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Innovative Methods for Handling Hitting, Biting, and Kicking

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by Temple Grandin, PhD
Autism Asperger’s Digest
 | January/February 2009

The use of restraint to control an adult client who is either hitting himself or attacking staff is a controversial area. Kim Sanders and her associates at Grafton Services in the northeast have found innovative ways to eliminate the use of restraint when a client has a meltdown. They have been able to do this and keep both clients and staff safe from injury. An added bonus was they were able to decrease the use of medications in some clients.

First of all, the staff has to believe this is possible. To change the mindset that restraint is the only way to deal with dangerous behavior requires a supervisor who absolutely believes in it. The principle of this method is both brilliant and simple. Instead of restraining the person, you block his/her actions with something SOFT. Soft large objects such as sofa cushions or bean bag chairs are held up as a shield. The staff let the client pound on it, and the staff are trained not to push with the soft shield. They want to block the person from causing harm to himself or others. For clients with really severe behavior issues, the use of padded martial arts shields or a baseball umpire chest protector works well because these soft objects have handles. If a particular client kicks at a staff person’s legs, they put soft soccer shin guards on the staff person’s legs. If they bite another person’s hands, soft, padded protective gloves are put on the staff’s hands. Providing a soft object for the client to attack seems to calm the client down, whereas forceful restraint makes the client more angry or scared. For head banging, the staff member puts on a furry fleece car wash mitt and holds it near the person’s head and lets him hit the glove. The client usually likes the feeling of the glove and stops hitting, and then the staff lets the client have the glove.

Some behavior analysts will say that this procedure will reward bad behavior. To this question, Kim replies, “You cannot teach during a crisis. These methods are only used during a crisis. When the crisis is over, then you can go back to behavioral methods.”

Kim and her staff have carefully documented the results of their program and showed these figures at the 2008 Autism Society of America conference. They presented graphs showing the decrease in the number of times they had to restrain a violent client using this technique. In 2005, restraint had to be used 1,400 times in their many facilities. In 2008, that number had been reduced to just 8 times! This is remarkable progress.

Staff injuries and turnover have also decreased. As staff started believing in the new method, and seeing its success with their clients, they became more and more creative in developing new ways to use it. However, the keystone of this technique remains having a manager who believes in the technique, one who will make sure staff are trained in using it, and monitor that it is being consistently used with clients.

BIO
Temple Grandin is an internationally respected specialist in designing livestock handling systems. She is the most noted high-functioning person with autism in the world today.

 

Copyright © Autism Asperger’s Digest. 2009. All Rights Reserved. Distribution via print means prohibited without written permission of publisher.


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Comments

  1. Terri says:

    Good points made here. And never forget: There are cruel caregivers out there who abuse self abusive or aggressive autistic individuals and then BLAME it on “technique”. Still other “caregivers” are too lazy to implement necessary pro-active interventions or other calming or care needed and use unnecessary restraints or holds or techinques so they don’t have to work with the autistic person. They may be too busy texting or watching a movie. They can’t be bothered with the intensive work it takes to actually help the autistic person. Overmedicating a patient is yet another way to restrain patients to AVOID helping patients in a more humane and dignified way.

  2. Cindy E says:

    Hi Temple,
    I sorry I missed you when you came to Boston. I have a 7 1/2 yr old with a form of high functioning Autism, seizures and multiple sensory issues, in your opinion do you think that restraint and seclusion or timeout rooms are appropriate for child with these issues ? My daughter was put in a timeout room when the could not get her to come down when they had given her a list of words and wanted her to right sentences. Some time when you are back in the North East I would love to have you meet her . Thanks, Cindy

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