A Clinical Demonstration of Individualized Restraint Fading

Individuals with intellectual and developmental disabilities who engage in severe problem behavior may often cause significant harm to themselves as well as their caregivers. It follows that severe problem behavior can interfere with skill acquisition and access to educational and community-based services. Behavior-analytic interventions primarily apply antecedent and consequence reinforcement-based treatments, which have substantial efficacy research supporting their application. However, at times, severe problem behavior does not respond to these approaches alone without the concurrent application of more restrictive interventions. Research featuring severe clinical cases is relatively rare. It follows that there appears to be a relative dearth of work highlighting effective and efficient fading of restrictive supports. The current report is a clinical demonstration of the systematic fading of restrictive support for a large adolescent male client who engaged in highly dangerous, pervasive problem behavior. The paper showcases creative clinical work that resulted in safely and successfully fading restraint application to zero with sustained zero application rates at a 4-month follow-up, wherein the restraint device was faded entirely from the setting. We also report participant engagement throughout the fading process (as a secondary dependent variable), something seldom done in restraint fading research. Innovative research and clinical processes are described in detail, as well as a call for more collaboration to address existing restraint-fading research gaps.

The online version contains supplementary material available at https://doi.org/10.1007/s40617-025-01074-9.