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We may have (according to some) plenty of pollution here in New Jersey; as of Thursday evening, we also have a package of five autism bills on detection, teacher training, and the needs of autistic adults that have been approved by both the state Senate and Assembly and are headed to the desk of Goveror Joe Corzine. (Though I hope these bills will ultimately be for and in the best interests of autistic persons, rather than being seen as “anti-autism measures.”)
Politics NJ refers to the five bills as a “landmark autism awareness package.” The Star-Ledger’s blog states that the package of bills was approved “in the wake of a national study that found New Jersey had the highest rate of autism in the nation” (a reference to the CDC’s study on autism prevalence rates; New Jersey’s is 1 in 94). Whether New Jersey’s rate is the highest is due to environmental factors or to heightened awareness about autism (or to a stereotypically pushy attitude that results in loudmouth parents loudly advocating for services for my kid), is something to debate. While I certainly do not know the answer, I do think there is something about the education and services here, or about the professionals—the teachers, therapists, psychologists, doctors—or about their training, that suggests that they have a quite good sense of how to teach autistic children.
“The Best Way to Teach Autistic Children” with all due respect to their sensory needs, communication difficulties, intellectual ability, and dignity is a topic that can (I think) provoke spirited exchanges on a par with those about autism aetiology. (To mainstream or not to mainstream? ABA or not? Private school or in-district?) I wish to consider one particular topic in this post, and will certainly return to the question. The topic I wish to consider is not one that generally arises in discussions of education for children who do not need special education services, because it is not an academic subject, not even a life-skills subject.
I wish to talk about the basket hold.
The basket hold is a type of physical restraint in which, as I have seen it implemented, a person stands behind a child who is most likely in a mode that I will call “tantrumming.” The child’s arms are crisscrossed over his chest and his hands held by a person standing behind him.
The basket hold was the type of restraint used on my son when he was thought to be on the verge of head-banging, or when he had head-banged and was now in the mode of “tantrumming.” The basket hold was used in a previous public school district. The use of this restraint, and the consequences—-a 12-year-old child died from a basket hold in 2005 in Texas—were not spelled out in any formal way to my husband and me. At one point, the basket hold was used almost daily (and somedays more than once) on my son, to stop him from hurting himself, or hurting himself further. But, as I think it over in hindsight (and hindsight is terrible), the basket hold made things worse. I suppose the idea behind the basket hold was to, in effect, wrestle down a tantrumming child. In reality, the use of force led to my son struggling even more, and there were times when the basket holds were used for long periods of time. When my son first started attending a private autism school in December of 2005 (after we had taken him out of the public school district), he would wrap his arms around his torso, bend over and make noises, and sometimes laugh, and I did not feel too good when I realized that he was re-enacting the basket holds.
Why am I telling you this (aside from to point out that not every New Jersey school district has a good autism program)?
There are ways to help a child not hurt himself when he is very, very upset that involve other means than the use of force. Our home ABA therapists and the teachers in the public school autism program that Charlie now attends devised a short-term strategy and a long-term one. The long-term one involved:
- Teaching Charlie to recognize he was getting upset before he was so upset that a tantrum ensued.
- Teaching Charlie to communicate that he needed a break.
- Teaching Charlie to go to a soft surface—a gym mat in his class, his bed at home—and lie down until he was calm enough to go sit at his desk.
The short-term strategy was Crisis Management Training. (This is a very serious business and a professional should be consulted; what I relate here is what aspects of Crisis Management that I found have most helped Charlie.) The most important thing I learned is something rather counterintuitive: If your child is in “tantrum mode,” you have to think of how to use as little physical contact and physical force as possible, and you have to not fight against him. You have to be as minimally intrusive as possible. You have to use what I call my “grass in the wind principle”: You need to hold a child with as minimal an amount of contact as you can, and as calmly as you can. You can’t communicate anxiety or fear, either in your words or our body language. As I wrote after a moment when Charlie threw himself back down on the floor of a supermarket some months ago:
……. instead of bracing my body against his twisting back and fighting with every last ounce of strength I don’t have to keep him still and keep his head from the floor, I had tried to shape myself along with the flow of his energy—-to lean back in, or with, or together with his body, livid and practically sparking with desperation. It certainly took less out of me than attempts in previous years to hand onto a thrashing boy and I am sure I used to hold on so hard because of my own most despairing fear: What will I do when he gets big? When he is bigger than me?
