Teaching Strategy #11: Training and the Problem With the Basket Hold
We may have (according to some) plenty of pollution here in New Jersey; as of Thursday evening, we also have a package of five autism bills on detection, teacher training, and the needs of autistic adults that have been approved by both the state Senate and Assembly and are headed to the desk of Goveror Joe Corzine. (Though I hope these bills will ultimately be for and in the best interests of autistic persons, rather than being seen as “anti-autism measures.”)
Politics NJ refers to the five bills as a “landmark autism awareness package.” The Star-Ledger’s blog states that the package of bills was approved “in the wake of a national study that found New Jersey had the highest rate of autism in the nation” (a reference to the CDC’s study on autism prevalence rates; New Jersey’s is 1 in 94). Whether New Jersey’s rate is the highest is due to environmental factors or to heightened awareness about autism (or to a stereotypically pushy attitude that results in loudmouth parents loudly advocating for services for my kid), is something to debate. While I certainly do not know the answer, I do think there is something about the education and services here, or about the professionals—the teachers, therapists, psychologists, doctors—or about their training, that suggests that they have a quite good sense of how to teach autistic children.
“The Best Way to Teach Autistic Children” with all due respect to their sensory needs, communication difficulties, intellectual ability, and dignity is a topic that can (I think) provoke spirited exchanges on a par with those about autism aetiology. (To mainstream or not to mainstream? ABA or not? Private school or in-district?) I wish to consider one particular topic in this post, and will certainly return to the question. The topic I wish to consider is not one that generally arises in discussions of education for children who do not need special education services, because it is not an academic subject, not even a life-skills subject.
I wish to talk about the basket hold.
The basket hold is a type of physical restraint in which, as I have seen it implemented, a person stands behind a child who is most likely in a mode that I will call “tantrumming.” The child’s arms are crisscrossed over his chest and his hands held by a person standing behind him.
The basket hold was the type of restraint used on my son when he was thought to be on the verge of head-banging, or when he had head-banged and was now in the mode of “tantrumming.” The basket hold was used in a previous public school district. The use of this restraint, and the consequences—-a 12-year-old child died from a basket hold in 2005 in Texas—were not spelled out in any formal way to my husband and me. At one point, the basket hold was used almost daily (and somedays more than once) on my son, to stop him from hurting himself, or hurting himself further. But, as I think it over in hindsight (and hindsight is terrible), the basket hold made things worse. I suppose the idea behind the basket hold was to, in effect, wrestle down a tantrumming child. In reality, the use of force led to my son struggling even more, and there were times when the basket holds were used for long periods of time. When my son first started attending a private autism school in December of 2005 (after we had taken him out of the public school district), he would wrap his arms around his torso, bend over and make noises, and sometimes laugh, and I did not feel too good when I realized that he was re-enacting the basket holds.
Why am I telling you this (aside from to point out that not every New Jersey school district has a good autism program)?
There are ways to help a child not hurt himself when he is very, very upset that involve other means than the use of force. Our home ABA therapists and the teachers in the public school autism program that Charlie now attends devised a short-term strategy and a long-term one. The long-term one involved:
- Teaching Charlie to recognize he was getting upset before he was so upset that a tantrum ensued.
- Teaching Charlie to communicate that he needed a break.
- Teaching Charlie to go to a soft surface—a gym mat in his class, his bed at home—and lie down until he was calm enough to go sit at his desk.
The short-term strategy was Crisis Management Training. (This is a very serious business and a professional should be consulted; what I relate here is what aspects of Crisis Management that I found have most helped Charlie.) The most important thing I learned is something rather counterintuitive: If your child is in “tantrum mode,” you have to think of how to use as little physical contact and physical force as possible, and you have to not fight against him. You have to be as minimally intrusive as possible. You have to use what I call my “grass in the wind principle”: You need to hold a child with as minimal an amount of contact as you can, and as calmly as you can. You can’t communicate anxiety or fear, either in your words or our body language. As I wrote after a moment when Charlie threw himself back down on the floor of a supermarket some months ago:
……. instead of bracing my body against his twisting back and fighting with every last ounce of strength I don’t have to keep him still and keep his head from the floor, I had tried to shape myself along with the flow of his energy—-to lean back in, or with, or together with his body, livid and practically sparking with desperation. It certainly took less out of me than attempts in previous years to hand onto a thrashing boy and I am sure I used to hold on so hard because of my own most despairing fear: What will I do when he gets big? When he is bigger than me?
