2024 Silva Lobato Nascimento Veduatto Modenesi

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Behavior Analysis in Practice 
https://doi.org/10.1007/s40617-024-00978-2
SI: IMPACTFUL LEADERS - LATIN AMERICAN WOMEN IN BEHAVIOR ANALYSIS
Assessment of the Social Validity of Physical Restraint in Behavioral 
Interventions for Autism with Brazilian Professionals
Rafael Augusto Silva1  · Juliana Lobato1  · Beatriz dos Santos Nascimento2  · Victoria Melo Alves Veduatto3  · 
Rafael Diego Modenesi4 
Accepted: 2 July 2024 
© Association for Behavior Analysis International 2024
Abstract
The use of physical restraint (PR) in behavioral interventions to ensure safety in response to severe aggressive behaviors in 
autism spectrum disorder (ASD) is a controversial subject. Its use should be planned and limited to behavioral emergencies, 
carried out by trained and supervised professionals. The present study evaluated the social validity of PR in the treatment of 
ASD with professionals from a Brazilian organization that follows the best practices for safety and implementation of PR, 
replicating the study by Luiselli et al. (2015). The results show that, overall, participants assessed this procedure as accept-
able, effective, and safe, and they agree that it should only be used when all deescalation procedures fail and exclusively to 
ensure safety. Factors that may influence participants' evaluations are discussed, such as access to information, the need for 
use, supervision, training, and previous professional experience implementing PR, highlighting the importance of conduct-
ing further studies that evaluate the social validity of PR use with different populations.
Keywords Physical restraint · Social validity · Assessment · Autism spectrum disorder
Severe aggressive (e.g., punching, kicking, and pushing) 
and self-injurious behaviors (e.g., head-banging and biting) 
in individuals with autism spectrum disorder (ASD) can 
pose risks to their safety and hinder their participation in 
educational and community activities (Lowe et al., 2007). 
However, research in applied behavior analysis (ABA) has 
shown that even severe cases can improve with appropriate 
treatments (Hagopian et al., 2020). Function-based treat-
ments have demonstrated efficacy in identifying anteced-
ent variables and reinforcing consequences that maintain 
aggression, while establishing new reinforcement contin-
gencies for appropriate behavior (Melanson & Fahmie, 
2023). Studies have supported the effectiveness of such 
treatments in reducing aggressive behaviors and promoting 
positive outcomes for individuals with ASD (e.g., Muharib 
et al., 2021).
Behavior analysts advocate for the use of less invasive 
procedures whenever possible (e.g., Vollmer et al., 2011). 
Studies have shown that effectively addressing less severe 
behaviors that precede severe aggression can prevent 
the need for more invasive procedures (e.g., Fritz et al., 
2013). These precursor behaviors, belonging to the same 
response class, can be targeted through deescalation strat-
egies. These strategies range from environmental modifi-
cations to enhancing safety to promoting communication 
between the individual and others (e.g., Metoyer et al., 
2020). By implementing deescalation strategies, unnec-
essary risks and invasive procedures can be avoided, and 
the escalation to more severe behaviors can be mitigated 
(e.g., Verret et al., 2019).
If deescalation fails and the behavior escalates to higher 
levels of severity, crisis management should be implemented 
through procedures used exclusively in behavioral emer-
gencies. One option for emergency procedures is physical 
The second, third, and fourth authors identify as Latina women; the 
remaining authors identify as Latino men; the participants are adults 
from Latin America (Brazil).
