Abstract
A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called restraint and seclusion. Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the content of the statement. The Executive Council accepted the statement, and it was subsequently approved by a two-thirds majority vote of the general membership. It now constitutes official ABAI policy. The position statement is posted on the ABAI Web site (www.abainternational.org/ABA/statements/RestraintSeclusion.asp). The purpose of the position statement is to provide guidance to behavior analysts and other professionals interested in the position of ABAI on these controversial topics. In extreme cases, abuses of procedures erroneously used in the name of behavior analysis are not defensible. On the other hand, behavior analysts acting ethically and in good faith are provided with guidelines for sound and acceptably safe practice. To the extent that behavior-analytic positions influence public policy and law, this statement can be presented to officials and lawmakers to guide informed decision making. At the conclusion of the document, a bibliography is provided of articles and presentations considered by one or more task force members in developing the position statement.
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References
Barton, E. S., Guess, D., Garcia, E., & Baer, D. M. (1970). Improvement of retardates’ mealtime behaviors by timeout procedures using multiple baseline techniques. Journal of Applied Behavior Analysis, 3, 77–84.
Barton, L., Repp, A., & Brulle, A. (1985). Reduction of stereotypic behaviours using differential reinforcement procedures and momentary restraint. Journal of Mental Deficiency Research, 29, 71–79.
Binik, Y. (1985). Psychosocial predictors of sudden death: A review and critique. Social Science and Medicine, 20, 667–680.
Bisconer, S., Zhang, X., & Sine, L. (1995). Impact of a psychotropic medication and physical restraint review process on adults with mental retardation, psychiatric diagnoses, and challenging behaviors. Journal of Developmental and Physical Disabilities, 7, 123–135.
Borrero, J. C., Vollmer, T. R., Wright, C. S., Lerman, D. C., & Kelley, M. E. (2002). Further evaluation of the role of protective equipment in the functional analysis of self-injurious behavior. Journal of Applied Behavior Analysis, 35, 69–72.
Burke, J. (1997). Physical and mechanical restraint as treatment of severe behavior disorders. Self-Injury Abstracts and Reviews, 6(1), 1–3.
Campbell, J. M. (2003). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: A quantitative synthesis of single-subject research. Research in Developmental Disabilities, 24, 120–138.
Clark, H., Rowbury, T., Baer, A., & Baer, D. (1973). Timeout as a punishing stimulus in continuous and intermittent schedules. Journal of Applied Behavior Analysis, 6, 443–455.
Cote, C. (1994). Sedation for the pediatric patient. Pediatric Clinics of North America, 41, 31–50.
Davidson, N., Hemingway, M., & Wysocki, T. (1984). Reducing the use of restrictive procedures in a residential facility. Hospital and Community Psychiatry, 35, 164–167.
Didden, R., Duker, P. C., & Korzilius, H. (1997). Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation. American Journal on Mental Retardation, 101, 387–399.
Dorsey, M. F., Iwata, B. A., Reid, D. H., & Davis, P. A. (1982). Protective equipment: Continuous and contingent application in the treatment of self-injurious behavior. Journal of Applied Behavior Analysis, 15, 217–230.
Drabman, R., & Spitalnik, R. (1973). Social isolation as a punishment procedure: A controlled study. Journal of Experimental Child Psychology, 16, 236–249.
Duker, P., & Seys, M. (1997). An inventory method for assessing the degree of restraint imposed by others. Journal of Behavior Therapy and Experimental Psychiatry, 28, 113–121.
Emson, H. (1994). Death in a restraint jacket from mechanical asphyxia. Canadian Medical Association Journal, 151, 985–987.
Falcomata, T. S., Roane, H. S., Hovanetz, A. N., Kettering, T. L., & Keeney, K. M. (2004). An evaluation of response cost in the treatment of inappropriate vocalizations maintained by automatic reinforcement. Journal of Applied Behavior Analysis, 37, 83–87.
