As professionals, caregivers, or parents, we want to make sure we support individuals with autism with full dignity, respect, and care. Some challenging behaviours or self-injurious behaviours may require temporary restraint from caregivers to ensure safety and to decrease further injury or health risk. Prone restraint is a specific type of restraint. However, it has been further evaluated that it serves more harm than benefits to any individual, thus is highly not recommended to implement
It is important to note that this article only provides general information around prone restraint. Do not attempt to implement any prone restraint strategies on individuals you serve unless under the strict guidance of a fully trained professional in ABA, mental health or crisis management.
Understanding Prone Restraint: What Is It?
Prone restraint is a technique used in certain situations to safely manage the behaviour of individuals with autism who may exhibit aggressive or self-injurious behaviours. It involves gently and temporarily holding the person face-down on a surface to prevent harm to themselves or others. Prone restraint is typically performed by trained professionals and is intended to be used as a last resort when other strategies have been exhausted or when there is an immediate safety concern. It is important to approach prone restraint with caution, adhering to ethical guidelines and considering the individual’s well-being and dignity throughout the process.
The Role of Prone Restraint in Autism Therapy
Prone restraint is a controversial and highly debated technique that is sometimes used in autism therapy, particularly in cases where an individual with autism poses a risk of harm to themselves or others. The initial purpose of prone restraint is to ensure the immediate safety of the individual and those around them by physically restricting their movement temporarily. However, it is important to note that nowadays the use of prone restraint has been further debated as cases of untrained caregivers implementing this technique has caused physical injury, psychological trauma, and even death to autistic individuals.
The focus of autism therapy especially in Applied Behaviour Analysis (ABA) prioritizes and promotes reinforcing and positive behavioural strategies before punishment or restraint based practices. Proper and thorough implementation of preventative strategies and personalized safety plans can decrease the need to use prone restraint on individuals with autism and provide an overall safer and more positive learning interaction.
Benefits and Considerations of Prone Restraint in Autism Interventions
Prone restraint was once perceived to provide safety and therapeutic aid to autistic individuals in a state of crisis or escalation. One potential benefit is that it can help ensure immediate safety by preventing self-injurious or aggressive behaviours that may put the individual or others at risk. Additionally, it was once argued that prone restraint may provide a temporary calming effect for some individuals with autism who experience heightened anxiety or sensory overload. However, it is crucial to consider the many potential negative consequences and ethical concerns associated with prone restraint, including the risk of physical harm, trauma, and the potential for reinforcing challenging behaviours.
It is essential that the consideration of even using prone restraint strategies is assessed to be highly justified. It is crucial these strategies are implemented by well-trained professionals, and regularly reviewed to minimize potential risks and prioritize the individual’s safety and well-being. Some might say implementing prone restraint techniques once is once too many. If there are safety risks identified, then the ultimate goal of autism interventions is to teach skills to decrease and ideally eliminate all instances of requiring restraint practices. As caregivers and professionals who support individuals with autism, it is our role to ensure thorough assessment is done regarding behaviour profiles and potential safety risks. Once these risks are identified, preventative strategies, reinforcing strategies, and environmental changes are implemented to ensure optimal success and safety of the individual and the ones supporting them.
Moreover, the focus of autism interventions should primarily be on using evidence-based positive behavioural supports, communication strategies, and creating a supportive and inclusive environment to promote the individual’s overall development and quality of life.
Ethical and Legal Considerations of Prone Restraint in Autism Treatment
Ethical and legal considerations surrounding the use of prone restraint in autism treatment are of utmost importance. Staying up to date on research, cases, and recommendations around prone restraint falls under ethical considerations are professionals and caregivers. Prone restraint involves significant physical force and restriction, which raises concerns about the individual’s safety, well-being, and potential for harm.
