Ecological assessment of self-protective devices in three profoundly retarded adults.

Three adults with profound intellectual disability wore protective gear all day. One got a camisole with tied sleeves. Two wore fencing masks. Staff counted pica, rectal digging, and talking or touching others.

The gear stayed on for weeks. Researchers watched if dangerous behaviors stopped and if side effects appeared.

Pica and rectal digging dropped to zero while the gear was worn. Social bids—smiles, words, touches—also fell by half. The camisole cut contact the most; the mask less so.

When gear came off, pica returned quickly. Staff reported no new injuries, but clients looked isolated.

Pilgrim et al. (2000) later replaced these same restraints with brief electrical aversion. After three years their adults needed far fewer mechanical holds. The 1980 gear worked, but the 2000 method moved care forward.

Einfeld et al. (1995) showed we can cut self-injury without any devices. They taught escape requests and gave breaks. Skills beat straps.

Rashid et al. (2010) warn that pica still sends autistic clients to surgery. Blocking mouths with masks helps today, yet teaching “no mouth” and locking up small items works better long-term.

Ahrens et al. (2011) filmed stereotypy stopping on its own. Their data remind us to ask: do we need the gear right now, or will the behavior end without it?

You now have safer tools than full-time restraints. If pica is life-threatening, a fencing mask buys time, but pair it with functional assessment and reinforcement for safe eating. Track social minutes; isolation is a real side effect. Plan to fade any device as soon as skills replace the danger.