 * Rafael Augusto Silva 
 rafael.augustosi@gmail.com
1 Department of Research and Training, Grupo Método 
Ensino e Pesquisa, Av. Padre Pereira de Andrade, 405, 
São Paulo CEP: 05469-000, Brazil
2 Universidade São Judas Tadeu, São Paulo, Brazil
3 Instituto de Educação e Pesquisa em Saúde E Inclusão 
Social, São Paulo, Brazil
4 Universidade de São Paulo, São Paulo, Brazil
http://crossmark.crossref.org/dialog/?doi=10.1007/s40617-024-00978-2&domain=pdf
http://orcid.org/0000-0001-8600-9783
http://orcid.org/0000-0003-3280-8330
http://orcid.org/0009-0001-7215-4581
http://orcid.org/0009-0006-0675-1675
http://orcid.org/0000-0003-1424-6135
 Behavior Analysis in Practice
restraint (PR). PR involves using physical contact to restrict 
the individual's movements. Lennox et al. (2011), and Lui-
selli (2009) define PR as, one or two people restricting the 
movement of the individual's arms, legs, shoulders, and/or 
hips while they are standing, sitting, or in a supine position 
to reduce the range of motion for a brief period until they can 
safely return to their activities (Lennox et al., 2011; Luiselli, 
2009).
According to Luiselli (2009), PR should only be used 
in emergencies for specific topographies (such as slapping 
one's own face from a distance of 40 cm, and not face slaps 
from a distance of 2 cm) and as part of a comprehensive 
behavioral intervention plan. The Association of Profes-
sional Behavior Analysts recommends PR never be imple-
mented as a standalone treatment. PR should be performed 
by a trained team under the supervision of an experienced 
behavior analyst. A client’s behavior plan should focus on 
reinforcement-based strategies, adaptive skills, and behavior 
problem prevention. It should include a specific description 
of the behavior emergency, the type of PR to be used (e.g., 
sitting, standing, supine), implementation criteria (e.g., two 
headbanging instances in 10 s), duration, and interruption 
criteria (e.g., 5 s without attempting aggression). Written 
consent from parents or guardians is necessary, along with 
ongoing training, monitoring of procedure implementation, 
and goals for discontinuation. These guidelines emphasize 
the importance of responsible and well-planned use of PR 
in treating severe behaviors (e.g., Kern et al., 2022; Luiselli, 
2009).
The use of PR is controversial due to several factors. 
Restraining a resisting individual during a behavioral emer-
gency is emotionally draining and risky for both parties 
involved (Williams, 2009). PR can inadvertently reinforce 
social attention and physical contact seeking behaviors (Magee 
& Ellis, 2001). Insufficient training and monitoring of PR 
implementation can lead to errors, procedural failures, and 
increased injuries (Lennox et al., 2011). Therefore, it is crucial 
to assess the acceptability and satisfaction of these procedures 
by implementers. Social validity in ABA refers to the degree to 
which the goals, procedures, and outcomes of an intervention 
are acceptable, appropriate, and valuable to the clients and 
their social network, including care providers and implement-
ers (Schwartz & Baer, 1991; Wolf, 1978). Their evaluation 
is influenced by their understanding and knowledge of the 
intervention, indicating that training and effective communi-
cation are vital for the successful implementation and ongoing 
refinement of ABA practices (Strohmeier et al., 2014). Ongo-
ing social validity evaluations allow for modifications based 
on implementer and consumer feedback, enhancing service 
delivery and outcomes (e.g., Nicolson et al., 2020). Research 
on social validity has explored methods to improve treat-
ment implementation integrity, satisfaction, and acceptance 
of responsibilities in professionals serving individuals with 
developmental disorders (e.g., Strohmeier et al., 2014).
Although there is a growing number of publications assess-
ing social validity in behavior analysis journals (Huntington 
et al., 2022), few studies have specifically evaluated the accept-
ability of PR as part of treatment (Cunningham et al., 2003; 
Luiselli et al., 2015; McDonnell & Sturmey, 2000). Many of 
these studies involved presenting videos depicting the imple-
mentation of different PR procedures(e.g., chair and floor) 
for participants to judge statements on a 5-point scale (e.g., 
1 = highly satisfied, 2 = satisfied, 3 = neutral, 4 = unsatisfied 
5 = highly unsatisfied).