Many professional organizations, such as the American Academy of Pediatrics, have expressed strong opposition to the use of prone restraint due to the associated risks and the potential violation of an individual’s rights and dignity. Additionally, the legal landscape varies across jurisdictions, with some countries outright banning or strictly regulating the use of prone restraint in any circumstances. It is crucial for practitioners, caregivers, and professionals to prioritize the principles of autonomy, dignity, and least restrictive alternatives when considering intervention strategies for individuals with autism. Alternative evidence-based approaches that focus on positive behaviour support, communication, and sensory regulation should be explored to ensure ethical and effective treatment practices.
Alternative Approaches to Prone Restraint in Autism Therapy
It is important to understand that prone restraint is not a regularly implemented technique. If used, it is only used during the highest level of emergency. Once implemented, thorough re-assessment must be conducted to ensure alternative approaches and new interventions plans are prescribed to decrease the likelihood of needing to use prone restraint in the future. Alternative approaches to prone restraint in autism therapy are crucial for ensuring the safety, quality of life, and dignity of individuals with autism.
Instead of relying on physical restraint, emphasis is placed on proactive and preventative strategies that address the underlying causes of challenging behaviours. Positive behaviour support (PBS) approaches, such as functional behaviour assessment and behaviour intervention plans, aim to understand the function of the behaviour and develop alternative, more appropriate ways for individuals to meet their needs. A comprehensive assessment on other factors to the underlying cause may include mental health or biological factors that need to be addressed and ruled out.
Additionally, interventions that focus on communication, social skills, sensory regulation, and emotional regulation can provide individuals with the tools they need to effectively navigate their environment and express themselves without resorting to challenging behaviours. These alternative approaches prioritize the individual’s autonomy, rights, and quality of life while promoting a positive, safe, and supportive therapeutic environment.
Training and Certification for Prone Restraint in Autism Therapy
Appropriate training and certification for prone restraint in autism therapy are critical components to ensure the safe and appropriate use of this technique. Professionals involved in providing autism therapy should undergo comprehensive training that includes understanding the principles of applied behavior analysis (ABA), recognizing the specific needs and characteristics of individuals with autism, and mastering proper techniques for safely implementing and monitoring prone restraint. Certification programs can provide standardized training and assessment, ensuring that practitioners have the necessary knowledge and skills to effectively and safely utilize prone restraint when necessary. Currently, there is no ‘global standardize training’ for prone restraint. However, there are many crisis management and physical intervention training programs available. These programs are dependent on the agency, school, or mental clinic you work for and the level of training required varies in different countries.
Ongoing professional development and supervision are also essential to maintain competence and ensure adherence to current ethical guidelines and legal requirements. By prioritizing thorough training and certification, professionals can confidently assess, support, and care for autistic individuals who experience crisis or heightened escalated states.
FAQ
What does prone restraint mean in autism?
Prone restraint in autism refers to a technique used in therapy, school, or intervention settings where an individual with autism, during a state of crisis or escalation, is positioned face-down to prevent or manage challenging behaviours. It involves safely and temporarily restraining the individual to ensure their safety and the safety of others while minimizing the risk of harm.
What are the restraint techniques for autism?
Physical restraint is a type of restraint technique that is too frequently used for individuals with autism. Restrictive practices is defined as any practice that may be used to restrain, or restrict the rights or freedom of movement of an individual.
What is prone restraint?
Prone restraint is an emergency technique used in certain situations to safely manage the behaviour of individuals with autism who may exhibit aggressive or self-injurious behaviours
Is it OK to restraint a child with autism?
The decision to use restraint with a child with autism should be approached with caution, highly justified, and should only be considered in situations where there is a life or death risk of harm to the child or others. Restraint should be used as a last resort and should be carried out in accordance with ethical guidelines and regulations to ensure the safety and well-being of the child
Janice is a Board Certified Behavior Analyst. She graduated from the University of British Columbia with a Bachelor of Arts in Psychology and Special Education. She also holds a Master of Science in Applied Behaviour Analysis (ABA) from Queen’s University, Belfast. She has worked with and case managed children and youth with autism and other intellectual and/or developmental disabilities in home and residential setting since 2013.
