Restraint Procedures and Challenging Behaviours in Intellectual Disability: An Analysis of Causative Factors

Abstract

Background Persons with intellectual disability often evince challenging behaviours. Efforts have been underway for some time to develop prosocial or positive skill acquisition treatments to address challenging behaviours. However, physical ⁄ mechanical and chemical restraint is still commonly used in many clinical and community settings. Such interventions may be planned or unplanned and in some cases implemented by staff ⁄ parents with little training. Method Physical ⁄ mechanical and chemical restraint and the factors that may result in the use and maintenance of restraint are reviewed. ResultsThe type, rate and intensity of challenging behaviours, and the age of the affected individual and residential placement appear to be among the major factors that put these persons at risk for restraint. Conclusions Restraint is still a commonly used intervention employed with people with challenging behaviours. Physical and chemical restraint should be used as a last resort, part of a planned programme, and implemented by trained people.

Addressing increasing demands on Australian disability support workers

“…A recent review by Phillips et al (2010) of behaviour support plans developed by DSWs showed that the key elements required of such plans were often omitted. Such omissions suggest that direct care staff rely on reactive strategies, including restrictive interventions, in managing behaviour (Matson & Boisjoli, 2009). Researchers have questioned the continued use of restrictive interventions and other reactive strategies in response to challenging behaviours in light of the strong evidence base to indicate the effectiveness of positive behaviour supports (Carr et al, 2002;Matson & Boisjoli, 2009;Sturmey, 2009).…”

An evaluation of the Team‐Teach behaviour support training programme in New Zealand

“…They are only used in specific isolated circumstances to "decrease the risk or harm to self or others when other behaviourally based methods are not effective" (Matson & Boisjoili, 2009, p. 113). Holden and Gitlesen (2006) and later Matson and Boisjoili (2009) found the prevalence of aggressive behaviour towards others and self injurious behaviour increased significantly for individuals with an intellectual disability and that these behaviours were utilized as "powerful ways to communicate and to control ones environment" (Matson & Boisjoili, 2009, p. 111) both at home and at school.…”

“…This raises some serious ethical and legal questions regarding justifiable grounds for restraint. Matson and Boisjoili (2009) emphasise that "staff understanding the parameters of physical restraint is important" (p. 113) to maintain a firm legal footing.…”

“…Matson and Boisjoili (2009) If we accept that challenging behaviour and violence is a working reality when dealing with students with an intellectual disability, we must then seek practical solutions that allow students to attend school, to receive an education and to do so in safety.…”

“…Matson and Boisjoili (2009) consider the available options in these emergency situations and advocate that "physical restraint in most circumstances should be preferred to chemical restraint" (p. 115) and should be used "as a last resort, part of a planned programme, and implemented by trained people" (p. 111).…”