On Thursday, Charlie calmed down enough to be directed to stand up and to carry the shopping basket through the store. I found myself not particularly enervated or upset.
The grass must bend, when the wind blows across it. [Confucius, Analects XII 19]
Or, the art of learning about letting go.
Friends who know more than I do in these matters have remarked that this—not fighting against Charlie’s energy but with it; being as minimally physical as possible—is a principle out of kung fu. Charlie’s teachers and home therapists all receive Crisis Management Training and I think this, and the fact that there is a consultant that they can readily speak to, gives them a certain confidence so that, if a child has a difficult moment, they do not communicate fear. They communicate, let’s help you through it. And they also teach a child other ways to express the feelings that brought on the tantrum; they know that the child can learn these other ways.
In contrast, when one uses a basket hold, one is not thinking any of this. One is thinking that here is a very upset, potentially self-injurious child, and one wants to stop the behavior as fast as possible, and so one uses force. And I wonder how often such methods were used on autistic persons in the past (and how often they are still used), and what does this do to a person over time?
And I am thankful to be living at a time when (though we have a long way to go) there is better understanding about autism, and there are better ways to help a child than grabbing his arms and hoping he’ll get tired. Charlie’s teachers know that they can help him through a difficult moment, and they know that he can help himself, too. It is this confidence, this self-assuredness that I have seen Charlie learning in school this past year: Today, Friday, June 22nd, is the last day of the regular school year for him. What he has learned could fill several, several blog posts indeed. What I have learned is that, if you can stop fighting—stop fighting against autism—-if you can bend and shape yourself to and with your autistic child, you have made a very big stride in your own education, in understanding autism.
I just read the article regarding the basket hold on children with autism. I also read some of the opposing views supporting the need for the basket hold. Now, here is my story. Four years ago my autistic daughter was in the second grade, a special day class. She had a teacher that I had become fast friends with and I truely trusted. As the school year progressed, my daughter was becoming increasingly aggitated to the point that when we arrived at school, I had to physcially carry her to the classroom. I just couldn’t figure out why my daughter was acting like this until one very upsetting day, when I received a phone call from her teacher asking me not to call the police on her because she performed the basket hold on my daughter and put multiple bruises on her. When my daughter arrived home on the school bus, I cannot even describe the anger I felt when I saw the condition of my daughter. She had hand shaped bruises on her arms, wrists, her chest, and her back. Not to mention areas on her thighs and her legs. I immediately called my daughter’s regional worker and she recommended I pull my daughter out of school immediately, and obtain an attorney. I also took my daughter to her pediatrician for an exam to document the injuries that she suffered. The doctor told me that the type of hold they had on my daughter could have potentially caused her to lose enough circulation in her arms (if held long enough) that she could have lost her arms over it!!!! Now, those of you who say you are in favor of the basket hold need to re-think your strategy. Is it worth it to you for your child to be bruised up and possiblie lose his/her arms over it??? I think not. Any physical aggression towards my child will NOT be tolerated, and if I ever find such aggression taking place that person will be reported to the child protective services and I will see to it myself they will not only be out of a job, but locked away for a very very very long time!
I think the Basket Hold issue, as being discussed here, is rapidly narrowing to bias as it’s being removed from it’s greater context which is “everyone’s immediate safety and overall welfare”. It’s not just about YOUR child.
Trying to generally classify this technique as BAD is just as irresponsible as generally classifying every low functioning child as being the same and treating them as such. Everyone and everything comes in degrees and in exceptions to the rules. There are few singular, one size fits all and all encompassing truths to be had here or on this issue.
