Factors Associated With Restraint Application in Children and Adolescents With Intellectual and Developmental...

Emergency physical restraints may still be widely used, with prevalence rates ranging from 11% to 78% across different service sectors (Fitton & Jones, 2020). At times, behavior analysts may recommend restraint when severe challenging behavior poses significant safety risks (e.g., intense aggression causing severe tissue damage; Foxx & Meindl, 2007; Vollmer et al., 2011). Most existing physical restraint literature featuring child and adolescent participants focuses on variables that behavior-analytic interventions do not manipulate (e.g., sex, diagnosis). Additionally, this literature most often features inpatient clinical populations with psychiatric conditions as opposed to those with intellectual and developmental disabilities. The current study applied a multi-level analysis informed by retrospective outpatient data (N = 12) from children and adolescents with intellectual and developmental disability who required emergency physical restraints. The study aimed to (a) examine and report on participant and restraint application characteristics and trends, and (b) determine if challenging behavior severity at intake predicted latency to restraint-application. According to the descriptive analysis, most participants were experiencing polypharmacy (i.e., prescribed at least three concurrent psychotropic medications), had been assigned moderate to high scores on challenging behavior severity, and primarily exhibited behavior maintained by access to tangibles or multiple reinforcers. Regarding restraint characteristics, the average restraint rate was 9.11 per 100 service hours, with most participants described as calm during restraint application. Typically, more than two staff members applied the restraints. Regression results indicated that challenging behavior severity scores significantly predicted latency to the first restraint application. Clinical implications related to these outcomes are discussed.