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| Considerations on Restraint Application and Removal in Clinical Practice |
| Monday, May 26, 2025 |
| 10:00 AM–10:50 AM |
| Marriott Marquis, M4 Level, Capitol & Congress |
| Area: DDA; Domain: Service Delivery |
| Chair: Thurka Thillainathan (Brock University) |
| Discussant: Adam M. Briggs (Eastern Michigan University) |
| CE Instructor: Adam M. Briggs, Ph.D. |
| Abstract: A subset of individuals with intellectual and developmental disabilities engage in high-risk challenging behavior that may result in profound injury (e.g., disfigurement, tissue damage) to themself and others, which can significantly impact their quality of life. When less restrictive approaches do not reduce the high-risk challenging behavior, there exists a substantial risk of harm. Thus, in these situations, it may be prudent to apply restrictive procedures concurrently with reinforcement-based approaches to prevent harm and instigate behavior change. Presently, demographic research suggests restraint applications are frequently observed across sectors. However, a thorough understanding of the factors predicting restraint application in certain subsets of this clinical population remains limited, with relatively little research focused on the effective, efficient, and ethical reduction of restraints. The purpose of this symposium is to feature two complementary talks that address these gaps in the literature by disseminating key findings related to restraint application and important resources for restraint fading considerations. The first presentation will describe a study enacting multilevel analyses to examine determinants of emergency restraint application in adolescents with intellectual and developmental disabilities who engage in high-risk challenging behavior. The second presentation will describe a restriction removal framework for clinical application to systematically and effectively fade restraints. |
| Instruction Level: Advanced |
| Keyword(s): challenging behavior, ethics, least-restrictive, restraints |
| Target Audience: Attendees will benefit from having: (1) prior exposure to restraint literature; (2) previous clinical or research experience with restraints and severe high-risk behaviors; and (3) a solid understanding of the implementation of comprehensive multi-component programming (e.g., restraints applied concurrently with reinforcement-based approaches) to support individuals engaging in severe high-risk behaviors. |
Learning Objectives: 1. identify common risk factors associated with restraint application in children and adolescents across various clinical populations
2. identify participant and emergency physical restraint application characteristics in children and adolescents with intellectual and developmental disabilities who are outpatient service recipients
3. identify restrictive interventions
4. describe a process for systematically removing restrictive interventions |
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Factors Associated With Restraint Application in Children and Adolescents With Intellectual and Developmental Disabilities Displaying Severe Challenging Behavior |
| ASUDE AYVACI (Brock University), Alison Cox (Brock University), Daniel R. Mitteer (Emory University) |
| Abstract: According to recent demographic studies, emergency physical restraints (PR) are still widely used, with prevalence rates ranging from 11%–78% across service sectors (Fitton & Jones, 2020). Behavior analysts may recommend PR when severe challenging behavior (CB) poses significant safety risks (e.g., intense aggression causing severe tissue damage; Behavior Analyst Certification Board, 2020, Ethics Code 2.14 & 2.15; Vollmer et al., 2011). Most PR literature features inpatient psychiatric populations despite the prevalence of restraints among individuals with intellectual and developmental disabilities. The current study partnered Rutgers University and Brock University. The multilevel analysis was informed by retrospective outpatient data (N = 12) from children and adolescents with intellectual and developmental disability who required emergency PRs. The study aimed to a) examine participant and restraint application characteristics and trends, and b) determine if CB severity at intake predicted latency to restraint application. Descriptive analysis results suggested most participants were experiencing polypharmacy, received moderate to high scores on the partnering agency’s CB severity tool, and primarily exhibited tangible or multiply controlled CB. Regarding restraint characteristics, the average restraint rate was 0.091 per hr. Regression results indicated that the median CB severity score significantly predicted latency to the first restraint applications. Clinical implications will be discussed. |
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| Considerations for Restriction Removal |
| CODY MORRIS (Salve Regina University), Stephanie M. Peterson (Western Michigan University), Kelsey Stapleton (Western Michigan University) |
| Abstract: The Ethics Code for Behavior Analysts (Behavior Analyst Certification Board, 2020) specifies that “behavior analysts must continually evaluate and document the effectiveness of restriction or punishment-based procedures and modify or discontinue the behavior-change intervention in a timely manner if it is ineffective” (p. 12). However, there is limited guidance on how to systematically and effectively discontinue or remove restriction-based procedures once they are utilized in clinical practice. Although some examples of restriction removal processes have been described in previous research, these examples alone do not sufficiently explain the nuances that must be considered when attempting to remove restrictions in the various treatment contexts in which they might be used. Thus, there is a need for more resources to guide clinical practice in this area. The purpose of this talk is to describe a restriction removal framework that can be adapted by clinicians working in a wide variety of treatment contexts to help discontinue or remove restriction-based procedures from treatment plans. |
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