Contingent Restraint

Contingent restraint is a procedure typically used to decrease or eliminate self-injurious behavior (SIB) or aggressive behavior in individuals with developmental disabilities. It has also been successfully used in the treatment of pica and in combination with biofeedback relaxation training. Contingent restraint involves physically preventing an individual from engaging in the maladaptive target behavior. The most frequent population of individuals it is used with are children with autism or mental retardation. It is best used in combination with other procedures, most notably reinforcement procedures. Differential reinforcement of alternative behavior (DRA) and differential reinforcement of other behavior (DRO) are two reinforcement procedures most commonly combined with contingent restraint. Because contingent restraint involves physically restraining the target individual, it is used as a method of last resort when other, less restrictive procedures have failed to eliminate or reduce SIB/aggression to acceptable levels. The procedure is highly effective in reducing SIB/aggression when used in conjunction with other procedures designed to reinforce alternative behaviors and when procedures are designed to teach the target individual adaptive skills that replace SIB/aggression. The amount of time contingent restraint is implemented may vary depending on the situation, but the procedure is most effective when used after every instance of SIB/aggression.

The function or purpose of the SIB/aggression must be taken into account when using contingent restraint. Researchers have demonstrated that some individuals will increase SIB/aggression as a means of being physically restrained, particularly when contingent restraint has been used for extended periods of time. In these situations, the function of the SIB/aggression must be carefully evaluated before an appropriate procedure is implemented to decrease SIB/aggression.

There are four categories of contingent restraint: personal restraint, mechanical restraint, planned restraint, and emergency restraint. Personal restraint involves holding the individual in a physical hold for a specified amount of time contingent upon the target behavior. Mechanical restraint, on the other hand, involves the use of mechanical devices (frequently leather straps placed on the wrists and ankles) that limit the individual's range of motion, inhibiting an individual's ability to engage in the target behaviors. Planned restraint involves a careful analysis of the antecedents, consequences, setting events, and topography of the target behavior. Furthermore, when using planned restraint, contingent restraint is used as one part of an overall behavioral plan to decrease the target behavior and increase adaptive behaviors. All individuals involved in the care of the target individual are trained in the proper use of restraint, and everyone is aware of his or her role in its implementation. Emergency restraint is unplanned and involves the use of either mechanical or personal restraint when SIB/aggression has become so severe that intervention is necessary for safety reasons. Research has demonstrated that planned, mechanical restraint is the safest form of contingent restraint for both the target individual and caregivers, while emergency restraint results in the most injuries.