Therapeutic/restrictive holding

Discussion in 'General Parenting' started by lovelyboy, Jan 5, 2012.

  1. lovelyboy

    lovelyboy Member

    We've been adviced by the psychiatrist to put difficult child face down on the floor and sit on his bum holding his hands beside his body when he becomes physickly out of control.....we used it twice and I hated the shame and hurt and humiliation on his face afterwards.
    I dont like using this method......I also read some literature that this can be very damaging to a trusting relationship and Reactive Attachment Disorder (RAD)!
    What way do you use or what do you do if your child start hurting you or kicking stuff exct?
    I dont exactly know how to do the method where you sit and hold them from behind.....will this be better?
  2. buddy

    buddy New Member

    Lovelyboy, very interesting you should bring this up. I have always been trained (even before my difficult child came into my life since I have always worked iwth special needs people) in methods that first focus on de-escalating the situation and then if any restraint is needed, you are taught how to do it sitting or standing (and it takes a specifically trained kind of procedure to do what you are doing called PRONE restraint...which people have died from because in the heat of the moment it is hard to stay calm). There are tricks for biters, spitters, etc.

    I recently requested an independent evaluation thru our district. The person we are considering for it is wonderful in all ways except one. She has gone to the legislature and in many cases has worked to get people to do prone restraint. she feels it is safe and needed for extreme violence ONLY if people are trained completely. Our state gave a temporary trial period and all those doing it have to be registered, part of a therapeutic program and showing what they are doing to avoid this and they must report to the state each and every time they try it.

    My son was put into an illegal prone restraint when he had never needed ANY restraint by Integrated Listening Systems (ILS) workers last summer. The guy was a former cop. My son was beside himself scared adn he was hurt too. For him it is dangerous because he can head bang and he cannot have another head injury. HE got some cuts and I was there...telling the guy the whole time I was uncomfortable with it. He had his knee in his lower back and of course it only escalated teh situation. I was beside myself scared. He did it because Q refused to get out of the pool. Restraint is only to be used as you said, when there is aggression that can't be handled in any other way. for Q we are always able to talk him down, or to get him to a private spot to let him work thru it. The guy really felt bad and the sad thing was he had just finished his cpi training. He asked what he should have done and i went thru it with him. He had received a promotion at the Integrated Listening Systems (ILS) company but he took himself out of the running because he felt so awful. really except for that automatic cop mode he went into, he had been good with Q. The company had to report him to cps but nothing came of it because he did not intend to hurt anyone but was just not ready to handle the risk that something could happen which goes against a cop instinct. He finally did quit the entire company.

    I personally feel that it is demoralizing to have that happen. And, for Q it means he will do things to have it happen again and again. It just gets too stuck in him then. HE has suspected ptsd from early childhood, and it seems to trigger fight or flight with his AD. There are other methods. See if you can find a place that teaches CPI (crisis prevention intervention) it teaches effective holds.

    When Q was little holding time was HUGE around here. When we went to attachment therapy we did a little of that but I was not comfortable with it. When he raged I did hold him though.... and rocked or bounced him on a ball. He would rage for LONG times...hours. I just held him and he liked his palm and feet tickled so I did that when he calmed. I spent hours/days/weeks and years doing these things.

    I have had times when I have had to restrain Q and it was not ideal. especially if he was already on the floor. I did use hotdog rolls (what we called it...and asked him if he wanted to roll up in a blanket...he loved that and woudl do it even when really mad and aggressive so I didn't ahve to hold him , could just monitor him and he liked me to roll a ball on him when he was wrapped up. His head was never ever covered.

    I am really scared of this lady and plan to talk to her by phone before she goes to meet us at the school. If she says she is going to suggest this for my son when he has NEVER been restrained in the school.... I will ask we not use her. I will check for someone who understands brain injury better.

