Use of restraint for the management of challenging behaviour in children with intellectual disabilities

Abstract

Purpose -This review seeks to provide an overview of the current research evidence on the use of restraint as an intervention in managing challenging behaviours in relation to children with intellectual disabilities. It also aims to discuss legal frameworks and ethical considerations that underpin the use of restraint in intellectually disabled children who present with challenging behaviours.Design/methodology/approach -The authors conducted a search of existing literature primarily pertaining to the management of challenging behaviours in intellectual disability on PubMed, PsycInfo and Google Scholar using combinations of the following key words -children, intellectual disabilities, learning disability, mental retardation, challenging behaviour, restraint, seclusion, physical restraint, mechanical restraint, personal restraint, and chemical restraint. Since research on the use of such interventions in children has been hitherto scant, literature relating to their use in intellectually disabled adult populations as well as cognitively able children was also examined to ascertain whether the broad principles informing the use of restraint interventions could be generalised to their use in intellectually disabled children. Findings -The review finds evidence to suggest that restraint interventions in their myriad forms are widely used to manage challenging behaviours in children with intellectual disabilities and outlines the evidence base, clinical scope, and the risks associated with the use of such interventions in children. It also helps highlight the current absence of comprehensive evidence based guidance that incorporates clinical, ethical, and legal aspects of the use of restraint interventions in children with intellectual disabilities and raises relevant questions in relation to their judicious use in this patient group.Originality/value -The authors believe that the review completes the first in depth evaluation of the use of restraint interventions in children with intellectual disabilities and are confident that this would serve as useful guidance for professionals working with this patient group who may be considering using restraint interventions in their everyday clinical practice.

Restrictive physical interventions and teacher professionalism: a discussion

“…Some research suggests challenging behaviours can be seen in a positive correlation with intellectual impairment (Borthwick‐Duffy, ). Menon et al () report that a range of complex, sometimes co‐morbid, physical and cognitive challenges to the successful development of communication and sensory skills sees children predisposed to challenging behaviour. However, the authors fail to consider a wide range of external factors, such as neglect or parental criminality, that can contribute to pupils experiencing episodes of distress.…”

“…For instance, following PLC discussions about a pupil who is currently involved in an alarmingly high number of RPIs (necessary due to assaults on staff), my colleagues and I have been in close consultation with the child's parents, two child psychologists, members of the Child and Adolescent Mental Health Services team, local police officers, the pupil's play therapist and general medical practitioner to work in unison in attempting to interrupt this negative cycle. Indeed, regarding the use of RPIs and the management of challenging behaviour in children with intellectual disabilities, Menon et al () note how these and similar consultations can lead to good practice: ‘Collaborative care planning involving the patients and carers … and debriefing procedures may aid in reducing the frequency of such interventions’. Such multi‐agency working is commonplace since the advent of Education, Health and Care Plans born out of the Children and Families Act (2014).…”

Use of medication for challenging behaviour in people with intellectual disability

“…Such approaches would be extremely problematic in community settings and offer no long-term solution. 12 A way to improve the evidence Without positive action this unsatisfactory state of affairs is likely to persist. We believe that the leadership of the profession and the pharmaceutical licensing authority have a responsibility to act, following their commitments in the Winterbourne View concordat.…”

“…Such approaches would be extremely problematic in community settings and offer no long-term solution. 12…”

Applying Restrictive Measures in the Care of Adolescents With Mild Intellectual Disabilities: Attitudes of Support Staff and Policy Implications

“…In recent years, policymakers in the Netherlands have become increasingly interested in the extent to which restrictive measures are used in the care of adolescents (ages 12–23) with mild intellectual disabilities (ID) and how to reduce such use. Internationally, there is evidence that restraints are widely used to manage challenging behavior in young people with ID (Menon, Baburaj, & Bernard, ). In the Netherlands, the general public became aware of the wide use of restrictive measures on adolescents with mild ID in 2011 when the Evangelische Omroep (E.O.…”