Freedom from restraint and seclusion: managing extreme challenging behaviours in a respectful way

Recently I have given a number of lectures and workshops on dealing with (extreme) challenging behaviour in children, young people and adults with autism (and intellectual disabilities). One of the things that struck me (once again) is how emotionally teachers, caretakers and parents become with those behaviours. And that is very understandable and human. Challenging behaviour, especially when it is behaviour that people experience as aggression, creates feelings of insecurity, uncertainty, anxiety and loss of control and safety. In short: it causes stress.

When we are stressed, our cognitive functions work less well. We become less concentrated, focus on details rather than seeing the big picture, we are prone to all kind of biases in our thinking and we lose part of our empathetic abilities because we are primarily focused on ourselves (which is again only human). The consequence of this is that we cannot offer the person who shows challenging behaviour what he or she needs at that moment: empathy, calmness, common sense and a non-judgmental approach.

Therefore, in my workshops and trainings, the first thing I tell people is not to focus only on the autistic person and the challenging behaviour, but also to self-reflect. And to see that challenging behaviours are communication, a loud cry for help from people who cannot otherwise indicate that they are not well. And the effect challenging behaviours have on us as caregivers, teachers, parents etc.

In my work on challenging behaviours and the strategies I recommend, I am highly influenced by the ideas and writings of several researchers and professionals who share one common thing: they care about people with (extreme) challenging behaviours and are not primarily interested in strategies to control, reduce or eliminate the challenging behaviours but in the needs that lie behind these behaviours. I am referring (a.o.) to the work of Tanja Sappok and her colleagues from Germany, Filip Morisse from Belgium and Andy McDonnell from the UK. Although working from different angles and backgrounds, they share the same basic philosophy: what needs to be changed in cases of severe challenging behaviour is not the challenging behaviour, but the mind and the behaviours of the people living and/or working with the people who show challenging behaviours. When faced with challenging behaviours, we do not need to try to control the behaviours and the people showing them, but we need to empathize, we need to try to understand the needs of those people. In short: we need to connect.

But this is often not what happens. When staff is scared and frightened by the behaviour of a person with special needs, the focus is on preventing that person to hurt people or destroy materials. And then strategies like restraint and seclusion (often referred to by the euphemism time-out zone) are being implemented.

Andy McDonnell recently wrote a new book on restraint and seclusion. In that book he describes in detail how restraint and seclusion can be avoided and make place for an approach that shows empathy and care for the person in distress and that involves a safe and respectful way of coping with crisis situations. This approach is known as ‘low arousal’ and is the core of the Studio 3 approach. In this book, full of ideas and reflections that stick around in your head, Andy describes in detail and in an open and honest way how they manage extreme crises at Studio 3.

This is a book that I can highly recommend! It shows that at times when we ourselves are distraught because of someone’s crisis behaviour, there are possibilities to find a way out of the crisis together in a safe and respectful way. This is a book that, in addition to many practical tips, offers a lot of hope. And on top of that: in this book, Andy McDonnell shows a huge amount of empathy for the people who use restraint and seclusion. He does not blame them, but understands why they engage in these practices (often because they were trained that way and had never been offered the alternatives). This book breathes empathy!

Some quotes from the book that I underlined while reading, because I found them inspiring or thought provoking:

Frightened, scared and stressed staff make poor decisions, which can escalate situations.

One key area in our work is the concept of emotional contagion.

When we concentrate too much on safety – in particular, staff safety – we pay a huge cost in terms of positive risk-taking.

Renaming seclusion rooms ‘quiet areas’ or ‘safe places’ is not the solution.

Accepting that challenging or distressed behaviours often serve a de-arousing function is crucial to the Low Arousal Approach.

The ultimate goal of good behavior management is to keep all people safe.

When managing the behaviour of a highly stressed individual, we must be aware that our own stress can also be contagious. Stress is a two-way street.

We must rid ourselves of what I call the ‘self-defense narrative’.

If we want to reduce physical aggression, we may allow for short-term increase in property destruction and verbal aggression. This is about an individual learning to self-regulate and these are small steps in the right direction.

Especially the last two quotes are quite thought provoking and I take a risk here by quoting them, because to fully understand them, one need to read the book (context!).

After the first chapters, where Andy McDonnell convinces us to change our ideas and abandon seclusion and restraint, the rest of the book describes in detail the Low Arousal Approach of crisis situations. Key elements are:

  • Building confidence in staff
  • Emotion regulation in staff
  • Staying calm, or at least showing calmness
  • Slow movements
  • The Studio 3 Walkaround method

Andy’s newest book is a must read for anyone working with highly stressed individuals showing very challenging behaviours.

One thought on “Freedom from restraint and seclusion: managing extreme challenging behaviours in a respectful way

  1. Between 2013 and 2017 there vere 6 034 violent assaults on care workers in UK resulting in serious injury most were made by residents in their care, many of whom suffered from mental health issues this also includes persons with ASD during their meltdown moments. It’s never too much concerns about safety of staff and self defense is reality not just narative. I’m very emphatetic person and I’m aware that restraining someone who doesn’t know to how to express their own feelings in neurotipical manner could be rather humiliating act but in reality saves lives. If for example providing appropriate, non overwhelming environment can prevent hypersensitive autistic person from meltdown and physical aggression toward other persons that would be much more productive than teaching staff not to defend themselves.

Leave a Reply