Overall, participants had negative evaluations of PR, with 
chair procedures being more acceptable than floor procedures 
(McDonnell & Sturmey, 2000). High school students with no 
experience working with developmental disorders and profes-
sionals without training or implementation experience in PR 
also evaluated the procedures negatively (Cunningham et al., 
2003; McDonnell & Sturmey, 2000). However, when partici-
pants received proper training, consistently used PR, and were 
monitored within organizations adhering to safety standards, 
social validity assessments were positive (Luiselli et al., 2015).
In a study by Luiselli et al. (2015), 25 professionals from a 
behavioral intervention program for adults with developmen-
tal disorders completed a social validity assessment question-
naire on the use of PR. Participants, with an average age of 33, 
underwent 10 h of specific PR and crisis management training. 
The questionnaire included three statements rated on a scale 
of 1 (strongly disagree) to 5 (strongly agree) in four domains: 
(1) rationale/justification; (2) training; (3) safety; and (4) 
implementation/effectiveness. Participants also reported their 
implementation frequency in their lives: never (one partici-
pant), 1–9 times (32%); 10–19 times (12%); and more than 20 
times (52%). Across all groups, high approval and acceptance 
(mean: 4.2–4.5) were observed in each domain.
These differences may be due to contextual and training 
variables. Replicating Luiselli et al.'s (2015) questionnaire in 
a similar context is important. Moreover, no study or social 
validity assessment of PR in ASD treatment has been con-
ducted in Brazil. Thus, this study aimed to assess the social 
validity of PR with Brazilian participants, replicating Luiselli 
et al.'s (2015) study with professionals from a behavioral 
intervention service dedicated to following standards and best 
practices in the implementation, training, supervision, and 
monitoring of PR use.
Method
Participants
The social validity questionnaire was distributed to 105 pro-
fessionals at a São Paulo organization serving individuals 
Behavior Analysis in Practice 
aged 2–25 years with autism spectrum disorder (ASD). 
Eighty-one completed the questionnaire and had an average 
age of 25 years (range: 19–40 years) and a varying level 
of experience working with individuals with ASD, ranging 
from 1 to 20 years.
The questionnaire was sent to professionals who par-
ticipated in and passed a training program in aggressive 
crisis safety. Seventy-nine professionals worked 40 h per 
week with individuals with autism (e.g., psychology, speech 
therapy, and education students and professionals), whereas 
three professionals had administrative roles and never had 
direct contact with them. The training included ABA and 
safety training, which involved 24 h of theoretical and prac-
tical components. Behavior skills training (BST) was used 
to train participants in deescalation and four PR procedures 
for behavioral emergencies.
The participants received the questionnaire from the 
organization's human resources department through a 
Google Forms link, accompanied by an invitation letter and 
an informed consent form. Participation in the questionnaire 
was voluntary, and respondents had the option to remain 
anonymous. It took approximately 5 min to complete the 
questionnaire, and the form automatically recorded the par-
ticipants' responses.
At the organization, the use of PR is strictly limited to 
individuals who were trained and received approval for 
the use of PR. PR is considered a last resort, meaning it 
should only be used when all deescalation procedures fail 
and exclusively to ensure safety in emergency situations, 
following a well-defined protocol outlined in the client's 
behavior plan. The organization maintains stringent guide-
lines for the implementation, documentation, and monitor-
ing of PR, demonstrating a commitment to upholding best 
practices in its utilization.
Social Validity Assessment Questionnaire
The Social Validity Assessment Questionnaire (see 
Table 1) was translated and adapted by the authors of 
the present study from Luiselli et al. (2015). It consisted 
of three questions each for the domains of justification/
rational, training, safety, and implementation effectiveness.
Participants rated their responses on a scale of 1 to 5: 
1: strongly disagree; 2: disagree; 3: neither agree nor disa-
gree; 4: agree; 5: strongly agree. In addition, participants 
provided information about their years of experience in 
the field, their role at the organization, and the number of 
physical restraints they had performed.
