Monday, September 27, 2010

The effects of restraint

As I've been writing my support blogs, I've found some areas get repeated. Those are often worth repeating and additional insight. They're worth keeping up front in our minds as reminders of their importance. Kind of like bullying or Halloween safety. Today it's about the use of restraint in meltdowns or other behavior.

First, I want to remind everyone that the proper use of restraint is more than just how a child is held or how restraint is used safely. It's also about when restraint even should be used. Restraint is a last resort only for physical protection of the child and others around him or her. The importance of this cannot be emphasized enough. The first line of defense or action should always, always, always be verbal. That's not taking extremes into account, but may prevent extremes from becoming the norm in a child.

Behaviors that do NOT require restraint would include; breaking a pencil, ripping a piece of paper, stomping feet or being verbally defiant. For that matter general defiance should never be responded to with restraint. Restraint must never become a disciplinary tool. That defeats it's purpose, which is only to protect.

Behaviors that should involve restraint are; head hitting, attempting to stab self or others with a pencil, flailing fits that could harm others or the child, violence that is a direct and fully recognizable threat. Not just tossing a book across the room either.

A singular act of defiance, like throwing a book or pencil, is not an action where restraint is required. If they start throwing everything, which makes it a repetitive action that doesn't stop with verbal or softer approach, that could be a restraint worthy situation.

I want to touch base on an important effect of restraint and it's a significant drawback, even to proper use. One effect I've found in research and reading is that restraint always makes the situation worse before it gets better. Why is that? I think you will find that most of our children on the spectrum are very sensitive to their personal space and anything that touches them. Things that touch or invade space without consent or by surprise can get some interesting and negative reactions. The action of being restrained, not only invades personal space, but adds to already overloaded sensory issues.

This isn't to say, "don't ever restrain", rather to keep this effect in mind if you are going to apply restraint to a situation. The child in the situation will feel worse and act out more before they calm down. That is a natural reaction to such intense sensory trauma. Yes, I said "trauma". Too much restraint, or misuse of restraint can be severely traumatizing. Sensory overload is already like that by itself. Sensory overload and stress overload are like your senses having a seizure event. Have you ever known anyone to have a non-traumatic seizure?

Because of this, the after effect is generally an exhausted person or child. It takes a lot out of you to have your body whip into high gear and hold like that for any amount to time, especially several minutes to as long as 45 minutes. Just 3-5 minutes feels like an eternity. I haven't seen a child go through a 45 minute meltdown, but I've heard of it. I can only imagine that child being out of action for the rest of the day.

So restraint, at first, will momentarily increase all effects of what the child is suffering that makes restraint necessary in the first place.

Now consider what it's like to anticipate being restrained. How would you feel, if you went into class with the conscious thought that you may be held down on the floor today? How would you feel if that was your thought every day? How would you fare if you already had an emotional disorder and that was stressing you out every day? That can be the effect of improper restraint and restraint used as a punishment. That added stress, makes it more difficult for a child to "behave" than without. That child already has a stressor in place that they cannot control and pushes them towards their personal limits of daily stress. This is more than simply learning to behave because of consequences of our actions. This is in excess of anything normal.

When my son throws a toy, I take it away. That's a natural consequence. I do not pin him to the floor. That would not be a natural consequence. Not anywhere in life.

My son has, years ago, had fits where he would bite himself or head bang. In those instances, where verbal failed to redirect him, I did scoop him up and hold him to stop it. He would escalate because that was the natural body reaction, but then, in time, calm down. I still remember the time around being 3 when he looked up at me and wanted to know why he couldn't stop. He recognized there was a problem, even at 3. Kids know and remember. We would do well to remember that ourselves.


Amy Caraballo said...

Something else that can cause the use of restraints to backfire - some people crave proprioceptive input. This means they like bear hugs and deep pressure on their bodies. Though restraint is often used to subdue an individual, it could inadvertently cause someone to purposely act out to receive that input.

The bottom line is that the use of restraint, in any form, should never be used unless there is real imminent danger - which would result in "serious" injury or death. Any by serious, I mean serious enough to cause permanent damage - not a kick or hit or hair pull.

Restraint has serious psychological side effects that are overlooked. There are many children who have deteriorated behavior and self esteem issues due to the misuse of restraint as punishment. Some actually have formal diagnosis of Post Traumatic Stress Disorder.

The use needs to be stopped. Much like a police officer is not supposed to shoot someone as a first line of defense, neither should anyone use restraints this way.

David Wilde said...

Excellent point Amy, a very excellent point.

Heather Babes said...

I couldn't have said it any better than Amy and Dave. Well done!