offered by this billion-dollar industry. At least three dozen teens have died in these programmes to date.
In the UK, an official military-style programme for problem teenagers was started in 1902, at Borstal prison in Kent. It was a last resort for young male offenders aged 16-22, as an alternative to prison. Reformatories were set up countrywide and referred to as ‘borstals’. Breaking the rules was likely to have resulted in caning or birching. Though these institutions were supposed to offer education and discipline, they have been described as ‘breeding grounds for bullies and psychopaths’. In 1982 the criminal- justice act abolished the borstal system. Recently, Home Office advisers recommended a return to strict regimes for young offenders. Based on the success of two prison-service programmes of the late 1990s — the Thorn Cross High Intensity Training Centre in Cheshire and the Colchester Young Offender Institution — the emphasis is on hard work and discipline, not physical punishment. Inmates receive education, anger management and drug rehabilitation. Studies show that, two years after release, inmates took longer to reoffend and committed fewer crimes. Shocking truths
In the UK about 15% of severely learning-disabled children have serious behavioural problems. Out of these, those with reduced IQ — or specific syndromes — often self-harm. ‘Self-injury behaviours can be extremely severe,’ says Dr Sarah Bernard, consultant psychiatrist in child and adolescent learning disability at the Maudsley Hospital, London. ‘Some require permanent splintage in arm and leg restraints to prevent serious harm.’ Some countries began using electric shocks and other pain-inducing methods, or ‘aversive therapy’, in the 1960s to try to stop self-harming. Though sometimes used abroad, these methods aren’t used in the UK. ‘It’s terrible to use something like that without clear evidence to show it works,’ says Bernard. The UK recommends a multi-disciplinary assessment looking at all aspects of the child’s behaviour and mental health. ‘You need to clarify if the child has autism, for example, and also exclude an underlying physical cause, such as pain.’ Experts assess level of function, IQ and run a functional analysis — examining why children show certain behaviours. ‘It’s a big assessment and most places don’t have the facilities to do that now,’ says Bernard. ‘We have a knee-jerk response when we hear children might be given electric shocks, but other, far less emotive, adverse treatments are worrying as well. Reducing stimulation to the child if they do something they shouldn’t might be seen as aversive. The whole area needs more research. It’s absolutely unacceptable to use something which causes pain if it’s not working.’ Getting with the programme
The best treatment for adolescents with behavioural problems is not ‘boot camp’, say the experts. More effective methods include improving communication between them and parents, setting clear boundaries, and ensuring that their needs for freedom, social connection and responsibility are recognised and met in a safe, healthy way. ‘In the UK, we work with psychology, psychiatry, family and behavioural therapy, and, if indicated, individual therapy,’ says Dr Sarah Bernard. ‘There are residential places for children with very dangerous conduct disorders. We take a multi-disciplinary approach — we don’t just send them off to residential settings.’ Dangerous behaviours can be modified in teens in response to practical, problem-solving, behavioural therapies, If the child feels respected and cared for by the therapist, according to experts. Effective therapies also recognise that different problems require different approaches. Medication and therapies that help children with autism differ from those needed in conduct disorder or depression. Residential camps in the States generally take a ‘one-size-fits-all’ approach. These programmes, which often exaggerate the danger of problematic but common teen troubles — such as poor grades, bad attitudes and experimentation with drugs — have been accused of ‘exploiting parents who feel desperate’. Giving tough love