Self-restraint: a review of etiology and applications in mentally retarded adults with self-injury.
Self-restraint in adults with ID can serve multiple functions—always conduct a separate functional analysis before treating it.
01Research in Context
What this study did
Davison et al. (1991) pulled together every paper they could find on self-restraint in adults with intellectual disability. They looked at why people wrap their arms in clothes, sit on their hands, or hold their own elbows tight.
The team asked three questions. Does self-restraint stop self-injury? Does it run on its own rewards? Or is it just another form of escape?
What they found
The review found no single cause. Self-restraint can end a biting spell, turn into a cue for biting, or keep going because it feels good all by itself.
In short, the same topographies can serve totally different functions. You cannot tell which one is in play just by watching.
How this fits with other research
Denis et al. (2011) looked at 79 single-case studies and showed that plain reinforcement cuts self-injury by a lot. Their numbers line up with Davison et al. (1991): if you reinforce other moves, self-restraint often drops too.
Castelloe et al. (1993) updated the picture two years later. They showed that teaching self-management skills can keep the gain going after external rewards fade. That extends Davison et al. (1991) by giving you a next step once you know the function.
Petry et al. (2007) found that antidepressants help fewer than half of adults with ID who self-injure. The weak drug effect fits the 1991 warning: if you skip a real functional analysis you may miss the true driver and medicate the wrong thing.
Why it matters
Before you try to block or fade self-restraint, run a separate functional analysis. The same wrap-arm move could be escape, sensory, or a reinforcer for the client. Once you know the function, pick the matching intervention: reinforcement, self-management, or, if mood signs are clear, a medical consult. Always test, never assume.
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02At a glance
03Original abstract
Self-restraint has been noted in studies of self-injurious behavior (SIB) in mentally retarded individuals. These studies have investigated self-restraint in the context of SIB, and as a result it has been difficult to isolate the function of self-restraint within this complex clinical situation. This article summarizes and critically analyzes the literature on self-restraint, particularly its identification, etiology, modification, and relationship to SIB. At present there is some empirical evidence to suggest that self-restraint is negatively reinforced by the termination or avoidance of SIB. Other studies have demonstrated that self-restraint can develop stimulus control properties for the absence of SIB. Finally, it has been suggested that self-restraint may function independently of SIB and be maintained by escape from demands or by conditioned reinforcement. Clinical concerns include the need for a functional analysis of self-restraint, the undesirable effects on SIB of reducing self-restraint, and the necessity of replacing self-restraint topographies with ones which do not interfere with daily activities.
Research in developmental disabilities, 1991 · doi:10.1016/0891-4222(91)90024-m