Review – Autism Spectrum Disorder and De-escalation Strategies

Autism Spectrum Disorder and De-escalation Strategies – Steve Brown

Autism Spectrum Disorders and De-escalation

If you go to Google News (or any website that allows you to search international news) and type in “autism restraint” you will find pages of results from 2015 alone. In fact, you will find more than one page of results from December alone. These are not positive articles either: spanning events such as the abusive restraints used at Carlton Palms Educational Centre, a damning article on restraint and seclusion in US schools, articles about children coming home with marks, or being restrained hundreds of times without their parents knowing.

Many autistic children can end up on the receiving end of poor practice involving restraint, such as a young child who was placed in a duffel bag which was hung on a peg by his teacher. (He was found by his parent)

Talking about restraint is always fraught with tension – and when we consider the horrible consequences when restraint goes wrong (see: all of the news articles in the afore mentioned search terms) it is not a surprise that this is the case. It is important to remember that what most, if not all, of these articles are discussing is not appropriate restraint, it is abuse. Perhaps unintentional abuse, but abuse nonetheless.

I am realistic about the subject of restraint – I would love to live in a world where limitless options mean that restraint never has to be used. Our world is not ideal. I have gone through training for the use of restraint (or as it was termed “Positive Handling and De-escalation Training”) and I believe it is important that staff receive appropriate restraint training because there may be occasions where it is the only option available. Without appropriate training, there can be terrible outcomes. The only three things I would ever consider using restraint for are the same three things Brown identifies as reasons for the use of restraint in this book:

  • Individual is immediate risk of harm to themselves.
  • Individual is immediate risk of harm to others.
  • Individual is destroying/damaging property (and this sometimes depends on the property)

I have worked with countless children who would have been excluded from their setting if staff could not physically intervene regularly. Personally, I have used physical intervention to prevent injuries to myself and other staff.

So if we take the view that the above situations might arise, despite our best efforts, then we should at least be prepared to safely manage the situation.

However, the bulk of this book and indeed the bulk of any decent restraint training has nothing to do with physical interventions, and everything to do with implementing strategies to make sure you don’t have to physically intervene.

Brown goes through a variety of factors, interventions, and strategies that staff can use that will help prevent situations escalating to the point that restraint even needs to be used. He discusses more common strategies such as visual strategies and language strategies, and goes in depth into how changes in work-load and the environment can have a bigger impact that professionals might originally have thought.

Reduce the amount of work the child may have to complete. For example, support a teenage boy with autism who is brilliant at maths by directing him to complete all of the even-numbered questions so he does half the work and finishes at the bottom of the page like everyone else.

He frames his de-escalation techniques with examples from his professional practice, and gives anecdotes from schools he has gone to and training sessions he has run that demonstrate how attitudes and views need to be changed, and how they can be.

There is no advice on how to physically restrain or any descriptions of types of restraints – unless he’s pointing them out as terrible practice – in this book because Brown can only give one piece of advice about it: if you think you’re going to need it, get quality training from the appropriate professionals.He even gives advice on how to seek out a quality training program, and what to look for to ensure it teaches appropriate skills.

However, there is page after page of advice on what professionals can do to try and ensure that they never have to use that training. I cannot emphasise just how important these de-escalation techniques are; anybody who works in a professional setting with autistic people should know how to de-escalate a stressful situation. Most of the advice in this book isn’t just about calming down students who would otherwise need to be restrained – it is about maintaining calm in any stressful environment.

Brown is also realistic about the fact that sometimes professionals might get it wrong. Now we’re not talking about “putting a child in a duffel bag” wrong because there’s no excuse for that, we’re talking about “this situation escalated to the point where my student attacked another child and had to be restrained for the safety of others, I should have done x,y, and z sooner”. And it’s true. Sometimes you will get it wrong, but Brown discusses different self-reflection methods that staff can and should use to help limit the occurence of these.

“It is not down to you to consider whether the way you acted was in the best interests of the child and whether you follow your duty of care, it is the responsibility of the court to decide. This is sobering and true advice that is helpful because it keeps us thoughtful and honest.

Is it worth reading?

For professionals, yes. It is a must read. Anybody who works with autistic people should know how to de-escalate situations before they get out of hand. For parents, it might not be as helpful but it does help you form a good idea of what you can expect as good practice from the professionals working with your family members.

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