Teaching Strategy #13: Physical Restraints, Fear, and Why We Need to Teach
It really is, I have to say, but—when Charlie was 5, was 4, was 2, I never believed that this could be so. I suspect I’m not alone among autism parents in connecting an older child with thoughts—fears—of that child becoming harder to control and “manage,” more aggressive and violent, and all around more difficult. Autistic children grow out, become adolescents, get bigger. It’s this last point that I’ve sensed is an unspoken worry of parents: What do I do when my child is bigger than me? stronger than me? When I can’t carry him or her anymore—-when I can’t scoop her up and transport her off the floor of a store and make a dash for the exit?
In truth, I’ve had this concern since Charlie was born. I’m no more than five feet tall and Charlie was a big baby—8 pounds, 3 ounces, and 21 1/2 inches long. He had already outgrown the “size newborn” clothes when he was born. He had (has) long limbs and, while I developed a good muscle in my left upper arm from carrying him (and learning to use my hip to support him), by the time Charlie was 6, I knew I would soon be carrying him no longer. I was sad at this reality, but I could only be sad for so long, as I had to figure out what to do to help Charlie if he flopped on the hard linoleum at a store or on the sidewalk, and he was bigger than me.
It was also around the time that Charlie was 6 years old that there was more and more talk about restraints as a way to “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). Teachers used a basket hold frequently when Charlie headbanged and they were trying to stop more headbanging—but their efforts often only made things worse. The teachers had been insufficiently trained in this sort of crisis management, and had little support from anyone with any expertise.There are simply better ways to help a child at such moments; best of all is to teach a child when he or she is not upset about dealing with feelings of anxiety and frustration.
Strategies that Charlie’s teachers now use have included teaching him to ask for breaks before he gets upset and knowing where there’s a mat in the classroom that he gets out on his own to lie down on when he needs to. The teachers themselves know Charlie and how he communicates very well from careful and thoughtful interactions. They can sense him getting upset, and accordingly change the pace of how they are teaching. They remind him that he can ask for a break (there is a flashcard on his desk that he can point to). These teaching methods communicate some important messages to Charlie: (1) We believe—we know—that he can learn ways to let us know he feels; (2) We’re not afraid of him getting angry or mad or crying out; we know he knows how to help himself; (3) We can help him do this in ways that are minimally physical and maintain his dignity as much as possible.
I’ve come to think that the basket hold and other restraint procedures are overused because of fear. There is fear that “I won’t be able to handle this large child”; there are wishes that a child was a young toddler and something like regret gets communicated to the child that he or she has gotten bigger. To me, this is an unfortunate message: Of course our kids get bigger. Of course they grow up and become pre-adolescents, teenagers, and adults. I understand why people have their fears but I think these can lead to mistaken practices like physical restraints and to the overuse of physical restraints (and I just heard today about two people restraining a four year old—-because he was not doing yoga as directed.) (Yes, a four-year-old doing yoga.)
The after-effect of my son being restrained too often was that he used to pretend to restrain himself. Steady and patient teaching—ABA has been the best teaching method for Charlie, always with an emphasis on flexibility, on building an interpersonal relationship between Charlie and the therapist, and on the belief that he can learn—has taught Charlie to communicate his anxieties and worries more and more. And, to be a smiling boy splashing in the pool with a new friend.
At 10 1/2, Charlie not only seems to understand as much as any child his age, though he does not have the language to say this. He is interested in helping out, in doing as we ask him; he knows that when we say we are going to his favorite hamburger stand, we are going, even if it’s a long drive away. He sighed when the old CD’s and DVD’s he found stopped halfway, due to too many scratches and sticky fingers, and I turned them over to show him the smudges; he said “yes” very calmly when I told him we could get new ones, tomorrow. He then kept himself busy playing and looking at photos and singing and hanging out in the same room where Jim was working.
It is good to be a 10 1/2 year old boy, and to be his mother, too.
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POSTED IN: Adolescence, Adulthood, Baby, Charlisms, Parenting, Safety, Sports, Teaching Strategies, Water
27 opinions for Teaching Strategy #13: Physical Restraints, Fear, and Why We Need to Teach
Leanne
Nov 25, 2007 at 9:27 am
Before our diagnosis I used to hold Patrick on my lap when he was out of control. I have no idea what a basket hold is but I imagine it was similar.
When I started to fear him getting bigger was when I stopped restraining him completely (this was post diagnosis). I reasoned that if I had to restrain him, this strategy would definately age out…so I needed a better solution.
I am so glad we did that. I agree that it’s gotten better as Patrick has gotten older…and he’s only five. I have high hopes for the future.
