Calm down or else

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http://www.iht.com/articles/2008/07/15/healthscience/15restraint.php

Calm down or else

By Benedict Carey Published: July 15, 2008

The children return from school confused, scared and sometimes with

bruises on their wrists, arms or face. Many won't talk about what

happened, or simply can't, because they are unable to communicate

easily, if at all.

" What Tim eventually said, " said Dr. , a podiatrist in

Allegany, New York, about his son, then 12, " was that he didn't want

to go to school because he thought the school was trying to kill him. "

learned that Tim, who has Asperger's syndrome, was being

unusually confrontational in class, and that more than once teachers

had held him down on the floor to " calm him down, " according to logs

teachers kept to track his behavior; on at least one occasion, adults

held Tim prone for 20 minutes until he stopped struggling.

The s are suing the district, in part for costs of therapy for

their son as a result of the restraints. The district did not dispute

the logs but denied that teachers behaved improperly.

For more than a decade, parents of children with developmental and

psychiatric problems have pushed to gain more access to mainstream

schools and classrooms for their sons and daughters. One unfortunate

result, some experts say, is schools' increasing use of precisely the

sort of practices families hoped to avoid by steering clear of

institutionalized settings: takedowns, isolation rooms, restraining

chairs with straps, and worse.

No one keeps careful track of how often school staff members use such

maneuvers. But last year the public system served 600,000 more

special education students than it did a decade ago, many at least

part time in regular classrooms. Many staff members are not

adequately trained to handle severe behavior problems, researchers

say.

In April, a 9-year-old Montreal boy with autism died of suffocation

when a special education teacher wrapped him in a weighted blanket to

calm him, according to the coroner's report. Two Michigan public

school students with autism have died while being held on the ground

in so-called prone restraint.

Michigan, Pennsylvania and Tennessee have recently tightened

regulations governing the use of restraints and seclusion in schools.

California, Iowa and New York are among states considering stronger

prohibitions, and reports have appeared on blogs and in newspapers

across the country, from The Orange County Register to The Wall

Street Journal.

" Behavior problems in school are way up, and there's good reason to

believe that the use of these procedures is up, too, " said Reece

, a professor of special education at the University of

Nebraska. " It's an awful combination, because many parents expect

restraints to be used — as long as it's not their kid. "

Federal law leaves it to states and school districts to decide when

physical restraints and seclusion are appropriate, and standards vary

widely. Oversight is virtually nonexistent in most states, despite

the potential for harm and scant evidence of benefit, said.

Psychiatric facilities and nursing homes are generally far more

accountable to report on such incidents than schools, experts say.

In dozens of interviews, parents, special education experts and

lawyers who work to protect disabled people said they now regularly

heard of cases of abuse in public schools — up to one or two a week

surface on some parent e-mail lists — much more often than a decade

ago. " In all the years I went to school, I never, ever saw or heard

of anything like the horrific stories about restraint that we see

just about every day now, " said Alison Tepper Singer, executive vice

president of Autism Speaks, a charity dedicated to curing the

disorder.

The issue is politically sensitive at a time when schools have done a

lot to accommodate students with special needs, and some have

questioned whether mainstreaming has gone too far. " Some parent

organizations, they're so grateful to the schools that their kids

have been mainstreamed that they don't want to risk really pushing

for change, " said Dee Alpert, an advocate in New York who reports on

the issue in the online journal specialeducationmuckraker.com.

For teachers, who have many other responsibilities — not least, to

teach — managing even one child with a disability can add a wild card

to the day. " In a class of 30 to 35 children, there's a huge question

of how much safety or teaching a teacher can provide if he or she is

being called on to calm or contain a student on a regular basis, "

said Patti Ralabate, a special education expert at the National

Education Association. " The teacher is responsible for the safety of

all the children in the classroom. "

The line between skillful conflict resolution and abuse is slipperier

than many assume. Federal law requires that schools develop a

behavioral plan for every student with a disability, which may

include techniques to defuse the child's frustration: a break from

the class, for instance, or time out to listen to an iPod.

But in a hectic classroom, children with diagnoses like attention

deficit disorder, anxiety or autism can seemingly become defiant,

edgy or aggressive on a dime — and the plan, if one exists, can go

straight out the window, investigations have found. Even defying a

teacher's instructions — " noncompliance " — can invite a takedown or

time alone in a locked room, they found.

In an extensive report published last year, investigators in

California documented cases of abuse from districts in the San

Francisco Bay Area, the suburbs of Los Angeles and in the rural

northeastern part of the state. During the 2005-6 school year, an 8-

year-old with a diagnosis of attention deficit disorder and mild

mental retardation was repeatedly locked in a " seclusion room " alone,

adjacent to the classroom — at least 31 times in a single year. His

parents heard about it from another parent, who saw the boy trying in

vain to escape.

In another school, a teacher held a 12-year-old with a diagnosis of

attention deficit disorder " face down on the floor, straddling him at

his hips, and holding his hands behind his back, " according to the

investigation, which was done by California's office of protection

and advocacy. Congress established such offices in each state in the

1970s to protect the rights of the disabled.

on, director of investigations at the California office,

said parents often complained about such episodes but were usually

reluctant to cooperate with an investigation. " They're afraid the

school will retaliate, " she said.

And the children, who have an array of psychiatric diagnoses, from

attention deficit to autism, often do not understand what is

happening or why. " They just think they did something wrong and are

being punished, " on said. " Many of them are not verbal at all

and can't even tell their parents. "

In Tim 's case, school logs obtained by his father illustrate

how quickly a situation can escalate, regardless of behavior plans.

In one entry, dated March 18, 2005, a teacher wrote: " Tim was

screaming down the hall. He ran past me and began to double his fist

to punch the locker. At this point I scooped my arm underneath his

and directed him into my room. "

After the boy continued to struggle, this teacher and another " laid

him onto the mat, where he was held approximately 20 minutes, " the

log said.

Tim, now 15, graduated from the school last year and in June

completed his first year of high school, excelling in a variety of

mainstream classes without incident. In a telephone interview, he

said he no longer thought much about the takedowns. " I just think now

that they were idiots to do that, " he said. " I remember telling my

mom to pray to God that they wouldn't keep doing it, and wishing the

other kids would see what was happening. "

When a school has a so-called zero tolerance approach to bad

behavior, it often does makes a public spectacle of controlling a

child's behavior, said several parents interviewed for this article.

Kathy Sexton, who lives near Dallas, had to pick up her 11-year-old

son, , who has a diagnosis of attention deficit disorder, at

the police station, after school staff members had the boy hauled

away in handcuffs for cursing at a teacher.

" I didn't hear about it for hours and had to go get him at jail, "

Sexton said in a phone interview. " He was hysterical, obviously, and

he's had his ups and downs since then. It's hard to know what a thing

like that does to a child that age. "

Several companies offer programs to teach so-called de-escalation

techniques to school staff, and a scattering of schools have

developed model programs to pre-empt confrontations, and defuse them

when they happen. But experts say that until policymakers and schools

adopt standards, on exactly which techniques are allowed and when,

children with behavior problems will in many districts run the risk

of being forcibly brought into line.

, the Nebraska professor, illustrates the challenges by

citing two recent cases in Iowa. In one, the parents of an 11-year-

old who died while being held down called for a ban on restraints; in

the other, parents charged that a school failed their son by not

restraining him. The boy ran away and drowned.

" It's damned if you do, damned if you don't, " said, " and it

reflects the level of confusion there is about this whole issue. "