Restraint and Seclusion

The majority of parents that commented on my last blog (see Cherry Hill's Chokey) were horrified when they learned that physical restraint and aversives, such as seclusion were being used on children in the Cherry Hill public school district. I received over 100 responses to that one blog! That is the highest ever on the Autism Blog, so it was obviously a great concern to many parents.


I was pleased that so many weighed in on this issue. We saw comments from parents of both special needs children and typical children, as well as a few teachers and other staff members that were able to offer their insight. It is my hope that through these public discussions, we can improve the situation for all of our children.


The issues of morality and legalities involved in this matter may seem complex. While we can all come to our own opinions on issues of morality, some parents may have been at a disadvantage since they may not be familiar with the laws related to special education. For the parents of typical children, without an IEP, I wanted to provide the legal information regarding the Individuals with Disabilities Education Act (IDEA) and the Free and Appropriate Public Education (FAPE) provisions. Obviously, IDEA is rather extensive, so I am just going to supply the basic information and that which relates to restraint and seclusion.


Every child in our school district that is "classified" as having a disability has an Individualized Education Plan (IEP). IEP's must follow the IDEA, which is a matter of Federal Law. There are also state laws that come into play, but for now I will focus on the requirements of IDEA as it relates to behavioral interventions.


IDEA supports positive approaches for all students.
The Individuals with Disabilities Education Act (IDEA) creates a presumption in favor of positive methods. IDEA requires that an IEP team consider positive behavioral interventions and strategies when it comes to a child's behavioral concerns.


A Functional Behavioral Assessment (FBA) is the type of evaluation used to determine a child's behavior support needs. This evaluation typically results in the development of a Behavioral Intervention Plan (BIP). The BIP will list the strategies to improve the child's behavior and determine the appropriate goals. All of this becomes part of the child's IEP.


The behavior plan is a very important aspect of the IEP because it tells staff how best to handle the behaviors of the individual child. Keep in mind it is an "Individualized" education plan. Special education is never a "one size fits all" approach and behavioral interventions must be individualized for the particular child.


Maladaptive Behaviors:
For parents of typical children and for teachers not specifically trained to work with children that display explosive behaviors, it is often hard to imagine why a child would "explode" in the classroom. There are many things that can lead to these maladaptive behaviors.


For children with neurological disorders, the behaviors are often triggered by skill deficits. Some of the common skill deficits are in the areas of social and communication skills. Perhaps the child has communication skill deficits that hamper his/her ability to express his needs verbally. Combine that with a low tolerance for frustration and this could easily trigger a meltdown. If the child's social skills are deficient, s/he may not understand what behaviors are socially appropriate. Effective teaching strategies could help the child learn what behaviors are appropriate in various social situations and curtail the maladaptive behaviors.


Some children have such severe Sensory Integrative Dysfunction that certain noises or lighting conditions become intolerable. This too, may manifest as inappropriate behavior. This is another thing that the behaviorist would need to consider in developing an "individualized" plan.


For some children, they may need to follow a very strict routine, so interuptions in their schedule (for assemblies, class parties, etc) may be triggering the inappropraite behaviors. Keep in mind that for most autistic children the inability to transition and extreme rigidness are part of the overall disorder. Just going from the classroom to the playground is a huge transition.


Some children may have simply learned that a certain behavior helps them to achieve a certain goal. The behaviorist then needs to consider what the child is accomplishing by displaying certain behaviors. Maybe the child becomes overwhelmed in the classroom and is actually acting out to get a "time out." In which case, the child can be trained to ask for a break when needed, rather than acting out in class. In this case, punishing the child would not teach them the appropriate way to ask for a break, it would just frustrate the child even more.


With so many pieces to the puzzle, the behaviorist needs to consider all of the possible antecedents in order to put together an effective behavioral intervention plan that is truly based on the individual child's needs.


Behavioral Interventions:
According to the IDEA, positive behavioral interventions and strategies must be considered first. Emphasis on the development of new, positive skills is different from the use of aversive techniques, restraint or seclusion, which are applied solely to control or reduce unwanted behaviors.


Some states have clarified the language in IDEA even further, specifying in state law or regulations that all methods used to support children with disabilities in the schools must be positive. At the present time, NJ continues to allow the use of physical restraint and aversive techniques in some situations, but requires advanced parental knowledge and consent before using any of these negative techniques. Basically, if it is not in the Behavioral Intervention Plan and it is not in the IEP -- it is not permitted.