On Thursday, Charlie calmed down enough to be directed to stand up and to carry the shopping basket through the store. I found myself not particularly enervated or upset.
The grass must bend, when the wind blows across it. [Confucius, Analects XII 19]
Or, the art of learning about letting go.
Friends who know more than I do in these matters have remarked that this—not fighting against Charlie’s energy but with it; being as minimally physical as possible—is a principle out of kung fu. Charlie’s teachers and home therapists all receive Crisis Management Training and I think this, and the fact that there is a consultant that they can readily speak to, gives them a certain confidence so that, if a child has a difficult moment, they do not communicate fear. They communicate, let’s help you through it. And they also teach a child other ways to express the feelings that brought on the tantrum; they know that the child can learn these other ways.
In contrast, when one uses a basket hold, one is not thinking any of this. One is thinking that here is a very upset, potentially self-injurious child, and one wants to stop the behavior as fast as possible, and so one uses force. And I wonder how often such methods were used on autistic persons in the past (and how often they are still used), and what does this do to a person over time?
And I am thankful to be living at a time when (though we have a long way to go) there is better understanding about autism, and there are better ways to help a child than grabbing his arms and hoping he’ll get tired. Charlie’s teachers know that they can help him through a difficult moment, and they know that he can help himself, too. It is this confidence, this self-assuredness that I have seen Charlie learning in school this past year: Today, Friday, June 22nd, is the last day of the regular school year for him. What he has learned could fill several, several blog posts indeed. What I have learned is that, if you can stop fighting—stop fighting against autism—-if you can bend and shape yourself to and with your autistic child, you have made a very big stride in your own education, in understanding autism.
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POSTED IN: Education, Legislation, New Jersey, Safety
29 opinions for Teaching Strategy #11: Training and the Problem With the Basket Hold
Shawn
Jun 22, 2007 at 1:02 am
Physical restraint seems like the most common sense approach to deal with someone who is physically out of control. Sensory issues, among other things, make common sense wrong on this one.
We’ve been following a similar path with MJ, teaching him to recognize the signs before he gets upset. MJ still struggles but he now regularly makes us aware of the struggles with the phrase “I’m anxious.” It sounds like a trivial thing, but that phrase is an incredibly important step towards self-regulation.
Another big step for Lee and I has been to learn to ask MJ if he wants to be touched when he is anxious or upset. It’s a simple thing, but it puts MJ in control of whether or not he is touched.
mysonsdad
Jun 22, 2007 at 5:36 am
One of my favorite Confucius quotes is:
“By three methods we may learn wisdom. First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest.”
Kristina, well put!
Had major concerns with school’s behavior protocols(bp). Private schools’ bps are even more challenging. Homeschool was the solution for us after our sonwas put in a four point hold( hog tied by four adult teachers; he was just 5 at the time ).
My son is pretty much non-verbal, so behavior is a form of expressive commincation for him.
Seriously speaking, I researched how trainers worked withkiller whales and actually found “some” techniques quite interesting. Think about it, using force to train/teach is out of the question :)
Hsien Lei
Jun 22, 2007 at 5:43 am
Gosh, this is a really hard one. I’m never quite sure what to do when a child lashes out and hits others around him/her. It seems best to hold their arms down even if it’s a comforting way like a hug but like what you said, it makes them struggle all the more. Yet it doesn’t seem right to let them continue hitting which is what i do to allow all the aggression out. :( I suppose I could strap on the pillows.
Rose
Jun 22, 2007 at 7:54 am
Thanks Kristina.You are wonderful!
You’d think I’d be able to process all these things, because Ben has been telling me for years how he needs to be treated. I just can’t generalize the ideas.
mumkeepingsane
Jun 22, 2007 at 9:26 am
We used to hold Patrick in a modified hug position to stop him from lashing out until we knew better. Now we follow the same “bend with the grass” philosophy and find it much better for him as well as for us. We started coming out of these exchanges feeling better instead of worse as I’m sure he does as well.
I made the change when I started thinking about how it must make him feel. I was taking a child who felt out of control and removing all of his control…I was trying to control him. That certainly won’t teach him self control.
That isn’t to say that, at the age of 5, I don’t still sometimes hold his hand or put myself between him and another person, but I no longer hold him as I once did. It has freed us both.
