The Use of Physical Restraint in the Treatment of Self‐injury and as Positive Reinforcement

Abstract

Two experiments investigated the effects of a treatment package on the self-injurious behavior of three profoundly retarded persons who appeared to enjoy the physical restraints used to prevent their self-injury. The treatment package included physically restraining subjects contingent on increasing periods of time during which no selfinjury occurred, and providing them with toys and attention during intervals between restraints. A reversal and multiple-baseline analysis documented that the rapid and complete reduction in self-injury by all subjects was due to this treatment package. Because these results suggested that physical restraint might function as a positive reinforcer, in a third experiment physical restraint was applied contingent on a marble placement response with one subject. A reversal design demonstrated that toy play systematically increased when each response resulted in restraint. The experiments have implications for the nonaversive remediation of self-injury in individuals who are restrained, as well as for the development and maintenance of self-injury in natural settings.

Protective Equipment: Continuous and Contingent Application in the Treatment of Self‐injurious Behavior

“…As noted previously, restraint may have reinforcing as well as punishing properties. Although the present study adds yet another example of the punishing effects, it should be noted that the devices used were different from those described by Favell et al (1978Favell et al ( , 1981, in that they did not restrict the subjects' movement during treatment. Rather, the served only to protect the individual's from self-inflicted harm.…”

“…Rather, the served only to protect the individual's from self-inflicted harm. Although this difference may have contributed to a divergence in the results of the two studies, a number of other variables may function to establish restraint as either a reinforcing or punishing event, including increased adult attention and/or increased physical comfort during periods of restraint (Favell et al, 1978), the opportunity to escape from a more aversive environment (Carr, 1977), or the discriminative properties of restraint as a "safety signal" from response requirements or aversive events (Jones, Simmons, & Frankel, 1974). Nevertheless, it is apparent that restraint can have similar effects on the occurrence of a common target behavior when used in different ways.…”

“…A review of this literature suggests a variety of therapeutic uses for restraint, including applications as consequence (Favell, McGimsey, & Jones, 1978;Favell, McGimsey, Jones, & Cannon, 1981;Hamilton, Stephens, & Allen, 1967;Rapoff, Altman, & Christophersen, 1980) as well as antecedent events (Parrish, Aguerrevere, Dorsey, & Iwata, 1980;Rojahn, Mulick, McCoy, & Schroeder, 1978), and both as punishing (Hamilton et al, 1967;Rapoff et al, 1980) as well as reinforcing stimuli (Favell et al, 1978(Favell et al, , 1981. Hamilton et al (1967) reported the use of a time-out procedure involving a padded restraint chair for periods ranging from 30 min to 2 hrs, with five individuals who engaged in self-injurious and aggressive behaviors.…”

“…A 30-sec period of physical restraint was used successfully in the elimination of her self-injury. Favell et al (1978), on the other hand, described the successful use of restraint, contingent upon the absence of selfinjury, for three profoundly retarded persons. Because their results suggested that restraint functioned as a reinforcer, Favell et al (1981) conducted a subsequent experiment in which contingent restraint was found to increase appropriate toy play.…”

Parent-Guardian Evaluation of Physical Restraint Among Adults with Intellectual Disability: a Social Validity Assessment

“…Implementation of PR should only be considered if (a) less restrictive procedures have been ineffective, (b) there is clinical justification for its use, (c) the emphasis of intervention is on positive behavior support, (d) careproviders receive comprehensive training, (e) treatment effects are continuously evaluated, and (f) PR reduction and elimination are therapeutic objectives (Lennox et al 2011;Reed et al 2013;Sturmey 2009) Notably, PR is not easy to implement, can cause injury, and even death (Chan et al 2012;Spreat et al 1986;Tilli and Spreat 2009), and may function as positive reinforcement (Favell et al 1978;Magee and Ellis 1988). However, as articulated by Chan and colleagues (Chan et al 2012(Chan et al , 2014Rickard et al 2013), perhaps the most critical concerns about PR are the vulnerability of people with ID to restrictive procedures, their freedom from potentially abusive treatment, and the protection of fundamental human rights as declared in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (United Nations 2006).…”