    OK, not much help, but it is crazy someone would post when I was just talking about this today. I know what you mean... it is better to be behind, cross their arms and have them more on the side of you so you can push your hip into them.... then you can actually raise them up a little off the ground and lean back so they can't head butt you. It takes practice and if you can really find a place to learn CPI or mandt training is would be great.
  3. TerryJ2

    TerryJ2 Well-Known Member

    Gosh, I've never heard of that one. Our therapist taught me to restrain difficult child in a seated position, from behind. It also involved wraparound tight hugging, so difficult child sometimes reacted negatively, and sometimes calmed down. Of course, once he got to be my size, that was the end of that.
    I really think it only works well on little kids, and only after all other methods have been exhausted.
  4. slsh

    slsh member since 1999

    You need to be well trained in restraints before using them. There is the potential for injury, either you or difficult child.

    We used the "basket hold" (encircling his body with ours, sitting, from behind) on thank you from about age 5 until 7 or 8. Actually it was a bit modified because he was really good at head-butting us. When he got too big for that, we did switch to the floor restraint (again, after training).

    We used restraints when he was violent towards us. Very rarely did we do it for destroying property, unless it involved safety issues for us (i.e. throwing objects at us or sibs). For quite a long time, restraints were daily. School and Residential Treatment Center (RTC) staff also used restraints - some appropriately, some not.

    I think it's important during a restraint to *not* engage verbally with- the difficult child - well, at least with- thank you anyway. Any verbal interaction just revved him up more. I've seen some "professionals" actually try to start processing with- him while doing a restraint - uh, no. The most we ever said to him (once we had figured it out) was that he was out of control, so we would maintain control of his body until he could regain it - calm voice, no emotion.

    A huge downside to restraints with- thank you was that they became terribly reinforcing to him. He would provoke and provoke (increasingly aggressive behavior) until a restraint was unavoidable, no matter how much we worked to deescalate. By the time he hit Residential Treatment Center (RTC) #3, he was having to be restrained multiple times a day, using a 3-person hold. The payoff for him was he had the undivided attention of several staff members, and even though he was being restrained, he was fully in control of the situation. What finally broke the cycle was when staff started using chemical restraints - an extreme measure and obviously not one you can use at home.

    I think restraints are necessary when you have a violent child, but I think it needs to be done, again, after good training by psychiatrist or therapist. Trying to learn how to deescalate before you get to that point is also important.
  5. lovelyboy

    lovelyboy Member

    Strangely enough Buddy.....I just got this thought the other day to roll son in blankets because I know he loves deep presure and I know from Occupational Therapist (OT) point of view its calming.....He kept on asking for more...later it was so nice to him....we had 6 double blankets around him....He then said:'Oh now I know why you did this...because now I cant hurt any one, because I cant move!!!!" Obviously I smiled and just said: "No its for calming you down and I know you love the feeling"! He even wanted me to lie on top of him for extra pressure....after that he said its fine when I asked him if I can run him a nice bath! He usually refuses....we both felt so good!
    Yes...last week my son started the head banging while lying on the floor...not restrained, out of free will! OMW He even wanted to cut himself, but luckily responded well when I said I will not allow him to hurt himself!
    My son loves tickleling...but only me and hubby knows how far is calming, before it turns into panic and excitement!
  6. buddy

    buddy New Member

    slsh, you make good points. for many kids any attention, or just having a pattern is reinforcing. the main principal is only as a last resort. And when trained and testing in a CPI class the emphasis is always on avoiding the restraint and deescalating things FIRST. They cover what if a child head butts, how to hold then.... how to deal with a bite or hair pull in an effective way..there are some reallly cool tricks that non violently get them off and minimize the chance for injury.

    You are trained not only not to talk to the person being restrained but not to talk to eachother when doing a restraint. That is why everyone has to be trained in the same method. You have signals and mouth counts and use just small numbers of words for cues what to do.

