Children with Down syndrome, like all children, can have challenging behaviors. This may be even more of an issue for a child with Down syndrome and another concurrent diagnosis, such as autism. These behaviors should be addressed with the same strategies that are effective for all children: positive behavioral supports. Strategies that would be considered inappropriate, unethical and even abusive when used with non-disabled children should not be condoned, nor considered "treatment" or part of a "behavior plan" if the child has a disability. Children with Down syndrome are at risk with respect to the use of restraints, aversive interventions and seclusion because they may be educated in segregated settings, including "alternative educational settings" under the discipline provisions of the Individuals with Disabilities Education Act, where these strategies are not held up to public scrutiny. In addition, children with Down syndrome may have communication difficulties that prevent them from reporting these abuses.
NDSS opposes the use of aversive interventions and seclusion under any circumstances. Aversive interventions include a broad spectrum of activities that range from clear physical and emotional abuse to more subtle forms of abuse (for example, purposely doing something to a child that he or she has an aversion to even though most children would not be upset by it). Activities that are oppressive, such as restrictions on freedoms that other children enjoy, also fall in this category.
Seclusion is often referred to as "time out" but seclusion is not the type of "time out" that parents frequently employ. Seclusion often involves placing a child alone in a separate area like a closet or a cage for extended periods of time. The child may even be locked into the "time-out" area.
NDSS opposes the use of any restraints except in emergency situations. An emergency is a crisis situation where restraint is the only recourse that will prevent serious bodily injury. It is unacceptable to allow "emergencies" to develop by the failure to use positive behavioral supports. These supports should be used to prevent a manageable situation from escalating into an emergency. Restraints should never be used on a child with a disability if they would not be used on a non-disabled child in the same situation.
NDSS opposes the use of "consent forms" to validate the use of restraints, aversive treatments or seclusion. Parents who sign these forms are often unable, due to lack of information, education or English proficiency, to provide informed consent. In addition, the natural tendency of parents to trust the professionals to whom they entrust their children creates tremendous pressure to agree to the strategies the professionals recommend.
NDSS is committed to eliminating the use of non-emergency restraints, aversive interventions and seclusion by taking the following steps:
- Providing information to parents that will help them understand how to protect their children's rights.
- Working to address the laws and regulations that permit, or do not prevent, these abuses.
- Providing resources on positive behavioral supports.
- Identifying examples of programs that successfully address behavioral issues without the use of non-emergency restraints, aversive treatments or seclusion.
- Addressing the negative public attitudes towards individuals with disabilities, especially cognitive disabilities, which make it acceptable for them to be treated in ways that would not be acceptable for any other group of individuals.
NDSS is a member of the steering committee for the Alliance to Prevent Restraint, Aversive Interventions or Seclusion (APRAIS). This group believes all children should grow up free from the use of restraint, seclusion, and aversive practices to respond to or control their behavior, and from the fear that these practice will be used on themselves, their siblings or their friends. The work of APRAIS is critically important to the physical and psychological well-being of individuals with disabilities, including Down syndrome.
- Policy Restraints and Seclusion