Mechanical restraints as positive reinforcers for aggression

Abstract

Research suggests that, in some cases, mechanical restraints may function as positive reinforcers. In this study, we conducted a functional analysis of severe aggression exhibited by an individual with a history of wearing arm splints. The results of this functional analysis demonstrated that his aggression was maintained by access to the arm splints. Copyright # 2008 John Wiley & Sons, Ltd. Historically, mechanical restraints such as arm splints have been used to prevent severe self-injurious behavior (SIB) as well as to minimize the injury that may result from SIB (Griffin, Williams, Stark, Altmeyer, & Mason, 1984;Sturmey, 1999). In many cases, the use of mechanical restraints can function as punishment or extinction (Mazaleski, Iwata, Rodgers, Vollmer, & Zarcone, 1994), which effectively decreases SIB. However, in some cases, prolonged use of mechanical restraints may lead to the restraint becoming a positive reinforcer. For example, Favell, McGimsey, and Jones (1978) used mechanical restraints as part of a differential reinforcement of other (DRO) treatment for severe SIB with three individuals with mental retardation. They found that providing access to the restraint contingent in the absence of SIB for prespecified periods of time resulted in a reduction in SIB. They subsequently showed that an arbitrary response (placing a marble in a box) could be reinforced by access to mechanical restraints.In light of these findings, it is possible that the loss (or removal) of mechanical restraints may lead to increase in problem behavior. That is, if mechanical restraints are a reinforcer, then the loss of the reinforcer may serve as an establishing operation (i.e., deprivation) resulting in an increase in the reinforcer value of the restraint. This in turn may lead to an increase in the future probability of problem behavior that may be associated with access to mechanical restraints. Therefore, the purpose of this

Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis

“…(Gómez-Durán et al, 2014;Mohr, 2010;O'Brien & Golding, 2003;Steinert et al, 2004;Wynn, 2006); clinical (Does it prevent agitation or assault?) (Irving, 2002;Kahng et al, 2008;Muralidharan & Fenton, 2006;Sailas & Fenton, 2000); economic (the personnel-related costs associated with MR) (Flood et al, 2008;Garrido Viñado et al, 2015;Lebel et al, 2005); and, especially, patient safety (the risks of harm to the restrained patient) (Nelstrop et al, 2006).…”

Use of a Direct Observational Measure in a Trial of Risperidone and Parent Training in Children with Pervasive Developmental Disorders

“…Alternatively, parents or teachers may compile “counts” of specific behaviors in school or in the home (Cooper et al 2007). Within the ASD and developmental disabilities fields, direct observations have been used to assess treatment efficacy in a wide range of problem areas, from self-injury (Yang 2003), to increasing food acceptance (Ahearn 2002), to eliminating aggression (Kahng et al 2008). Such measures have also been used to assess treatment efficacy in numerous psychopharmacology trials among a range of childhood disorders, especially ADHD (e.g., Abikoff et al 2004; Pelham et al 2002).…”

Treatment of Life-Threatening Pica with 5-Year Follow-up

“…However, response blocking, contingent aversive consequences, and the use of seclusion, restraint, and protective devices, which are some of the most common approaches to managing severe pica (Sturmey and Williams 2016), can also be associated with a variety of negative outcomes. Restrictive behaviour management practices have been associated with a failure to effectively prevent the occurrence of pica (Mace and Knight 1986), a contribution to the onset of physical aggression and other collateral behaviours (Hagopian and Adelinis 2001;Lerman et al 2003), a reliance on or development of preference for restraints (Kahng et al 2008;Singh et al 1984), restraint-related physical injury (Singh et al 2009), social stigmatization (Sturmey and Williams 2016), and detriments to the individual's quality of life (Rojahn et al 1987).…”