Use of restraint for the management of challenging behaviour in children with intellectual disabilities
| Pages | 62-75 |
| Date | 02 March 2012 |
| DOI | https://doi.org/10.1108/20441281211208428 |
| Published date | 02 March 2012 |
| Author | Krishna Menon,Raghavendra Baburaj,Sarah Bernard |
| Subject Matter | Education,Health & social care |
Use of restraint for the management
of challenging behaviour in children
with intellectual disabilities
Krishna Menon, Raghavendra Baburaj and Sarah Bernard
Abstract
Purpose – This review seeks to provide an overview of the current research evidence on the use of
restraint as an intervention in managing challenging behaviours in relation to children with intellectual
disabilities. It also aims to discuss legal frameworks and ethical considerations that underpin the use of
restraint in intellectually disabled children who present with challenging behaviours.
Design/methodology/approach – The authors conducted a search of existing literature primarily
pertaining to the management of challenging behaviours in intellectual disability on PubMed, PsycInfo
and Google Scholar using combinations of the following key words – children, intellectual disabilities,
learning disability, mental retardation, challenging behaviour, restraint, seclusion, physical restraint,
mechanical restraint, personal restraint, and chemical restraint. Since research on the use of such
interventions in children has been hitherto scant, literature relating to their use in intellectually disabled
adult populations as well as cognitively able children was also examined to ascertain whether the broad
principles informing the use of restraint interventions could be generalised to their use in intellectually
disabled children.
Findings – The review finds evidence to suggest that restraint interventions in their myriad forms are
widely used to manage challenging behaviours in children with intellectual disabilities and outlines the
evidence base, clinical scope, and the risks associated with the use of such interventions in children.
It also helps highlight the current absence of comprehensive evidence based guidance that
incorporates clinical, ethical, and legal aspects of the use of restraint interventions in children with
intellectual disabilities and raises relevant questions in relation to their judicious use in this patient group.
Originality/value – The authors believe that the review completes the first in depth evaluation of the use
of restraint interventions in children with intellectual disabilities and are confident that this would serve as
useful guidance for professionals working with this patient group who may be considering using restraint
interventions in their everyday clinical practice.
Keywords Children (age groups), Intellectual disabilities, Challenging behaviour,Individual behaviour,
Restraint, Seclusion, Physical restraint, Mechanical restraint, Personal restraint, Chemical restraint
Paper type Literature review
Introduction
Intellectual disability is defined by ICD 10 (WHO, 1992) as overall intelligence significantly
lower than the general population, i.e. IQ less than 70, with cognitive impairment being
evident during the child’s development and accompanied by limitations in adaptive social
functioning.
Theprevalence of mildto moderate intellectualdisabilitiesis approximately2-3 percent and that
of severe intellectual disabilities is 0.35-0.5 percent in Europe (Courtman and Mumby, 2008).
In England, there are an estimated 55,000-75,000 children who have a moderate to severe
intellectualdisability (Department of Health, 2002b,‘ ‘Factsand figures’’).
Challenging behaviours in intellectual disabilities
Challenging behaviour is described by Emerson (1992) as ‘‘culturally abnormal behaviour of
such an intensity, frequency and duration that the physical safety of the person or others is
PAGE 62
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 6 NO. 2 2012, pp. 62-75, QEmerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/20441281211208428
Krishna Menon is
a Specialist Registrar in
Child and Adolescent
Psychiatry for South London
and Maudsley NHS
Foundation Trust,
London, UK.
Raghavendra Baburaj is a
Specialist Registrar in
Psychiatry of Learning
Disability for Aneurin Bevan
Health Board,
Pontypool, UK.
Sarah Bernard is
a Consultant Psychiatrist in
the Mental Health of Child
and Adolescent Learning
Disability Service,
South London and
Maudsley NHS Foundation
Trust, London, UK.
To continue reading
Request your trial