Consult the 8-Ball
You promote positive approaches but you teach physical restraint. Isn't that a contradiction?
There is nothing contradictory about using positive approaches and keeping everyone safe as you do so. The contradiction—some would say the crime—comes when we use physical restraint without working conscientiously to see that we never have to. We are firmly committed to using positive approaches with everyone, no matter how extreme their behavior, and we believe that having thoughtful and effective procedures for intervening in serious behavioral emergencies increases our capacity to do so.
I was very optimistic when our school adopted a positive behavior support system, especially since that meant committing to a data based decision making process, but unfortunately, it hasn’t made getting consensus any easier. For instance, last month after doing a very involved functional behavior assessment involving many people, we developed a behavior intervention plan for a student with verbal aggression.
After three weeks of implementing the plan and collecting data, not only have we seen no reduction in this student’s behavior, we can’t agree on what to do about it. Our psychologist wants to give the program more time to work, the classroom teacher wants to scrap it and start over, and everyone else basically wants to avoid team meetings. Any ideas?
We have a 29-year-old woman with Down Syndrome in our center that has recently begun having toileting accidents. As far as anyone here knows she has never had this problem as an adult. Her doctor said there was nothing medically wrong with her and it was probably for attention. We have a referral in to the staff psychologist but for now, it’s hard not to give her attention when we’re having to change her when she wets.
You were right to have her see a doctor. In our experience, incontinence in a person after years of independent toileting is almost always indicative of a medical problem. Because her doctor could not find a medical reason does not mean that there isn’t one. Unfortunately, doctors familiar and comfortable with providing care for persons with developmental disabilities are relatively hard to find. It is not uncommon for many physicians to attribute all behavior in persons with mental retardation to attention seeking, if there is no obvious medical condition. If these accidents don’t resolve soon we recommend seeking another medical opinion.
We have a client who needs extensive dental work. It is believed that some challenging behaviors are related to his dental health condition. This person does not communicate through speech. Although this man was able to sit for procedures on a previous visit, during his most recent appointment he became impatient and uncooperative in the middle of the procedure, which led us to restrain him for medical purposes. Because he is on a lot of behavior meds, the dentist didn’t feel it was safe to give him a sedative. Can you suggest a way to restrain this client safely so he can get the dental care he needs?
Let’s back up. Physically restraining this man in order to complete dental work can cause significant psychological trauma. How would you or I wish to be supported if we became fearful during a dental procedure? We would ask the dentist to stop and expect our wishes to be respected. If we were experiencing pain, we might ask for more anesthesia and expect it to be given. If we were fearful or if the vibrations, smells, tastes, pressure or other sensory phenomena of dental work became intolerable we might ask for a break. Since this man cannot speak we must accept his behavior as communication. Because he has tolerated dental procedures in the past, his behavior suggests distress, either pain or fear, that the person needs to be supported through.
We work with a 26 year old woman who [has mental retardation]. She came to live in our program four months ago. She is very negative. She always talks about not feeling well or about something hurting. We do check to make sure she’s not really injured or sick but she never is. Unless she’s talking about something wrong with her body she hardly ever really says anything. When I walk into the home she’ll come up to me and say, “My stomach hurts” or “I have a temperature.”
Our behavior specialist is having us take data on how often she makes these statements, but honestly, it’s pretty much all the time. It seems obvious she says these things so we’ll give her attention, but we can’t always ignore her because what if she’s really sick this time? Do you have any suggestions for reducing this lady’s negative verbalizations?