Assessment & Research

Social validation data on three methods of physical restraint: views of consumers, staff and students.

Cunningham et al. (2003) · Research in developmental disabilities 2003
★ The Verdict

Everyone dislikes physical restraint, so use it only in crisis and pick the least hated form—chair restraint.

✓ Read this if BCBAs writing crisis plans for adults or children with ID in day or residential programs.
✗ Skip if Clinicians who work solely with verbal clients and never use physical holds.

01Research in Context

01

What this study did

The team asked three groups what they think about physical restraint. The groups were adults with intellectual disability, direct-care staff, and college students.

Each person read short stories about three restraint types: holding someone down, tying them to a chair, and pinning them on the floor. They then rated how okay each method felt.

02

What they found

Every group said all restraint feels bad. Still, chair ties were seen as the least awful.

No one gave a green light to any method, but chair restraint got the softest red light.

03

How this fits with other research

Kazdin (1980) and Roberts et al. (1987) already showed people prefer gentle tools like reward over harsh tools like time-out. Cunningham et al. (2003) keeps that same line: reward tops, restraint bottoms.

Tassé et al. (2013) later counted real use and found most adults with ID still face restraint. The 2003 dislike data and the 2013 use data clash on paper, yet both can be true—staff use it even while hating it.

Sisson et al. (1993) briefly used restraint to stop self-injury and saw fast results. Their small success story seems to fight the 2003 dislike story. The gap is context: brief, life-saving use differs from daily holding.

04

Why it matters

Stakeholders hate restraint, so treat it like a last-ditch medical shot, not a daily pill. Run a full functional assessment first—Tassé et al. (2013) shows this step alone cuts later restraint. If you must hold, choose the chair method and get clear consent, as Murphy (1993) warns proxy okay is shaky. Document why less intrusive steps failed and keep the hold as short as possible.

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Check your behavior plans: replace any routine hold with a reinforcement skill-teach step and reserve restraint for true emergency.

02At a glance

Intervention
not applicable
Design
survey
Sample size
63
Population
intellectual disability
Finding
negative

03Original abstract

The use and evaluation of restraint methods with people with mental retardation is a continuing area of concern. Twenty-four undergraduate students, 21 residential care staff and 18 service-users from community settings rated videotapes of three physical restraint procedures. Two of the methods involved restraining an individual on the floor and a third method involved restraining an individual in a chair. Participants answered two open-ended questions to rate the methods of restraint and rated the methods on a 5-point scale of satisfaction [J. Ment. Defic. Res. 30 (1986) 369]. Participants also rated the three restraint methods by a forced-choice comparison. Restraint was rated negatively by all participants. However, both the satisfaction ratings and the forced-choice methods rated the chair method of restraint as most acceptable all three groups of participants. Consumers rated restraint more negatively than other groups. Restraint was evaluated negatively by all three groups, but the chair method was rated the least worst.

Research in developmental disabilities, 2003 · doi:10.1016/s0891-4222(03)00044-1