Utility of the implementation of programmatic systems to reduce and eliminate restraint use for the treatment of problem behaviors with individuals with mental retardation

Persons with mental retardation continue to remain one of society’s most vulnerable groups as the number of individuals served increases and non-proportional resources are allotted to take of their needs. With results of national investigations indicating widespread indiscriminate abuse of restraints and overmedication to manage dangerous behaviors, federal mandates have been initiated to ensure ethical, safe and clinically sound use of these techniques. This study addressed the implementation of systemic changes that included a restraint education program and policy changes, careful monitoring and review of restraint and behavioral programming by oversight review bodies, and intense training of preventative and de-escalation techniques to all staff. A statistically and clinically significant reduction in restraints was evidences upon programmatic implementation during this 18-month study. Psychotropic medication use also decreased significantly as did polypharmacy use for persons with mental retardation. Results supported research noting that reduction of behavioral restraint does not result in an automatic increase in alternative highly restrictive management techniques. Further research is warranted to isolate specific elements of effective systemic change which weigh more heavily in the improvement of behavioral management for persons with mental retardation

An analysis of Snoezelen equipment to reinforce persons with severe or profound mental retardation

Systematically developing methods of reinforcement for persons with severe and profound mental retardation has only recently received a good deal of attention. This topic is important since professionals in the field often have difficulty identifying sufficient numbers of positive stimuli. Snoezelen equipment as reinforcement for individuals with severe and profound mental retardation was evaluated because of the promise it holds for this population. Types of Snoezelen equipment which were most often approached and most reinforcing for these persons were identified. Implications of the findings for future assessment and treatment are discussed

Tardive dyskinesia associated with metoclopramide in persons with developmental disabilities

Metoclopramide is an anti-emetic medication that has been associated with movement disorders such as extra-pyramidal reactions and tardive dyskinesia (TD). Reports of these reactions have been documented in the general population, but investigations of side effects in persons with mental retardation are scant. Given the high incidence of gastrointestinal disturbance in persons with mental retardation, and the popularity of this medication to treat such problems, these individuals could be at risk for developing movement disorders resulting from metoclopramide use. We compared incidence rates of TD over a 1-year period in developmentally disabled individuals taking either metoclopramide, typical antipsychotics, or no psychotropic medications (Table 1). Assessment was completed using the Dyskinesia Identification System--Condensed User Scale (DISCUS), a standardized measure of TD found to be reliable and valid for persons with mental retardation. No significant differences in DISCUS scores between the metoclopramide and antipsychotic treated groups were noted across four measurements taken during the course of 1 year. Additionally, no difference was found between these two groups for a number of participants who met criteria for probable TD on at least one of the DISCUS administrations. Comparisons between all three groups on one testing occasion revealed a significant difference between groups. The no psychotropic control group showed significantly less TD symptomology than the antipsychotic or metoclopramide groups