Autismville
Nov 25, 2007 at 10:08 am
Thank you for this post. It’s nice to hear that things can get easier as we go along …
Niksmom
Nov 25, 2007 at 10:27 am
And it’s good to be the mother of a soon-to-be four year old boy and reading this. Your words give me something positive to focus on and a specific goal to work toward with communication for Nik. To give him the ability to not only recognize hen he needs a break but to be able to communicate that need to us could transform so much in his life. Thanks for the words of wisdom; I find comfort in them.
Rose
Nov 25, 2007 at 11:13 am
Oh, man, does it get better!!!!!
Along that line, maybe our children make us better parents…
When we try to change our kids, make them something they are not, nor will ever be…we are emotionally banging our heads against the wall.
When we decide, before those teen years hit, that the thing we want most is a good relationship with our children…Oy!
At least it worked that way for me………….
Beth
Nov 25, 2007 at 12:05 pm
It definitely gets easier. My son is 8 1/2 now and things have been getting steadily easier since he was about 5. Things began to get easier once he started understanding words like “later” and “tomorrow”. He knows now that if something breaks, we can get a new one (like Charlie) and that it’s not the end of the world.
This is something I have to practice myself. As a mom of 3 kids, I have to be careful not to over react when something in the house breaks. How many times do we scold the kids for spilling milk? I’m trying to practice what I preach since I’m setting an example of how to cope with frustration.
mcewen
Nov 25, 2007 at 12:34 pm
Yes you’ve hit a nerve for me but maybe that’s in part because I read a long article on aversives in Facing Autism in New Brunswick yesterday. Don’t know if you saw it but it was disturbing and heart wrenching at the same time. I didn’t have the wherewithall to comment at the time.
For us, the day I had to relinquish the double buggy was the day I lost control. I could chase one child with the other two safely in the buggy at high speed but three on the loose was crazy.
The aggression has always been difficult to handle and the self injurious behaviours but slowly, slowly,slowly. I still don’t always know what ’sets them off’ but I’m getting better at reading the warning signs and heading them off before it happens. There are so many techniques available I just wish I’d started earlier.
Best wishes
KimJ
Nov 25, 2007 at 12:42 pm
I absolutely agree about educational techniques to teach control and coping mechanisms. We resisted the drug suggestions because we didn’t see how we could teach him to self-manage while he was doped up.
Looking back, perhaps I could have given a nightly sleep aid. But I just didn’t want to risk starting him so young. I’m fully prepared for the onslaught of puberty and the hormonal change that happens.
My son was the same size at birth and wore his newborn clothes in the hospital! That’s about it.
We were worried that we couldn’t teach him out of the tantrums by the time he was too big to control. the acquisition of language has changed his outbursts quite a bit.
Beth
Nov 25, 2007 at 1:26 pm
I should add that my son is on stimulant medication for ADHD (he is dx with both AS and ADHD). The medication is instrumental in helping him control his own behavior. His ability to listen and follow directions is significantly improved on the medication and it doesn’t have the effect of doping him up the way that some other types of medication can have. I don’t consider it a form of restraint because it doesn’t restrain him; on the medication he is better able to exercise self-control. It works well for him but I know other kids who can not tolerate it.
Marla
Nov 25, 2007 at 1:30 pm
I too felt the same way you did. I pictured Maizie growing and me being unable to help her through melt downs due to her size. Luckily, her melt downs were less frequent and she is able to have them in an appropriate place, like at home. Well, typically anyway. Like previous commenters have said, with language development the melt downs seemed to have went way down. And if she is very upset it is usually because we can not understand what she is trying to say. Even then, we all take deep breaths and try to understand.
I used to work in childrens’ group homes where we had to do lots of restraining. I never liked doing it and found it heart wrenching. The only time I agreed with it would be if the child was tyring to harm themselves or someone else physically. Unfortunately, this was not the only time we were told to resort to restraints.
With Maizie we were taught several methods for her severe melt downs. We learned through our own process of elimination that she craved deep pressure and would throw fits just to be restrained because the deep pressure of being held made her feel better. That was when we broke down and spent money on the squeeze machine and taught her ways to get deep pressure without throwing fits. We also stopped restraining her unless she was tyring to hurt herself. Her trying to hurt herself also stopped as she got older.
Now it seems are biggest challenges are learning, social issues like making friends and eating issues still remain, and of course seizures and other health issues.
When I look back I can’t believe how far we have come. People just would not believe how difficult it used to be.
Kristina Chew, PhD
Nov 25, 2007 at 1:38 pm
mcewen, I did read that article—-I’ve been reading some other things about how some schools (including a not unfamous one) send kids to the JRC, after they have not been able to address the SIB’s. The hard part for me is that I can see my son in the accounts of children who were sent there—-I’ve had my black and blue marks, but the worse thing is that Charlie has had more than a few.