I also feel that calling the behaviors, that usually get addressed with the Basket Hold, “tantruming” is a parental “feel good statement” and a gross understatement even by liberal observation and definition. Slamming another kid’s into the wall is not a tantrum and most behaviors that do not pose the risk of some form of injury are nor treated with the BH!
When warning signs of aggressive and/or certain problematic and injurious behaviors are displayed then the best course is to always redirect and diffuse it using other less or non-physical means of prevention. You had a warning shot and time to think first. The goal is to prevent the escalation and hopefully channel it in a safe and healthy manner.
Then there are the instantaneous blind rage outbursts and attacks. Triggered events. There is no reasoning with a child already in this condition. The idea of talking this child down whilst engaged in pummeling others or intense self destructive behaviors isn’t just tantamount to gross negligence… It IS gross negligence! This child must be stopped as quickly, efficiently and as safely as is possible. i.e. The “properly executed” Basket Hold.
If you are the parent of a child who is on the receiving end then do you want a lengthy diplomatic solution while your child is being beaten to a pulp or do you want it stopped ASAP? You would bring a lawsuit if they didn’t stop it ASAP, right? i.e. Gross negligence! It’s idealistic optional choices vs. absolute necessity in some cases.
The deterrent effect hasn’t been address here. Other children in the class typically witness these events. They may or not be very low functioning but they still usually understand discipline and consequences. i.e. Deterrent by example.
Has anyone here ever personally experienced what happens to an entire class when a situation isn’t controlled properly or quickly enough? You can get a very dangerous mob mentality disaster in mere seconds! Controlling one particular child may be paramount to safely controlling the entire class.
All methods, techniques and processes are TOOLS. The BH is JUST a tool and the issues are not in the tools themselves as it’s being portrayed here. The BH is not a BAD tool. It’s also not and end all solution to all problems.
The issues lie in the question “Was the correct tool used for the situation at hand?” Sometimes there isn’t a correct answer in the heat of the moment and it’s purely reactive or at best a frantic judgment call. The point is that YOU WEREN’T THERE when it happened and it’s all too easy to consider and judge everything in hindsight while calmly sipping you coffee as you muse over your own mentally created version of the events which of course are bound to favor your child. It probably didn’t happen quite the way it did in your mental version!
At home. You don’t have the welfare of 3-15 other children to consider or to deal with. When at home, it’s all one-on-one, no other children or classroom distractions and your child has a very high home turf comfort/security factor and is there with a parent, unlike the classroom. You also don’t have social behavior issues to muddy the waters. It’s also likely that you will have an easier time and greater success using redirection and other more diplomatic techniques than a teacher because you have the home turf advantage and get to work with your child in isolation and in highly controllable conditions.
School vs. home and school vs. “just you alone anywhere with just your child” is practically an apples vs. stones comparison. The supermarket incident was just HER and HER KID throwing a fit in the asile. No one else’s welfare was ever a consideration!
This is all a matter of degrees, a matter of perspective and a matter of viewing things correctly and each in their full context.
You can create a classroom or personal disaster as easily with diplomatic approaches as you can with forceful ones if you picked the wrong tool for the job! You only need to misread little Charlie’s warning signal or intent to mess that up. I doubt that even mom doesn’t also make her own fair share of misinterpretations.
I can’t leave without addressing the Kung Fu wisdom “bending with the grass”. The actual wisdom is that the sapling bends and survives the wind while the mighty tree breaks in resistance. That is not the same as going with the flow as was implied. Kung Fu uses the opponents energy against them using the least amount of your own force and energy. I’d like to note that a properly executed Basket Hold is conducted in much the same fashion and there is where the similarity ends! Kung Fu does not work WITH another’s energy. It uses it AGAINST them! Another apples vs. stones comparison.
Bending with the grass? Care must be taken even with the correct thinking of this ideal. Your bending, giving in and going with the flow may easily be used against you by your child as a tool of manulation. Throw a tantrum and pretty much get its way. That’s exactly what normal kids do. Sure they settle down when they get their own way but is that the way it’s best for them to be?