Data Analysis
The data analysis followed an identical approach to the 
study by Luiselli et al. (2015). The mean ratings (range: 
1–5) were calculated for each statement in the question-
naire. These data were summarized as average ratings for 
each domain. Participants were categorized into three 
groups based on the number of PR they had implemented 
in their lives. The average ratings for each domain were 
compared among these participant groups.
Results
Of the 81 participants, 41% reported implementing PR 0–9 
times, 17% reported implementing PR 10–19 times, and 42% 
reported implementing PR more than 20 times.
Figure 1 depicts the average rating responses for each 
domain based on the number of PR. The results consistently 
Table 1 Assessed domains and statements of the social validity questionnaire
Statements Assessment domains
S1: Physical restraint is sometimes needed to ensure the safety of the individuals we serve
S2: Physical restraint should only be used if less intensive intervention procedures have failed
S3: Physical restraint is an acceptable procedure for behavior support
Rationale-justification
S4: The training I received taught me how to properly implement physical restraint
S5: The training I received taught me methods to avoid using physical restraint
S6: The training I received taught me to use physical restraint as one component of a comprehensive behavior support 
plan
Training
S7: I am able to implement physical restraint safely without physical harming the person being held
S8: I am able to implement physical restraint safely without physical harming myself
S9: If needed, physical restraint can be adapted to ensure safety and minimal-to-no risk
Safety
S10: I am confident implementing physical restraint
S11: Physical restraint is an effective emergency intervention procedure
S12: The effective use of physical restraint makes it possible for clients to make progress and achieve a better quality of 
life
Implementation-
effectiveness
 Behavior Analysis in Practice
demonstrated approval and acceptance across all partici-
pant groups within each domain. The average ratings across 
the groups were 4.6 for the rationale/justification domain, 
4.5 for training, 4.4 for safety, and 4.3 for implementation 
effectiveness.
Table 2 shows the mean rating responses for each state-
ment of the questionnaire in the present study and compares 
them with those in Luiselli et al. (2015). The overall aver-
age rating across all statements was 4.4 (see Table 2). The 
lowest average rating (4.0) was observed for statement A8, 
whereas the highest average ratings (4.7) were recorded for 
statements A1, A2, and A4. Statements A8 and A12 had the 
lowest average ratings (4.1).
In the present study, the average rating responses for each 
statement in the questionnaire were higher by 0.2 points or 
more compared to the study by Luiselli et al. (2015) for 6 
out of the 12 statements (see Table 2). The statements that 
exhibited the largest differences were A8, with a 0.2 point 
lower average rating, and A12, with a 0.5 point higher aver-
age rating compared to Luiselli et al. (2015).
Fig.1 Average Rating 
Responses for Each Domain 
Based on the Number of PR
Table 2 Mean Rating Responses for Each Statement of the Questionnaire in the Present Study and in Luiselli et al. (2015)
Statements Mean Luiselli 
et al. 
(2015)
S1: Physical restraint is sometimes needed to ensure safety of the adults we serve 4,7 4,5
S2: Physical restraint should only be used if less intensive intervention procedures have failed 4,7 4,4
S3: Physical restraint is an acceptable procedure for behavior support 4,4 4,4
S4: The training I received taught me how to properly implement physical restraint 4,7 4,3
S5: The training I received taught me methods to avoid using physical restraint 4,5 4,3
S6: The training I received taught me to use physical restraint as one component of a comprehensive behavior support plan 4,4 4,3
S7: I am able to implement physical restraint safely without physical harming the person being held 4,4 4,3
S8: I am able to implement physical restraint safely without physical harming myself 4,0 4,2
S9: If needed, physical restraint can be adapted to ensure safety and minimal-to-no risk 4,6 4,2
S10: I am confident implementing physical restraint 4,4 4
S11: Physical restraint is an effective emergency intervention procedure 4,3 3,9
S12: The effective use of physical restraint makes it possible for clients to make progress and achieve a better quality of life 4,1 3,6
Behavior Analysis in Practice 
Discussion
The aim of the present study was to conduct a social valid-
ity assessment of PR, replicating the study by Luiselli et al. 