    If you know you are emotionally upset by the behavior...and all of us knows what I mean by that... you can not do it. It is to easy to want to hurt a child during that..even it is holding a little harder etc. It is hard not to want to yell at a child (I have to really talk to myself during that because it is natural to get mad when being hurt). There are full agencies and unless the psychiatrist and therapist are trainers who have taken all the courses and know all the potentials for law suits, cps threats etc... I would go through a licensed agency. (I realize that is not an option for some but kids have DIED under teh watch of psychiatrists and tdocs... I mean even in their offices)

    Having worked in settings where seclusion and restraints are allowed and where they are not I will promise you this. Where it is allowed the mindset goes there even if people are very good. IF it is an option it is used. The very same people can be in another program where it is prohibited and then it is not used. This is what has happened with Q. And they can defend the use because he does get more aggressive if being touched.

    These times are why people THEN support seclusion (monitored rooms with guidelines for how long they can be there... ) tehy say then the child can rage and kick and bang etc... but THEN people start abusing that by leaving kids there, not watching closely etc.

    I would rather have broken items that to do this routinely. I agree only if a chance of SIGNIFICANT injury (and one thing to decide that for myself, another to risk children.... that is when this year with the medication reactions we did go there with Q... luckily both times the Integrated Listening Systems (ILS) workers were there and I called the shots. WE did side by side standing restraint.

    what people dont tell you is how sweaty and adrenaline filled you get. they slip thru holds and you get emotional unless really well trained.

    I do understand there are times, I have been there. BUT I have to , just have to say I have seen UGLY things over time. Here is another story. A child with Autism Spectrum Disorders (ASD), in grade K, just last year... in a school that hadn't done an fba. we have these mandates that (except for an emergency and that can only happen 2 times a month and then an IEP meeting MUST be held to re do the IEP to avoid these things from happening) that say restraint can't be used. Prone NEVER unless trained and registered with the state and then you have to report the incident fully right after.

    OK, so this kid gets put on a table in a restraint face down with people all over him.... NONE of them even trained in any form of restraint. they argue that they HAD to because he was beating them up. They have no clue how their behavior is making it worse. tehy tell him he has to calm down. etc. of course he revs up. They dont report themselves because the ones who do that are the ones following the rules in the first place. They were not even willing to admit they did nothing after the first time (there can always be an emergency then they should go OMG what can we do to avoid this ever again??) This went on for months. The parents had no idea how serious until their lawyer confronted everyone in a meeting.

    I can't even think about the deaths. and the fact that people will shackle kids... oh my gosh. There is no easy answer.... and as I said, I am nto saying it is not needed at times.... there obviously are times.. But first priority.... analyze the behavior. do all you can to prevent it... make sure you are at the bottom of the source of the behaviors... language, Auditory Processing Disorders (APD), speech, sensory, counseling, medications, etc. STRESS for us was a huge deal. I realized my pms and just the fact that at the time i had to rush off to work and had NO PCA or Integrated Listening Systems (ILS) or respite... you could count on his needing restraint in the morning before school/work (and that was also before clonidine patches so now he has medications in the morning) and it would happen more often when I had PMS. I had to record all of this to see it. seems obvious now...

    Once he was out of my house a few hours a week....AND I quit my job to just focus on him and not have the pressure of his cooperating for me not to be in trouble at work, etc..... my stress went down, and his went down and that plus the medication patches... no more restraints. Before this medication reaction...Q hadn't been restrained for years. He also has NEVER been restrained in school. he has had people hold his hand or arm and walk him places (again using cpi approved holds) and he has also had those times when people abused him (the school psychiatric who grabbed him and shoved him and the ex cop who did the prone restraint).

    Am I emotional over this??? Sorry. It is a hot button for me because I see the need, have done it and have seen how it makes things worse. I also see how i need the tool in my bag for emergencies. IF this is routine... something needs to be done. It can hurt everyone's heart. His new counselor says that is her biggest concern. When people are restrained against their will it can really do psychological stuff to them.

