Andrew McDonnell

The Acceptability of Physical Restraint Procedures for People with a Learning Difficulty

Three methods of physical restraint were videotaped and presented to two groups of subjects (undergraduate students and teenagers). Two of the methods recommended restraining a person with a learning difficulty on the ground; the other method proposed seating the individual in a chair. Subjects were asked to rate the social acceptability of the procedures using the Treatment Evaluation Inventory (TEI). Both undergraduate students and teenagers rated the chair method as more acceptable. The implications of these findings for the use of physical restraint procedures were discussed.

The Social Validation of Three Physical Restraint Procedures: A Comparison of Young People and Professional Groups.

The treatment acceptability of three forms of physical restraint was evaluated with three groups of raters. One restraint method involved personal restraint in a chair, two other methods involved personal restraint on the floor. The three groups of raters were special education staff, residential staff, and a group of young adults with no experience of residential services. Ratings, of videotaped role-play using the Treatment Evaluation Inventory (Kazdin, 1980) revealed that the chair method of restraint was rated as more acceptable than the other method to all three groups. The residential staff rated the chair method as more acceptable than the other methods. The results are discussed in terms of the importance of evaluating restrictive, emergency procedures, and future methodological refinements.

Functional Analysis and Challenging Behaviours

Some of the weaknesses and ambiguities of the currently accepted definition of a functional analysis (Owens and Ashcroft, 1982) are outlined. Functional analysis is re-defined in order to try and overcome some of these difficulties. The utility of this new definition is discussed in relation to the assessment and treatment of challenging behaviours. A possible structure for the more general use of a functional analysis in the assessment and treatment of problems is outlined. The implications of this type of approach are discussed.

Coping with violent situations in the caring environment

In a recent survey of over 1000 people in the workplace, it was found that 19.6% could recall an incident involving threatening behaviour and 13.5% could recall an actual physical assault (Philips et al., 1989). Yet carers are often surprised when they experience violence from those who are in their care (Owens and Ashcroft, 1985). Health service surveys do not present an optimistic picture; physical assaults can account for as much as 11.5% of all reported incidents; threat with weapons 4.6% and verbal abuse 17% (Health Services Advisory Committee, 1987). Despite these findings comparatively little research is available on how best to manage violent situations in care settings.

The role of physiological arousal in the management of challenging behaviours in individuals with autistic spectrum disorders

Challenging behaviours restrict opportunities and choices for people with autistic spectrum disorders (ASD) and frequently lead to inappropriate and costly service interventions. Managing challenging behaviours of people with autism is an important area of research. This paper examines some of the evidence for the role of physiological arousal influencing these behaviours. Evidence from the emerging literature about sensory differences is examined. It is proposed that sensory reactivity is associated with hyperarousal; catatonic type behaviours are associated with low levels of reactivity (hypoarousal). A low arousal approach is proposed as a generalised strategy to managing challenging behaviours with ASD. The use of non-contingent reinforcement and antecedent control strategies are recommended for use with challenging behaviours which have a sensory component. Examples are provided to illustrate the approach. The implications of arousal and the use of physical interventions are discussed. It is proposed that arousal is a construct which has significant heuristic value for researchers and practitioners.