Yes I know I that’s not the intent of that ideal. I’m merely showing that like everything else it can backfire on you despite being well intentioned just like the Basket Hold or any other methods.
i agree…safety of all is paramount and strategies to mange aggression will come in time. A bh on an 8 year old is much better then handcuffs n a 22 year old.
1352 days ago
[...] behaviors themselves. but the way they were trained to handle these turned out to be the basket hold and other physical restraints which have had lasting, and frankly bad, effects on Charlie. The [...]
1393 days ago
[...] down prone on the floor, for one thing—-were the stuff of some benighted Victorian past. But physical restraints were repeatedly used on my own son in a New Jersey town we used to live in, and without the school [...]
Tristan is back in his old daycare for 2 half days this summer. The girl that takes care of him on Tuesdays had helped out with him last summer and the previous school year and was excellent with him. She knows he likes deep pressure, so when she noticed he was getting upset, she came up behind him, put a hand on each of his cheeks and held him close, the pressure calmed him down, because she reacted based on what he likes.
What happened with Charlie was that he’d butt his head onto the shoulder or chest of whoever was doing the restraining and then they’d have to hold onto him more and so the restraining went from 4 minutes to 45—–Chuck, I think I will keep your point in mind, though I’m not able to wrestle with Charlie, not at all.
Justthisguy,
If the child does it wrong, misses, or is too weak, then that will just tick off the people who are trying to restrain the child and they will just slam the child into the ground.
BT seen that
I tell any teacher that thinks they are qualified to restrain a child to restrain me. I have yet to meet one or teams of two that could hold me for more than 5 seconds and I don’t hurt them, which I could. I have problems of restraining my own son using techniques that do not require pain as the restraining factor. He enjoys wrestling with me and I can’t hold him for long.
Ah, now I know what “basket hold” means; basically a human straight jacket, behind you, up close and personal.
That would drive me nucking futs. If I had a kid, NT or autie, I’d train ‘im to resist and/or break such an obnoxious imposition.
PROTIP: If somebody gets you in one of those, stomp down really hard on the top of one of his feet.
1483 days ago
[...] a previous school district, physical restraints—the basket hold—were used on my son when he engaged in self-injurious and aggressive behaviors We were not [...]
No I actually filed a no restraint letter after the first time & they did it 3 more times.
1627 days ago
[...] “manage” a tantrum—and, as I also learned through sad and remorseful experience, physical restraints like the basket hold can be easily misused, and abused (see this Florida boy’s story). [...]
Thank you for the link with the video about the Port St. Lucie school. Did the district inform parents that such practices (physical restraint) would be used on autistic children?
http://www.news12now.com/news/school_4705701___article.html/boy_says.html
1659 days ago
[...] child; an autistic child who is very upset; an autistic child who is very upset and is being physically restrained; an autistic child who is very upset, is being physically restrained, and is [...]
1690 days ago
[...] teacher or us, or throws himself on the ground—our strategy is to be as minimally physically restraining as posssible. The first order of business is always to keep Charlie safe and calm as soon as [...]
1738 days ago
[...] Moines Register has photos of Isabel in the concrete “timeout” room and describes the use of restraints and physical prompting by teachers. The word “physical battle” is used to describe one [...]
1757 days ago
[...] of time can be) fun. Third, we agreed that no force must be used—nothing at all suggesting a restraint. Fourth, Charlie’s home ABA consultant (who used to be one of his therapists) came to the [...]
1768 days ago
[...] autistic children are particularly cited but not because of the benefits to their learning that a well-trained and properly supervised 1:1 aide can provide, but because they “can be difficult to manage” and because [...]
1779 days ago
[...] read about an autistic boy who is restrained in a van while on an outing from the residential placement where he lives: He stops breathing. He [...]
1779 days ago
[...] has given Charlie his best year in school ever, in a sunny and cheerful and orderly classroom with well-trained teachers and therapists. Indeed, Charlie become so fond of school that the end of the school year was cause for a week of [...]