Daisy
Jun 22, 2007 at 10:36 am
I don’t remember learning the term “basket hold”, but I’ll keep this in mind when I complete my renewal of Non Violent Crisis Intervention training, which includes various holds. The most useful piece of this training for me, a classroom teacher, is the set of skills for de-escalating the situation.
Irene
Jun 22, 2007 at 10:50 am
This post applies not just to children with autism but it makes sense with children in general. As far as I know, my son has not needed to be restrained other than “blocking.” But it did always bother me that the teachers would have to restrain other students in the class from time to time. A good friend of mine was a Life Skills teacher at the local high school. She’s a real stickler for following the rules to a “T” and so she’d not allow anyone who’d not been trained to restrain or “help” restrain a student in her classroom. HOWEVER, I was shocked that the “training” was just a short, one-hour (if that) session.
We are actually moving to Delaware for exactly the reason you mentioned above. From long distance it was too hard to try and figure out with districts were “good” and which were not. Experiences are so individual. We would hear about a school and inquire from parents and we’d get good and bad “reviews” for the exact same place. The first place looked into was Bergen County but the cost of living was a HUGE jump for us and again, it was hard to know which district would be the best to land in. We are confident that Delaware is, at very least, a great improvement from where we are. AND we are excited to be nearer to where all the action is, such as national conferences and states taking action as setting precedent. BONUS: NYC is just a few hours away!
Caroline
Jun 22, 2007 at 11:34 am
Thank you Kristina!!!! I am going to research crisis management training. Is it a national organization or as individual as ABA providers?
My child acts out out of frustration with a curriculum based on ‘mastery’, and while schools have a requirement for mastery of skills, the rote way it is often taught can be just incredibly boring for a curious child with communication ‘deficits’, however loving and well-meaning the teachers may be.
My child used to be very independent, before the epilepsy and migraine headaches became so debilitating, and he needed so much help to get through a day.
I think it is this loss of independence, combined with sheer boredom, that causes my child to act out in a big way. (and sometimes it is a big migraine. The school staff can often tell the difference thank goodness)
I am sure it is true for most children, ‘on the spectrum’ or not.
For long periods, when the therapy had been delivered in a natural loving limits sort of way, we would forget that our child even has ‘behavior issues’.
What constitutes a successful ‘program’ is the the discussion I wish all the big voices would weigh in on.
Sometimes it is the simplest things that make a wonderful difference in a person’s life. (e.g, not yelling at and grabbing an individual who drops a backpack on the floor when entering a classroom, but rather using non-invasive, non-verbal cues to remind the person to pick it up and put it in its proper place)
You can catch more flies with honey…
Club 166
Jun 22, 2007 at 2:40 pm
“…For long periods, when the therapy had been delivered in a natural loving limits sort of way, we would forget that our child even has ‘behavior issues’.
What constitutes a successful ‘program’ is the the discussion I wish all the big voices would weigh in on.
Sometimes it is the simplest things that make a wonderful difference in a person’s life. (e.g, not yelling at and grabbing an individual who drops a backpack on the floor when entering a classroom, but rather using non-invasive, non-verbal cues to remind the person to pick it up and put it in its proper place). …”
I believe Caroline has laid out the essence right here.
The goal, as Daisy pointed out, is early recognition that someone is having a problem, and deescalation before there is a need for physical intervention. These are much more important skills to have.
When there is a staff that’s vigilant, open, respectful and loving towards their kids, then in most cases there won’t be a need for physical intervention. Talking about how to be physical in those rare instances when it is needed may be needed, but somewhat misses the point. We need to put much more emphasis on avoiding confrontation.
That being said, body posture and tone of voice can sometimes serve to soothe and settle people down. Failing that, a basket hold applied properly (holding only tight enough to prevent them harming themself or others, moving with them, continuing to talk soothingly) is probably not the worst thing in the world.
Joe
Kristina Chew, PhD
Jun 22, 2007 at 11:23 pm
Caroline: I got my Crisis Management Training through someone who was specially trained in it; she worked for the Lovaas Agency. We received the training along with our therapists. For us, it involved showing us different, and much less invasive, methods of holding onto Charlie when upset. Is there an ABA center that you could get in contact with? I will keep looking…..