A parent must sign a consent form BEFORE physical restraint or aversive techniques, such as seclusion may be utilized on their child. This is what led to the concerns in the last blog because the parent(s) were not notified in advance and did not give parental consent.


Restraint and Aversives:
Physical restraint refers to a broad category of restraints in which a person's movements are restricted by the use of physical force. Physical andor mechanical restraint has been used in the past as a means of behavioral intervention in a variety of programs for special needs children. If a child did not respond in the fashion that the adult felt was appropriate, staff was permitted to restrain the child to teach them a lesson.


An aversive would describe a type of punishment for displaying an inappropriate behavior. It refers to the deliberate infliction of physical and/or emotional pain and suffering, for the purpose of controlling or conditioning behaviors deemed unacceptable (like hand flapping or refusal to sit in a chair) by teachers or behaviorists. In general, aversive techniques include direct physical or corporal punishment: things like, spraying water at the person, Tabasco sauce in the mouth, slaps, pinches, blindfolds, hair pulls and rubber band snaps and isolation or confinement. The temporary but significant loss of movement, perceptual, or sensory ability; the disruption of basic emotional equilibrium and sense of safety; and the ongoing loss of freedom or of pleasure.


Some of the aversive techniques used were quite severe and in some cases resulted in injury and even death to a child. As sickening as this sounds, many special needs children were actually subjected to this type of treatment.


We have evolved enough as a society to recognize that aversive techniques ignore the neurological context of behavior and frequently target aspects of the disability that are not under the individual's control. We also realized that we were teaching our children that the bigger stronger person wins. We were not teaching them effective or appropriate ways to regulate their behaviors and were not teaching the skills necessary to resolve conflicts or solve problems without becoming combative.


Fortunately for our children, we also realized that there were better methods for teaching appropriate behaviors. This is where the "Best Practice" methods came into play in dealing with restraint, seclusion and aversive techniques.


The use of aversive techniques, restraint, and seclusion can lead to violations of the "free and appropriate public education" (FAPE) provision of IDEA. *
Under IDEA, an appropriate special education program must be designed to provide the student with meaningful educational benefit. However, students do not learn meaningful lessons about alternative ways of communicating and interacting when teachers and program staff respond to their challenging behaviors with aversive interventions, restraint, or seclusion. Often the frustration and anxiety caused by these negative procedures cause the child's original behavior to worsen, or to be replaced by other equally undesirable activities. When children suffer a high degree of anxiety and stress, their ability to process, retain, and act on new information is severely compromised, further undermining their ability to access the Free and Appropriate Public Education (FAPE) for which they are entitled.


The implementation of aversive techniques, restraint, and seclusion takes time and attention away from the child's IEP goals, so that educational progress is hampered. The use of these techniques, or even a request from the child's program for permission to use them, should immediately suggest that the student's program or services are not effective.


Parents can exercise their right to a new IEP meeting, at which time all aspects of the student's IEP and behavior support plan should be re-evaluated. Because of the dangers involved in using aversive techniques, restraint, and seclusion; programs wishing to use them must require the child's parents or guardians to give "informed consent" and parents have the right to deny consent.


Some parents may pre-emptively deny permission for their child's school or program to use these methods on him or her by using a letter stating "No Consent for Physical Restraint or Aversive Techniques." But even in the absence of such a letter, a special education program developed without parental input is in violation of the procedural requirements of IDEA.


In summary: No informed consent = No physical restraint, aversives or seclusion.


I hope this information is helpful to those that did not quite grasp some of the legalities involved in the use of restraint and seclusion. All readers are welcome to comment. My next blog will focus on the Best Practice methods that the Child Welfare League of America has established.


Please note: This information is in no way provided to be construed as legal advice. If you require legal advice, please contact a qualified attorney.


*Portions of the above text have been copied with permission from The Alliance to Prevent Restraint, Aversive Interventions, and Seclusion (APRAIS). Reproduction of this publication all or in part is authorized for noncommercial advocacy or educational purposes with full attribution to APRAIS.


*Originally published in the Courier Post, Autism Blog, Kathi Magee: On Autism 10/24/07.