Favell, J. E., McGimsey, J. F., & Jones, M. L. (1978). The use of physical restraint in the treatment of self-injury and as positive reinforcement. Journal of Applied Behavior Analysis, 11, 225–241.
Favell, J. E., McGimsey, J. F., Jones, M. L., & Cannon, P. R. (1981). Physical restraint as positive reinforcement. American Journal of Mental Deficiency, 85, 425–432.
Fidone, G. (1988). Risks in physical restraint. Hospital and Community Psychiatry, 39, 203.
Fisher, W. (1994). Restraint and seclusion: A review of the literature. Journal of Psychiatry, 151, 1584–1591.
Fisher, W. W., Piazza, C. C., Bowman, L. G., Hanley, G. P., & Adelinis, J. D. (1997). Direct and collateral effects of restraints and restraint fading. Journal of Applied Behavior Analysis, 30, 105–119.
Foxx, R. M. (1998). A comprehensive treatment program for inpatient adolescents. Behavioral Interventions, 13, 67–77.
Foxx, R. M., & Dufresne, D. (1984). “Harry”: The use of physical restraint as a reinforcer, timeout from restraint, and fading restraint in treating a self-injurious man. Analysis and Intervention in Developmental Disabilities, 4, 1–13.
Friman, P. C. (1990). Nonaversive treatment of high-rate disruption: Child and provider effects. Exceptional Children, 57, 64–69.
Gast, D. L., & Nelson, C. M. (1977). Legal and ethical considerations for the use of timeout in special education settings. Journal of Special Education, 11, 457–467.
Grey, I. M., & Hastings, R. P. (2005). Evidence-based practices in intellectual disability and behaviour disorders. Current Opinion in Psychiatry, 18, 469–475.
Griffin, J., Ricketts, R., & Williams, D. (1986). Reaction to Richmond et al.: Propriety of mechanical restraint and protective devices as tertiary techniques. In K. D. Gadow (Ed.), Advances in learning and behavioral disabilities (Vol. 5, pp. 109–116). Greenwich, CT: JAI Press.
Griffith, R., & Spreat, S. (1989). Aversive behavior modification procedures and the use of professional judgment. The Behavior Therapist, 12, 143–146.
Gurguis, E. (1978). Management of disturbed patients: An alternative to the use of mechanical restraint. Journal of Clinical Psychiatry, 39, 295–299.
Hamilton, J., Stevens, L., & Allen, P. (1967). Controlling aggressive and destructive behavior in severely retarded institutionalized residents. American Journal of Mental Deficiency, 71, 852–856.
Hanley, G. P., Piazza, C. C., Fisher, W. W., & Maglieri, K. A. (2005). On the effectiveness of and preference for punishment and extinction components of function-based interventions. Journal of Applied Behavior Analysis, 38, 51–65.
Hill, J., & Spreat, S. (1987). Staff injury rates associated with the implementation of contingent restraint. Mental Retardation, 25, 141–145.
Jacobson, J. (1992). Who is treated using restrictive behavioral procedures. Journal of Developmental and Physical Disabilities, 4, 99–113.
Kahng, S., Iwata, B. A., & Lewin, A. (2002). Behavioral treatment of self-injury, 1964 to 2000. American Journal on Mental Retardation, 107, 212–221.
Keeney, K. M., Fisher, W. W., Adelinis, J. D., & Wilder, D. A. (2000). The effects of response cost in the treatment of aberrant behavior maintained by negative reinforcement. Journal of Applied Behavior Analysis, 33, 255–258.
Killebrew, J., Harris, C., & Kruckeberg, K. (1982). A conceptual model for determining the least restrictive treatment-training modality. Hospital and Community Psychiatry, 33, 367–370.
Konarski, E., & Johnson, M. (1989). The use of brief restraint plus reinforcement to treat self injurious behavior. Behavioral Residential Treatment, 4, 45–52.