    (by the way, Q in part seeks holds and deep pressure. when he asks for hugs etc... and pushes people too far, they need to see how rejecting that can be not listening to communication which means I need help with a sensory integration issue right NOW.... THey say they are using a ball to do deep pressure, but I have never seen the ball in his sensory room EVER. he used to crawl under mats but now there is only one mat and furniture is on it. These are hints I am going to give the independent fba person.
  7. buddy

    buddy New Member

    WOW, do you have a squeeze vest or weighted clothing? We have commercial kinds and also our Occupational Therapist (OT) helped us turn an old jean jacked into a weighted coat. She bought those circle weights... flat hardware from a hardware store...and hot glued and sewed them all over the jacket on the inside. the pockets were filled with small weights too. He also likes to go under mats and you know those big therapy balls??? you can roll them ON the child... they are soft but you can push. Q likes to sit against it and rock into it (he used to sit in couches and chairs with bouncy backs and rock and bounce off the backs of them... for long periods of time) I sometimes let him use those little battery vibrators (and I have bought them for school) and he can use that on his head and it is softer. neuro said it was fine. he also has those plug in vibrator chair pads....he has the FULL length one so you can lie on it. He also has a recumbent bike that has NUMBERS (LOL) on it for him to watch how the numbers go up for speed and miles... the exercise along with the number watching helps calm.

    The trick to all of that of course is not to do the measures only when they are starting to kick off. (though you do have to help cue them and help them learn to recognize that and try to calm themselves of course).... but if you make it timed...part of the schedule as in a sort of "diet" then you can help maintain the more integrated state. Use of squish vests, pants, hats and weighted ones need to be timed too. You know how you have something touching you and eventually you dont even feel it? they say 20 minutes or so and it is not take a break and you can use it again. But I am told it does not hurt to leave it on, just becomes not effective. For q he sometimes just can't transition it off easily so we wait him out.... no biggie. not worth a power struggle. He will wear bike helmets all day at times because he likes that pressure. (nto at school) and they let him leave a hat on at times even though against the rules... because of the pressure... those neoprene kinds (like spanx for the head!) work nicely.

    Yes, we have been thru the mill. but I feel so blessed that some of these things work. I know for many people nothing really helps, they try and try... not medications, not sensory things etc... very sad and difficult.

  8. TerryJ2

    TerryJ2 Well-Known Member

    Lovelyboy, great! There are items you can buy online that are weighted and then you don't have to use up so many blankets. Best of luck with-future discoveries. :)
  9. mstang67chic

    mstang67chic Going Green

    I apologize.....I haven't read completely through the rest of the replies but I"m in a hurry. I had to restrain my difficult child when he was younger and did it two different ways. One was the "hugging" method where I would encircle him with my arms from behind while sitting and also use my legs to wrap around the lower half. I never really squeezed but tightened my arms enough that he couldn't move but I wasn't really "squeezing" him.....if that makes any sense. Instead of holding on to him my hands were connected with each other. I would also make sure that my rings were turned inward so that if they scratched, they scratched me and not difficult child.

    The other method I used was straddling him. I kind of sat on him but never put my full weight on him. My knees were on either side of him and I had his arms pinned down to the side of his head.....upper arms straight out from his shoulders and elbows at a 90 degree angle. While I had SOME weight on him to hold him in place, the majority of my weight was on my knees. I sat just far enough back that he couldn't kick/knee me and his hands were far enough from his own face that he couldn't scratch himself. An interesting note about him and this particular hold. He managed to get one hand free just enough to grab my face. I wanted to see what he would do so I told him to go for it, do his worst. He grabbed my cheek in his hand....kind of like a baby would, but he didn't do anything. You could still see the rage but you could also see that he didn't want to actually HURT.

    Once he got bigger, obviously restraining was out of the question but I have been known to barricade doors with my body so he couldn't leave the house.
  10. HaoZi

    HaoZi Guest

    That's what I've been doing, looking for something else now that she's almost my size and will head butt me in the face with the back of her head.