Thanks to everyone for responding to this post, which I hesitated much about before writing. It’s about the kinds of things that people fear and prefer to keep silent about, but—from talking to others over time—I’ve realized that our experience with improper use of physical restraints is not uncommon. I know we can do better for our kids.
Jennifer
Jun 23, 2007 at 12:20 am
My school district has a two-day initial course that requires a yearly one-day referesher.
In 4 years of teaching, I’ve only used the basket hold once, on a student that was had bitten his wrists until they bled, and another student on the back, drawing blood, within a minute of each other.
It was a rainy day (rare for Southern California) and I believe he’d reacted badly from the noise of having to eat inside; I was in the teacher’s lounge and was not present at the time to know for sure.
With my other students (and with him on other days), having a quiet, secluded area to be directed to (and, ultimately, for the students to request) has been sufficient.
I’ve always regretted having to restrain C., and the hold was released when the other children were no longer close to him, but it’s a hard thing to have to do, or discuss afterwards.
kyra
Jun 23, 2007 at 8:54 am
thank you for this honest, beautiful post.
Upstairs, Downstairs
Jun 26, 2007 at 1:20 am
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Up High in the Trees (and at the dentist)
Jul 18, 2007 at 1:03 am
[…] of time can be) fun. Third, we agreed that no force must be used—nothing at all suggesting a restraint. Fourth, Charlie’s home ABA consultant (who used to be one of his therapists) came to the […]
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Oct 24, 2007 at 1:15 pm
[…] child; an autistic child who is very upset; an autistic child who is very upset and is being physically restrained; an autistic child who is very upset, is being physically restrained, and is […]
Anna
Nov 24, 2007 at 5:01 pm
http://www.news12now.com/news/school_4705701___article.html/boy_says.html
Kristina Chew, PhD
Nov 24, 2007 at 9:19 pm
Thank you for the link with the video about the Port St. Lucie school. Did the district inform parents that such practices (physical restraint) would be used on autistic children?
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Nov 25, 2007 at 7:42 am
[…] “manage” a tantrum—and, as I also learned through sad and remorseful experience, physical restraints like the basket hold can be easily misused, and abused (see this Florida boy’s story). […]
Anna
Nov 25, 2007 at 10:46 pm
No I actually filed a no restraint letter after the first time & they did it 3 more times.
Prone Restraint Used on 7-year-old Autistic Boy
Apr 16, 2008 at 6:52 pm
[…] a previous school district, physical restraints—the basket hold—were used on my son when he engaged in self-injurious and aggressive behaviors We were not […]
Justthisguy
Apr 16, 2008 at 7:35 pm
Ah, now I know what “basket hold” means; basically a human straight jacket, behind you, up close and personal.
That would drive me nucking futs. If I had a kid, NT or autie, I’d train ‘im to resist and/or break such an obnoxious imposition.
PROTIP: If somebody gets you in one of those, stomp down really hard on the top of one of his feet.
Chuck
Apr 16, 2008 at 10:42 pm
Justthisguy,
If the child does it wrong, misses, or is too weak, then that will just tick off the people who are trying to restrain the child and they will just slam the child into the ground.
BT seen that
I tell any teacher that thinks they are qualified to restrain a child to restrain me. I have yet to meet one or teams of two that could hold me for more than 5 seconds and I don’t hurt them, which I could. I have problems of restraining my own son using techniques that do not require pain as the restraining factor. He enjoys wrestling with me and I can’t hold him for long.
Kristina Chew, PhD
Apr 16, 2008 at 11:00 pm
What happened with Charlie was that he’d butt his head onto the shoulder or chest of whoever was doing the restraining and then they’d have to hold onto him more and so the restraining went from 4 minutes to 45—–Chuck, I think I will keep your point in mind, though I’m not able to wrestle with Charlie, not at all.
navi
Jun 28, 2008 at 3:59 pm
Tristan is back in his old daycare for 2 half days this summer. The girl that takes care of him on Tuesdays had helped out with him last summer and the previous school year and was excellent with him. She knows he likes deep pressure, so when she noticed he was getting upset, she came up behind him, put a hand on each of his cheeks and held him close, the pressure calmed him down, because she reacted based on what he likes.
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Jul 15, 2008 at 8:25 pm
[…] down prone on the floor, for one thing—-were the stuff of some benighted Victorian past. But physical restraints were repeatedly used on my own son in a New Jersey town we used to live in, and without the school […]
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