Intrusiveness of behavioral treatments for adults with intellectual disability.

Ellingsen et al. (2014) sent an online survey to Board Certified Behavior Analysts. They asked how often adult behavior plans include intrusive parts like restraint, seclusion, or extra medication.

Each BCBA also rated the same plan with the free Treatment Intrusiveness Measure. The tool scores how much a plan limits freedom, privacy, or comfort.

Most plans for adults with intellectual disability had parts that could be made less intrusive. The worst spots were physical holds, locked time-out rooms, and add-on drug orders.

Analysts rarely used simple fixes such as fading restraints faster or swapping seclusion for a quiet break corner.

Matson et al. (2009), Cudré-Mauroux (2010), and Willner (2015) all reviewed drug studies. They agree: antipsychotics barely beat placebo for aggression in ID. Ellingsen et al. (2014) now show these same drugs sit in the top three intrusive plan items, so the survey gives a practical way to spot and trim that over-use.

van den Hazel et al. (2009) also used a staff survey. They found that when a client carries a “personality disorder” label, staff expect longer, harsher treatment. Ellingsen et al. (2014) move past bias and give a ruler—the Intrusiveness Measure—to check if the plan is truly too harsh.

Taken together, the papers say: stop reaching for the med chart first; measure how much the plan already intrudes, then cut what you can.

If you write or supervise plans for adults with ID, run the free Treatment Intrusiveness Measure on your next case. Circle any item scored “high.” Replace that piece with a skill-teaching step or an environmental fix. You will lower risk, keep the client’s dignity, and still meet the behavior goal.