Kuhn, D. E., DeLeon, I. G., Fisher, W. W., & Wilke, A. E. (1999). Clarifying an ambiguous functional analysis with matched and mismatched extinction procedures. Journal of Applied Behavior Analysis, 32, 99–102.
Kumar, A. (1997). Sudden unexplained death in a psychiatric patient—A case report: The role of phenothiazines and physical restraint. Medicine, Science, and the Law, 37, 170–175.
Leestma, J., & Koenig, K. (1968). Sudden death and phenothiazines: A current controversy. Archives of General Psychiatry, 18, 137–147.
Lerman, D. C., & Iwata, B. A. (1996). A methodology for distinguishing between extinction and punishment effects associated with response blocking. Journal of Applied Behavior Analysis, 29, 231–234.
Lerman, D. C., Iwata, B. A., Shore, B. A., & DeLeon, I. G. (1997). Effects of intermittent punishment on self-injurious behavior: An evaluation of schedule thinning. Journal of Applied Behavior Analysis, 30, 187–201.
Lerman, D. C., Iwata, B. A., Smith, R. G., & Vollmer, T. R. (1994). Restraint fading and the development of alternative behaviour in the treatment of self-restraint and self injury. Journal of Intellectual Disability Research, 38, 135–148.
Lerman, D. C., Kelley, M. E., Vorndran, C. M., & Van Camp, C. M. (2003). Collateral effects of response blocking during the treatment of stereotypic behavior. Journal of Applied Behavior Analysis, 36, 119–123.
Lovaas, O. I., & Simmons, J. (1969). Manipulation of self-destruction in three retarded children. Journal of Applied Behavior Analysis, 2, 143–157.
Lown, B., Verrier, R., & Corbalan, R. (1973). Psychologic stress and threshold for repetitive ventricular response. Science, 182, 834–836.
Luiselli, J. (1992). Protective equipment. In J. K. Luiselli, J. L. Matson, & N. N. Singh (Eds.), Self-injurious behavior: Analysis, assessment, and treatment (pp. 201–233). New York: Springer-Verlag.
Magee, S., & Ellis, J. (2001). The detrimental effects of physical restraint as a consequence for inappropriate classroom behavior. Journal of Applied Behavior Analysis, 34, 501–504.
Marholin, D., & Townsend, N. (1978). An experimental analysis of side effects and response maintenance of a modified over-correction procedure. Behavior Therapy, 9, 383–390.
Matson, J., & Keyes, J. (1988). Contingent reinforcement and contingent restraint to treat severe aggression and self-injury in mentally retarded and autistic adults. Journal of the Multihandicapped Person, 1, 141–153.
Matson, J., & Keyes, J. (1990). A comparison of DRO to movement suppression time out and DRO with two self-injurious and aggressive mentally retarded adults. Research in Developmental Disabilities, 11, 111–120.
McCord, B. E., Grosser, J. W., Iwata, B. A., & Powers, L. A. (2005). An analysis of response-blocking parameters in the prevention of pica. Journal of Applied Behavior Analysis, 38, 391–394.
Miles, S. (1996). A case of death by physical restraint: New lessons from a photograph. Journal of the American Geriatrics Society, 44, 291–292.
Mirchandani, J., Rorke, L., Sekula-Perlman, A., & Hood, I. (1994). Cocaine induced agitated delirium, forceful struggle, and minor head injury: A further definition of sudden death during restraint. American Journal of Forensic Medicine and Pathology, 15, 95–99.
Moldawsky, R. (1985). Sudden death. Hospital and Community Psychiatry, 36, 81.
Moore, J. W., Fisher, W. W., & Pennington, A. (2004). Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury. Journal of Applied Behavior Analysis, 37, 73–77.
Mulick, J. A., & Schroeder, S. R. (1980). Research relating to management of antisocial behavior in mentally retarded persons. The Psychological Record, 30, 397–417.
