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.

Restraint versus sensory disorder

So how does use of restraint affect a person with a sensory disorder? It’s actually very intense. First you have to understand that the senses of a person with this disorder (touch, taste, etc) are not working properly and are likely turned up “too high” on that person. Various sensations are amplified and hard to live with. This can effectively “overload” the brain at times, hence the term: sensory overload.

Try to imagine, every little sound turns into a series of echoing and crashing bombardments; slight sensations on your skin make it just crawl and make you shudder; light hurts your eyes, and there’s even a flavor or taste on the air that makes you just want to spit or gag. It’s not always all of these at the same time, heck, just one is sufficient. It can make you want to curl up in the fetal position and just scream. Intense is a good word for it and even that may not do it justice.

So take a look at a child in school or anywhere else who goes into a self damaging fit. That fit comes from all that intensity and sensory input that can’t be sorted or even slowed down. It causes total chaos in that poor kids head. It triggers fight or flight response and they may even resort to pounding their head against objects trying to funnel it all out. It creates an overload of stimulation and adrenalin. And remember, adrenalin also magnifies your senses. Once you get that much energy conflicting in such a small place, it has to go somewhere.

So you have no choice, you must hold your child or someone has to hold them to protect them from themselves. In this you take inherent risks of being hit or kicked, but it’s not out of malice. It’s out of sheer pain, rage and panic. That’s right, sensory overload HURTS. But what does that do? For a while, it only intensifies the effects of the overload. After all you are touching, and maybe even squeezing to hold on to the poor kid. You don’t mean to hurt him, and you’re just trying to protect him, but he escalates because no matter what you do, you still add to the sensory input for the time being.

No, that cannot be helped. All you can do is all you can do. You have to weigh the end results. Do you let them bash their head on the floor (they won’t be able to stop on their own until absolutely exhausted). Or, do you hold them and help them ride it out with minimal lasting damage? There really isn’t a choice there. You have to help your child and then teach them how to handle it themselves for when they get older. Soon I will write about how to establish a safety protocol to deal with sensory overload at home. One you may even be able to teach your kids.

Restraint and Seclusion in our schools

All is peaceful as the 2nd grade student works on his spelling words along with the class. In the blink of an eye, something agitates him. He gets frustrated over something that others can only guess at and instantly shreds his spelling paper. His aide and teacher move swiftly and the child finds himself with arms held down in place, restrained against his desk. No one will let go of him until the thrashing and struggle cease. Unfortunately, while restraint has its place, this is not a scenario that restraint was required in.

The proper use of restraint seems to have gotten lost over the years since introduced as a solution in public schools decades ago. It’s getting used for infractions of behavior more as a punishment than a safety protocol. The proper use of restraint is for a child who endangers himself or someone else beyond the scope of being redirected from behavior. Consider my scenario again and ask yourself; who was in danger? Who was being hurt? A piece of paper, that’s all. At this point, it is time to attempt redirection of the child’s behavior and attention. Should that fail, and the child turns destructive behavior to self harm or goes for another student, then restraint may be necessary.

Seclusion is the next issue that’s causing problems. Consider this, therapists tell us that time out should only be used for a period of about a minute per child’s age. They’ll even tell you that a child with shortened attention span will have to be adjusted in shorter increments of time. How is it then, that our schools are locking children in “seclusion rooms” for 30 minutes and more? Some for more than an hour! Just to get started, that’s about 3x the amount that we are taught, isn’t it? As if that weren’t bad enough, seclusion areas could be anything from a blank concrete room to a janitor’s closet! Another thing that “time out” is not supposed to be is intimidating or frightening. Think about it.

So why have our schools gone to such extreme measures? I think they simply don’t know what to do with these kids and what ever conditions they may be living under. That’s why they need additional education. Let’s face it, the number of children who have autism, ADHD, or any other condition, isn’t dropping. In fact, it’s increasing by leaps and bounds. It’s creating a shift in the kinds of students that teachers are doing to find in their classrooms. This calls for the system to adapt to the changing needs of the students.

When it comes to restraint, we need to set a guideline for it’s use and train our educational staff in proper application. When considering the child’s needs what do we know about them? What is their medical condition and how does it affect them? There’s no need to be perfectly knowledgeable, but knowing the basics certainly can’t hurt. Here’s an important consideration; can the child in question be redirected from behavior? If so, there should be no need for restraint. If the child has fits that cannot be consoled or redirected, and they become dangerous to themselves or others, then safe and appropriate restraint should be used. But what does restraint really do to a child? In my next posting, I’ll be addressing just that.