I’m a proponent of ABA because, for me, it’s a way to look at what is happening (SIBs) and (if this is possible) remove one’s emotions from it. We used to have 45-minute plus tantrums that were very violent and everyone was crying through it…… The ABA requires me to look at what is going on, how often and so forth and think of how to teach him better ways of dealing with things. And yes, Charlie is on medication and it does help some (Risperdal and Zoloft)—I noted the medication to the other moms at the pool and it is a difficult topic.
The Lovaas agency, who provides Charlie’s ABA, no longer uses aversives. It did in the past, and has dropped this.
Kristina Chew, PhD
Nov 25, 2007 at 1:41 pm
I never thought it would get easier—-just figured getting older meant it would be harder. From 8 1/2 on for us, Charlie has really changed—he’s tons more aware, patient, able to deal with frustrations. Plus, he carries his share of the groceries instead of me carrying him (and the groceries).
Kassiane
Nov 25, 2007 at 1:59 pm
Restraint was ALWAYS counterproductive with me–and I’m the smallest member of my family by several inches and at least 40 pounds. But I can also panic the hardest, and have more muscle per square inch…and when freaked out, have zero regard for keeping my joints IN socket (so imagine the first time a parent dislocated both shoulders at once. Now imagine them NOT LEARNING from that experience. Now you have an inkling of why I have no parents).
Regan
Nov 25, 2007 at 6:22 pm
Thanks Kristina. I can corroborate that it can be easier when older, although I speculate a symbiotic give-and-take in addition to maturity (for both of us).
We also use ABA, but after 1 restraint of Eleanor at 3 1/2, I swore that I would never allow anyone to do it again…esp. just for “compliance”. There was a lack of respect and expression of brute power that made and makes me extremely uneasy.
The process involved is years worth of telling, but the short version is that if someone had told me at diagnosis or early on how it would be now, I might not have seen it, because I was told much that was negative. Our children are individuals, but I enjoy reading your blog because it is an approximate mirror to our life in surprisingly many ways and the kinds of things that happen daily. On the whole, very positive.
Misha
Nov 26, 2007 at 1:39 am
It definitely does get easier as they get older. I look at J now in comparison to how he was 2-3 years ago. I see in him a level of understanding and awareness that wasn’t there. He’s been learning how to regulate himself. This has been done on his own and with the help of a therapist. He loves the doctor he sees and I see him taking what he’s getting out of therapy and utilizing it. J is also on medication and I can say they have helped him learn the control he has so far. He’s still learning. Right now the focus is on helping him understand his stress levels and ways to deal with it and express it appropriately. The therapist doesn’t refer to it as anger levels but stress levels which helps J out tremendously. It’s been difficult but he’s come a long way from where he was a year ago. I know I’ve had to learn myself how to deal with his stress levels and how to help him, redirect him when necessary. J, at 10 almost 11, is already 5 feet tall. He wears a size 9 men’s in shoes! He’s going to be a tall one, but all men in my family are. I know I worry about whether or not I’ll be able to handle him when he towers over me. I have difficulty now when my intervention is needed. He’s never hurt me but he sure is strong! Knowing J, though, and watching how he’s grown - in so many ways - over the past couple of years. Things will just keep getting easier.
athina
Nov 26, 2007 at 3:54 am
My son is also becoming easier to handle as he ages and he is just 4 (in fact he will be next month). As has been noted, his behavior and reactions improve with his language.
However, this is not the case for everyone. Kristina, do you remember this woman from Phillipines (I think her name is Yolanda)? She has a son named Arvin who is 17 or so, and her life whith her autistic son as she describes it in her blog, is anything but easy. I’ve read her story some time ago and I remember her saying that she wasn’t able to go out with her husband because somebody had to stay with their son all the time. There was a lot more there, like him insisting wearing some particular gloves and throwing tantrums when the gloves weren’t the “right ones”, or putting his hands in the toilet. Things haven’t improved much for them, have they?
Regan
Nov 26, 2007 at 5:17 am
Yolanda’s blog
“My Autistic boy: Autism Through the Years”
http://www.myautisticboy.com/available-interventions.htm
KC'sMommy
Nov 26, 2007 at 3:22 pm
Thank you so very much for writing this post. We are going through a bit of a tough time with K.C. and s.i.b.s. and it helps to know it does get better along the way :)
I love this post and love reading about Charlie, he is such an awesome kiddo!
Caroline L.
Nov 26, 2007 at 6:22 pm
Thank you for this great post.
Teaching flexibility and the importance of building a personal relationship between teacher/ therapist and student, has been my own clarion call to our school district (met with some indifference of course).
I always try, try, try to have ‘easy breathing’ and divorce my own emotions as a parent during tough moments but of course I am sometimes very low functioning in this area.
But if the episodes did not involve my own child, I would be much much more relaxed and I would do a better job!
e.g., how can some teachers/therapists expect students to be easy going and roll with changes and have empathy when they themselves demonstrate frustration, anger and inflexibility?
Easy breathing and chilling, is what is needed maybe.
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