National Alliance for the Mentally Ill. (2003). Position on seclusion and restraint. Retrieved from http://www.nami.org/update/unitedrestraint.html
Nord, G., Wieseler, N., & Hanson, R. (1991). Aversive procedures: The Minnesota experience. Behavioral Residential Treatment, 6, 197–205.
Obi, C. (1997). Restraint fading and alternative management strategies to treat a man with Lesch-Nyhan syndrome over a 2 year period. Behavioral Interventions, 12, 195–202.
O’Brien, F., Azrin, N., & Bugle, C. (1972). Training profoundly retarded children to stop crawling. Journal of Applied Behavior Analysis, 5, 131–137.
Oliver, C., Hall, S., Hales, J., Murphy, G., & Watts, D. (1998). The treatment of severe self-injurious behavior by the systematic fading of restraints: Effects on self-injury, self-restraint, adaptive behavior, and behavioral correlates of affect. Research in Developmental Disabilities, 19, 143–165.
Paniagua, F., Braverman, C., & Capriotti, R. (1986). Use of a treatment package in the management of a profoundly mentally retarded girl’s pica and self-stimulation. American Journal of Mental Deficiency, 90, 550–557.
Pendergrass, V. (1972). Timeout from positive reinforcement following persistent, highrate behavior in retardates. Journal of Applied Behavior Analysis, 5, 85–91.
Perry, A. C., & Fisher, W. W. (2001). Behavioral economic influences on treatments designed to decrease destructive behavior. Journal of Applied Behavior Analysis, 34, 211–215.
Persel, C., Persel, C., Ashley, M., & Krych, K. (1997). The use of noncontingent reinforcement and contingent restraint to reduce physical aggression and self -injurious behaviour in a traumatically brain injured adult. Brain Injury, 11, 751–760.
Powers, K. V., Roane, H. S., & Kelley, M. E. (2007). Treatment of self-restraint associated with the application of protective equipment. Journal of Applied Behavior Analysis, 40, 577–581.
Rapoff, M., Altman, K., & Christophersen, E. (1980). Elimination of a blind child’s self-hitting by response contingent brief restraint. Education and Treatment of Children, 3, 231–236.
Reid, D. H., Parsons, M. B., Phillips, J. F., & Green, C. W. (1993). Reduction of self-injurious hand mouthing using response blocking. Journal of Applied Behavior Analysis, 26, 139–140.
Rincover, A., Cook, R., Peoples, A., & Packard, D. (1979). Sensory extinction and sensory reinforcement principles for programming multiple adaptive behavior change. Journal of Applied Behavior Analysis, 12, 221–233.
Rolider, A., & Van Houten, R. (1985). Movement suppression time-out for undesirable havior in psychotic and severely developmentally delayed children. Journal of Applied Behavior Analysis, 18, 275–288.
Rolider, A., Williams, L., Cummings, A., & Van Houten, R. (1991). The use of a brief movement restriction procedure to eliminate severe inappropriate behavior. Journal of Behavior Therapy and Experimental Psychiatry, 22, 23–30.
Rubin, B., Dube, A., & Mitchell, E. (1993). Asphyxial deaths due to physical restraint: A case series. Archives of Family Medicine, 2, 405–408.
Rush, A. J., & Frances, A. (Eds.). (2000). Expert consensus guideline series: Treatment of psychiatric and behavioral problems in mental retardation [Special Issue]. American Journal on Mental Retardation, 105, 159–228.
Saloviita, T. (1988). Elimination of self-injurious behaviour by brief physical restraint and DRA. Scandinavian Journal of Behaviour Therapy, 17, 55–63.
Shapiro, E., Barrett, R., & Ollendick, T. (1980). A comparison of physical restraint and positive practice overcorrection in treating stereotypic behavior. Behavior Therapy, 11, 227–233.
Sheridan, N., Herrior, R., Robinson, L., & Baxter, V. (1990). Precipitants of violence in psychiatric inpatient setting. Hospital and Community Psychiatry, 41, 776–780.
