Calm Down or Else

By BENEDICT CAREY
Published: July 15, 2008
International Herald Tribune
http://www.iht.com/articles/2008/07/15/healthscience/15restraint.php

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 John Miller, a podiatrist in Allegany, N.Y., 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.”
Dr. Miller 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 Millers 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 L. Peterson, 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, Dr. Peterson 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.

Leslie Morrison, 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,” Ms. Morrison said. “Many of them are not verbal at all and can’t even tell their parents.”

In Tim Miller’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, Anthony, 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,” Ms. 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.

Dr. Peterson, 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,” Dr. Peterson said, “and it reflects the level of confusion there is about this whole issue.”