Factors Associated with Restraint Application in Children and Adolescents with Intellectual and Developmental Disabilities Displaying Severe Challenging Behaviour

Abstract

Emergency physical restraints (PR) are widely used, with prevalence rates ranging from 11% to 78% across different service sectors (Fitton & Jones, 2020; Ye et al., 2019). Behaviour analysts may recommend PR when severe challenging behaviour (CB) poses significant safety risks (e.g., intense aggression causing severe tissue damage; Foxx & Meindl, 2007; Vollmer, 2011). Most existing PR literature featuring child and adolescent participants focuses on variables that behaviour-analytic interventions cannot manipulate (e.g., gender, diagnosis). Additionally, the literature predominantly features inpatient clinical populations with psychiatric disorders despite the prevalence of restraint application among individuals with intellectual and developmental disabilities. The current study applied a multi-level analysis using 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, as reported by the partnering agency's severity tool, predicted the latency to restraint application. According to the descriptive analysis most participants were experiencing polypharmacy (i.e., concurrent psychotropic medication use), received moderate to high scores on the partnering agency’s CB severity assessment tool, and primarily exhibited tangible or multiply controlled behavioural functions. Regarding restraint characteristics, the average restraint rate was 0.091 per hr, with most participants being described as calm during restraints. Typically, more than two staff members applied PR. Regression results indicated that the median CB severity score significantly predicted latency to the first restraint applications. Clinical implications are discussed.