Restraint in ABA: Why It Is Not a Treatment

Restraint means holding or limiting a person so they cannot move freely. In behavior work, it shows up in three main forms. There is physical restraint, chemical restraint through medication, and mechanical restraint using devices.

Restraint is one of the most serious things that can happen in care. It is meant to keep people safe in a crisis. It is not a way to teach or change behavior. This page explains what restraint is, why that difference matters, and how teams can use it less.

Restraint is safety, not treatment#

The most important idea here is simple. Restraint does not fix behavior. It only manages a dangerous moment while it is happening. Dr. Shane Spiker draws this line hard for behavior analysts.

restraint procedures are not treatment options. They're last resort. They're management strategies. They're risk mitigation. From the talk — Dr. Shane Spiker

When a hold ends, nothing has been taught. The person has not learned a new skill. The reason for the behavior is still there. That is why Spiker uses such a plain image.

It's not a treatment. It's a bandaid. From the talk — Dr. Shane Spiker

A bandaid covers a wound. It does not heal what caused it. Restraint works the same way. It buys time and keeps people safe, but it changes nothing on its own. The real healing still has to come from a solid treatment plan.

The overuse problem#

A tool for rare emergencies can slowly become a habit. That is what many experts worry about with restraint. When it feels easy, teams reach for it too often.

Spiker names this directly across all three forms.

restraint is overused, whether it's mechanical, chemical or physical, it's being overused. From the talk — Dr. Shane Spiker

Overuse is a real risk for a few reasons. Restraint can be faster than a good plan. It can feel like control in a scary moment. But every extra use adds risk of harm to the person and to staff. The goal is to make restraint rare, not routine.

Different meanings of the word#

The word restraint carries more than one meaning in our field. Knowing the difference helps you read the research well. Two other uses come up a lot.

One is self-restraint. This is when a person limits their own movement, like sitting on their hands. It often appears with self-injury. The person may be trying to block harm to themselves.

The other is a safety-device restraint, like a car seat. Here the restraint protects a child during travel. Teaching caregivers to use these correctly is its own line of work. Same word, very different purpose.

Working toward less restraint#

Good practice does not stop at using restraint safely. It pushes to need it less over time. That means looking at what happens before a crisis, not just during one.

The real work is prevention. Teach the person new skills to get their needs met. Change the setting so triggers show up less. Reward calm and safe behavior when it happens. Over time this lowers how often a crisis starts at all.

Tracking also matters. When teams count every restraint, patterns become clear. You can see what set off each event. Then you can plan to stop the next one. A tool used less each month is a sign the plan is working.

Making a last resort truly rare#

The phrase "last resort" only means something with a plan behind it. A team needs clear steps to try first. Those steps come before any hold ever happens.

Start with prevention built into the daily plan. Teach the person to ask for what they need. Watch for early signs that stress is rising. Step in with calm support before things boil over.

Every setting should also have a written policy. The policy names who may use a hold and when. It spells out how each event gets reported. Clear rules protect both the person and the staff.

Then review the data as a team on a set schedule. Look at each restraint and ask what led to it. Ask what could have worked instead. Over time this review shrinks the list of crises. That is how a last resort actually stays rare.

For a deeper dive on crisis practice, see Crisis Management is a Crisis in Behavior Analysis - Applied 2022.

What the research says#

Restraint research splits into a few very different areas. Each one uses the word in its own way.

One line studies self-restraint in people with developmental conditions. Reviewers note that self-restraint is a mixed group of behaviors that may serve more than one function. Treatments include noncontingent reinforcement, differential reinforcement, functional communication training, and restraint fading (Mann, K., & Falligant, J. M. (2025). Understanding Self-Restraint in Neurodevelopmental Conditions: A Primer for Assessment and Treatment. Behavioral Sciences, 16(1)). A related study used a competing stimulus assessment to find items that reduced both self-injury and self-restraint by 80% or more (Frank-Crawford, M. A., et al. (2025). Application of the augmented competing stimulus assessment to identify and establish competing self-restraint items. Journal of Applied Behavior Analysis, 59(1)).

A very different line teaches caregivers to use child car seat restraints correctly. Correct install can lower the risk of fatal injury by 45% to 95% (Zonneveld, K. L. M., Rasuratnam, N., & Vladescu, J. C. (2025). The influence of video prompting with embedded safety checks to teach child passenger safety restraint skills. Journal of Applied Behavior Analysis, 58(2), 433-451). Behavioral skills training reduced car seat misuse better than standard training, both in person and by telehealth (DeCarli, J. M., et al. (2025). In-Person and Telehealth Behavioral Skills Training to Reduce Child Restraint System Misuse. Journal of Organizational Behavior Management, 45(1), 48-79).

Together these studies show one thing. Restraint is a broad word that needs careful context every time you use it.

FAQ#

Is restraint a form of treatment in ABA? No. Restraint is a safety and risk-management tool for emergencies. It keeps people safe during a crisis but does not teach skills or change why the behavior happens. Treatment is the plan you build to reduce future crises.

What are the main types of restraint? The three common types are physical, chemical, and mechanical. Physical restraint is a hands-on hold. Chemical restraint uses medication to limit behavior. Mechanical restraint uses a device. Experts warn that all three can be overused.

How can a team reduce the use of restraint? Focus on prevention. Teach replacement skills, change triggers in the setting, and reward safe behavior. Track every restraint event so you can spot patterns. Over time, strong plans make crises rarer and reduce the need for holds.