587 - Reducing Physical Management in a Day Treatment Program for School-Age Children with ASD and ADHD through Home Collaboration

Poster Number: 587
Publication Number: 587.308

Benjamin Aaronson, University of Washington School of Medicine, Seattle, WA, United States; Tyler Sasser, University of Washington School of Medicine, Seattle, WA, United States; Zoey Phillips, Cognitive and Behavioral Consultants, White Plains, NY, United States; Donna Kaczynski, Creighton University School of Medicine, Omaha, NE, United States; Jeff Munson, University of Washington School of Medicine, Seattle, WA, United States; Mark Stein, University of Washington School of Medicine, Seattle, WA, United States; Annette Estes, University of Washington, Seattle, WA, United States

Background: Children with disabilities including autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) are significantly more likely to experience the use of restraint in schools and other settings. The use of restraints is often justified by safety concerns, though restraints present inherent safety risks. The identification of effective alternative de-escalation strategies may increase safety for school-age children and staff.

Objective: We examined whether utilizing a tangible home consequence would reduce the use of physical management during time out procedures in a summer day treatment program for school-age children with ASD and ADHD.

Design/Methods: The UW Autism Center hosts a summer day treatment program for children with ASD and ADHD. It has historically implemented a timeout protocol manualized in the Summer Treatment Program (Pelham et al., 2012). Timeouts are assigned for intentional aggression, intentional destruction of property, or repeated non-compliance. For two summers (2019, 2020), a “drop-the-rope” option was added in which a home consequence could be coordinated if the child was not responding to the standard timeout protocol. When a home consequence was initiated, the timeout was immediately concluded and the child was given the option to return to group activities. Staff consulted with parents regarding reasonable home consequences. Examples included losing 10 minutes of screen-time or an earlier bedtime. Timeouts were categorized as requiring no physical management, minor physical management (physical guidance), and significant physical management (any use of a therapeutic hold or restraint). The number of timeouts assigned and the level of physical management required to maintain safety were compared using the original timeout protocol (2018) and the revised "drop the rope" protocol (2019, 2020). 

Results: No significant differences were indicated in diagnosis, age, or gender based on Fisher’s exact test between our 2018, 2019, and 2020 samples. A significant reduction in the use of physical management was found from 2018 through 2020 (Fisher's exact test, p < .00001). Table 1 illustrates a 70% reduction in significant physical management from 2018 to 2019, and an 89% reduction through 2020.Conclusion(s): Children with disabilities are 7 times more likely to be restrained than their peers. The adoption of our "drop-the-rope" procedure involving a home consequence may be a useful de-escalation strategy for school-age children with ASD and ADHD. Further replication is needed to establish whether this practice can be effective in other settings.
Table 1.Timeouts assigned and degree of physical management required to maintain safety by year.
Figure 1.Total timeouts by year, color indicating degree of physical management required to maintain safety.