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The Learning Disabilities Elf

Restraint interventions widely used in children with learning disabilities despite absence of evidence based guidance

John Northfield

The term ‘physical interventions’ refers to ‘any method of responding to challenging behaviour which involves some degree of direct physical force to limit or restrict movement or mobility’

The authors of this literature review set out to look at the current evidence on the use of restraint as an intervention in managing challenging behaviours in to children with learning disabilities. They also looked at the legal frameworks and ethical considerations underpinning the use of restraint in such children.

They reviewed literature from a search of electronic databases using a combination of keywords. Because of the relatively small number of studies in this area, they also used studies from adult with and cognitively able children to try to come to a view on whether broad principles underpinning the use of restraint interventions could be generalised to their use in children with learning disabilities.

They found evidence suggesting restraint interventions in were widely used to manage challenging behaviours in children with learning disabilities. They outline the risks associated with the use of such interventions and the current absence of evidence based guidance incorporating clinical, ethical, and legal aspects of their use.

The authors suggest that the review finding could constitute guidance for professionals working with children with learning disabilities and challenging behaviour considering using restraint interventions in their clinical practice.

Use of restraint for the management of challenging behaviour in children with intellectual disabilities, Menon K et al in Advances in Mental Health and Intellectual Disabilities,  6 2, 62 – 75

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Written by

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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  • james hourihan

    james hourihan

    14 years ago
    This is an interesting article with regard to physical interventions in this area, however, the failing of all of the current information on physical interventions is the vagueness of the terminology used by people. I was running training the other day and was told quite clearly that they didn't use restraint or physical interventioins they used "positive redirection techniques". The technique used was appropriate in the circumstances (trying to prevent someone running into a busy road) and the procedure used would be defined by most as the least intrusive in the circumstances. The problem is, they didn't see it as restraint, because in their eyes, restraint was wrong. Until people get away from the concept that "restraint" is wrong and more towards the wrong type of restraint in inappropriate circumstances is the problem then we will always have a vague approach to this subject.
    • 1 reply
    • John Northfield
      John Northfield 14 years ago
      Hi James, thanks for your comment. I entirely agree that accurate and precise terminology is key, that's one of the reasons I used the definition to open the posting. Physical interventions of course includes physical restraint, but also other forms of intervention that restrict liberty. john