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for the Welfare of Persons with Autism, Cerebral Palsy,
Mental Retardation & Multiple Disabilities
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Policy Statement on Aversives and Restraints for Children with Autism

Everyday, in this country, children with disabilities are needlessly subjected to harmful practices in the name of treating "challenging behaviours". They are strapped, tied to chairs, pinched, shaken violently, startled with cold water sprays to the face. This, despite the fact that there is no adequate research to show that such practices work. On the other hand, they can potentially exacerbate challenging behaviours, do nothing to teach the child appropriate behaviours', and often prevent the child from learning needed skills.

The problem is further compounded by the absence of a regulatory body in India, that can monitor professionals and act upon inappropriate interventions by therapists and teachers who have been entrusted with the care and teaching of children with disabilities. The Rehabilitation Council of India (RCI) requires professionals in the field of treating children with disabilities to be registered with it. However, because of gaps in policy, many professionals are not registered, and are out of the ambit of any monitoring process. Many parents are unaware that their children are routinely being hurt, restrained and subjected to painful and ineffective practices, by such programs. Sometimes, parents are aware of and troubled by the methods used on their child, but have been convinced that the treatment will work or may have been threatened that they will not get any further services if they do not comply.

The need, really, is to empower parents and families of children with disabilities, to understand that all children are the bearers of rights, and that there are dangers inherent to using aversive interventions, restraints and punishments. At the same time, families must be assisted in keeping their children safe while dealing with challenging or inappropriate behaviours in a positive way.

The objective of this statement by the National Trust is to provide guidelines to assist parents and professionals, who are faced with decisions regarding use of an intervention that involves use of aversives, restraints or punishments in the teaching or treatment of children with Autism. The following review is meant to help parents make choices that are based on scientific evidence and are in keeping with the rights of children and individuals with disability. This document has been prepared by the National Trust in consultation with its Expert Group on Autism.


Aversive Interventions:Aversives involve the deliberate infliction of physical and emotional pain, for the purpose of changing or controlling a child's behaviour These include techniques such as direct punishments like hitting or pinching, visual screening like blindfolds, and significantly, depriving the child of the ability to move.

Restraints:This involves the forced restriction or immobilization of the child's body or parts of the body. Manual restraint involves various "holds" for grabbing and immobilizing a child.

Mechanical restraint is the use of straps, cuffs and other devices to prevent movement and sense perception.

Chemical restraint means using medication to stop behaviour by dulling a child's ability to move and think. Medications specifically prescribed to treat symptoms of a disability or illness is not a chemical restraint.

Seclusion involves forced isolation from which a child cannot escape. Allowing a child to voluntarily take a break from activities is not considered seclusion.

When to suspect aversives are being used on your child:

Many children assume that their parents must know and approve of what is being done to them. A child may be too young to inform his parents directly, or may not be able to speak because of his disability, or despite having fluent speech may not be able to communicate his experience to his parents.

For many parents, the first clues could be any unusual injuries, bruising or abrasions. Sudden regressions (that is losing skills they already had), or the emergence of new behaviour may indicate psychological distress and offer clues to their origin. Newly emerging behaviours may include sleeplessness, increased anxiety levels, sudden persisting and unexplained distress when brought to the therapy centre, self injurious behaviours, a sudden change in weight, or a decrease in sociability. There may also be increased aggression and emotional outbursts.

If a parent has seen any warning signs in their child's behaviour or appearance, it is important to ask questions immediately. The parent must review the child's progress reports, and keep careful records. Parents should also never hesitate to share their concerns with the child's physician, or other health care provider.

Do aversives and restraints work?

Some studies like the Lovaas study ( Lovaas et al, 1980) showed efficacy of aversives when used by appropriate personnel. However, there is little data to suggest that this is more useful than safer, effective methods of teaching.

There is no evidence that these methods offer a safe means of teaching desirable, self directed behaviour that a child can maintain over the long term.

On the other hand, safe, positive methods for changing and redirecting behaviour are well documented. Evidence shows them to be successful regardless of the child's diagnostic label, degree of disability, or severity of behaviours.

Can use of physical restraints and aversives be harmful?