Singh, N., & Bakker, L. (1984). Suppression of pica by overcorrection and physical restraint: A comparative analysis. Journal of Autism and Developmental Disorders, 14, 331–341.
Singh, N., Dawson, M., & Manning, P. (1981). The effects of physical restraint on self-injurious behavior. Journal of Mental Deficiency Research, 25, 207–216.
Singh, N., Winton, A., & Ball, P. (1984). Effects of physical restraint on the behavior of hyperactive mentally retarded persons. American Journal of Mental Deficiency, 89, 16–22.
Smith, R. G., Russo, L., & Le, D. D. (1999). Distinguishing between extinction and punishment effects of response blocking: A replication. Journal of Applied Behavior Analysis, 32, 367–370.
Spreat, S., & Baker-Potts, J. (1983). Patterns of injury in institutionalized residents. Mental Retardation, 21, 23–29.
Spreat, S., Lipinski, D., Dickerson, R., Nass, R., & Dorsey, M. (1989). A paramorphic representation of the acceptability of behavioral programming. Behavioral Residential Treatment, 4, 1–13.
Spreat, S., Lipinski, D., Hill, J., & Halpin, M. (1986). Safety indices associated with the use of contingent restraint procedures. Applied Research in Mental Retardation, 7, 475–481.
Spreat, S., & Stepansky, D. (1986). The effectiveness of contingent restraint of aggression, self-injury, and property destruction of institutionalized mentally retarded persons. Behavioral Residential Treatment, 1, 57–71.
Spreat, S., & Walsh, D. (1994). Impact of treatment efficacy and professional affiliation on ratings of treatment acceptability. Mental Retardation, 32, 227–233.
Stratton, S., Rogers, C., & Green, K. (1995). Sudden death in individuals in hobble restraints during paramedic transport. Annals of Emergency Medicine, 25, 710–712.
Sweerissen, H., & Carruthers, J. (1987). The use of a physical restraint procedure to reduce a severely intellectually disabled child’s tantrums. Behaviour Change, 4, 34–38.
Swett, C., Michaels, A., & Cole, J. (1089). Effects of a state law on rates of restraint on a child and adolescent unit. Bulletin of American Psychiatry Law, 17, 165–169.
Tilli, D., & Spreat, S. (2009). Restraint safety in a residential setting for persons with intellectual disabilities. Behavioral Interventions, 24, 127–136.
Tomporowski, P. (1983). Training an autistic client: The effect of brief restraint on disruptive behavior. Journal of Behavior Therapy and Experimental Psychiatry, 14, 169–173.
Vorndran, C. M., & Lerman, D. C. (2006). Establishing and maintaining treatment effects with less intrusive consequences via a pairing procedure. Journal of Applied Behavior Analysis, 39, 35–48.
Wacker, D. P., Steege, M. W., Northup, J., Sasso, G., Berg, W., Reimers, T., et al. (1990). A component analysis of functional communication training across three topographies of severe behavior problems. Journal of Applied Behavior Analysis, 23, 417–429.
Wallace, M. D., Iwata, B. A., Zhou, L., & Goff, G. A. (1999). Rapid assessment of the effects of restraint on self-injury and adaptive behavior. Journal of Applied Behavior Analysis, 32, 525–528.
White, G. D., Nielsen, G., & Johnson, S. M. (1972). Timeout duration and the suppression of deviant behavior in children. Journal of Applied Behavior Analysis, 5, 111–120.
Yell, M. L. (1994). Timeout and students with behavior disorders: A legal analysis. Education and Treatment of Children, 17, 293–301.
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Vollmer, T.R., Hagopian, L.P., Bailey, J.S. et al. The association for behavior analysis international position statement on restraint and seclusion. BEHAV ANALYST 34, 103–110 (2011). https://doi.org/10.1007/BF03392238
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DOI: https://doi.org/10.1007/BF03392238