Injuries ranging from mild to severe, and sometimes even resulting in death have been reported with the use of restraints and aversives. Even an adult with the best of intentions can potentially harm a child. There is also the human factor-when an adult pits his or her weight against a child, especially when the child is frightened or agitated the result can never be certain.

Advances in our understanding of child development emphasize the importance of a secure, well balanced emotional life. A child subjected repeatedly to such techniques grows up feeling helpless, frightened and angry. Over time, an ongoing state of high arousal (or agitation) is created in the child's brain. The child becomes less able to control emotions, pay attention, or use new information to make appropriate decisions. The child may mistake even well intentioned actions as threatening. Eventually, the child may end up lashing-out out of fear and confusion; and gets labelled 'violent', which is then used to justify violation of the child's rights.

The responsibility to employ best practices, and the obligation to do no harm in treatment require that the least dangerous, least intrusive, and least restrictive methods always be used.

A rights based approach to use of aversives and restraints in children with Autism

There are no "beneficial outcomes" of physical punishment of children. This is equivalent to a search for the benefits of physical punishments of wives, senior citizens, employees, or any other groups of human or other lives. Children are as much bearers of rights an anybody else.

International laws and regulations generally agree that aversive interventions, restraint, and seclusion may not be used for purposes of convenience, or as coercion, punishment, retaliation, or as a means to "teach" acceptable behaviours. These methods are not teaching methods because they do not teach positive behaviours.

The use of such interventions in therapy or education is unethical, because these procedures takeaway basic rights in addition to creating risk.

Children without disabilities generally enjoy far greater protection than their siblings or peers with disabilities. Children with severe disabilities, and children with Autism, a disorder not understood well by many people, are the most vulnerable, and are the most likely to be subjected to stressful, frightening and dangerous interventions.

As societies gradually came to the conclusion the violence against women was a matter of rights, not of culture, they are increasingly drawing the same conclusions about violence against children in general, and children with disabilities, in particular. For example, the High Court in New Delhi, in it's ruling on corporal punishment, ruled the "fundamental rights of the child will have no meaning if they are not protected by the State."

According to the UN Convention drafted to protect the Rights of Children, and the rights of children with disability, "The child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before, as well as after birth."

This is echoed, also, in the Draft Rights of Persons with Disabilities Bill 2012, by the Ministry of Social Justice, Government of India, to be legislated soon into Law. According to the Bill, "No one shall be subjected to cruel, inhuman or degrading treatment or punishment, and that the appropriate authorities shall take all necessary measures to ensure that children with disabilities enjoy human rights on an equal basis with other children."

Policies, procedures and even legislation, however noble in intent, are all but meaningless if not enforced. The National Trust strongly believes that it is incumbent upon various professional and advocacy organizations to monitor and hold therapists accountable. Organisations need to act as watchdogs and monitor the compliance of best practices, to ensure that every child is kept out of harm's way.

What you can do if you discover your child is being subjected to aversives or restraints
  • Your first priority is to make sure your child is removed from the environment that is causing her harm. Start to explore options for your child's schooling/ therapy, keeping in mind the need for an organization where the policy does not support use of aversives and restraints.
  • Seek professional support for child and yourself - the experience may have been traumatic for both of you. Professionals with experience in the field of Autism and mental health will be able to support you. Sometimes the best starting point may be reaching out to your local parent support group for parents of children with Autism or other developmental disabilities
  • Take action to ensure the safety of your child as well as other children - make sure you report the incident to an child advocacy organization such as Childline (www.childlineindia.org.in, Phone number 1098) or a local disability rights organization

www.Aprais.org A.P.R.A.I.S - The Alliance to Prevent Restraint, Aversive Interventions, and Seclusion.

www.tash.org - TASH is a membership association focused on the elimination of barriers to full inclusion. TASH has extensive research and information relating to positive behaviour support.

www.childlineindia.org.in Childline India Foundation is a not for profit organization committed to protecting the rights and protection of all children. It is the nodal agency of the Union Ministry of Women and Child Development acting as the parent organization for setting up, managing and monitoring the CHILDLINE 1098 service all over the country

  Autism Spectrum Disorders or ASD is commonly called Autism Neuro- typical: A term used for people who do not have Autism or ASD  
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