(2015) with professionals from a Brazilian behavioral inter-
vention service for cases of autism spectrum disorder. This 
service adheres to the recommendations and standards for 
training, supervision, and monitoring in the use of PR.
Overall, the participants rated the use of PR as acceptable 
and effective when used appropriately. Participants agreed 
that PR should only be applied as a last resort, after attempt-
ing less intrusive procedures. In addition, they agreed they 
had received adequate training and expressed confidence in 
implementing PR without causing physical harm to those 
involved.
These results differ from those of Cunningham et al. 
(2003) and McDonnell and Sturmey (2000), where par-
ticipants negatively judged the use of physical restraint. 
However, they are similar to those of Luiselli et al. (2015), 
suggesting that factors such as access to information, the 
need for use, supervision, training, and participants' imple-
mentation experience of PR influenced their positive evalu-
ation in the present study. The similarity between the set-
tings where the study by Luiselli et al. (2015) and this study 
were conducted may have contributed to these results, as 
both followed strict guidelines for PR approval, and its use 
was planned for behavioral emergencies. Therefore, similar 
to Luiselli et al. (2015), the opinions of these participants 
should be interpreted considering their service setting is 
dedicated to best practices and standards for the use of PR 
(e.g., Kern et al., 2022).
The present study has limitations. First, the questionnaire 
used for social validity assessment lacks proper validation, 
hindering group comparisons. Luiselli et al. (2015), the 
present study, and most behavioral publications containing 
social validity assessment have used subjective measures 
instead of normative measures (Huntington et al., 2022). 
Future research should evaluate its psychometric properties 
to ensure validity and comparability. In addition, the ques-
tionnaire could be used to assess and recommend specific 
interventions and trainings for consumers and professionals 
in public and private services in Brazil. Second, no person 
with autism rated the acceptability and safety of the proce-
dures. Future studies should include this measure, because 
these individuals are directly affected. Another limitation is 
the lack of information regarding the participants' gender 
and race, which prevented the evaluation of possible gender 
differences and contributed to the scarcity of information 
about the race of participants in ABA research. Furthermore, 
a specific group of participants who have never implemented 
PR was not included in the study.
Finally, this study was pioneering in evaluating the social 
validity of using PR in emergencies for the treatment of indi-
viduals with ASD with Brazilian participants, which is valu-
able considering that behavioral research often lacks ethnic 
information and rarely includes Hispanic individuals (e.g., 
Jones et al., 2020). Future studies could assess the social 
validity of PR in autism treatment by including other groups 
such as parents, caregivers, individuals directly affected, and 
professionals like teachers and nurses, considering their 
training and the type of training they have received. Evalu-
ating social validity in ABA is essential for changes that are 
meaningful and valuable to those experiencing them (e.g., 
Wolf, 1978). It is hoped that this study will inspire further 
research on the subject, considering the safety, respect, and 
dignity of individuals with autism and all those involved.
Funding The authors received no financial support for this research.
Data Availability The datasets generated during and/or analyzed dur-
ing the current study are available from the corresponding author on 
reasonable request.
Declarations 
Conflicts of Interest The authors declare that they have no conflicts 
of interest.
Ethical Approval Approval (CAAE 60063422.0.0000.0089) was 
obtained from the ethics committee for human research at the Univer-
sidade São Judas Tadeu (University São Judas Tadeu) in São Paulo.
Informed consent Informed consent was obtained from the participants 
included in the study.
References
Cunningham, J., McDonnell, A., Easton, S., & Sturmey, P. (2003). 
Social validation data on three methods of physical restraint: 
Views of consumers, staff and students. Research in Develop-
mental Disabilities, 24(4), 307–316. https:// doi. org/ 10. 1016/ 
S0891- 4222(03) 00044-1
Fritz, J. N., Iwata, B. A., Hammond, J. L., & Bloom, S. E. (2013). 
Experimental analysis of precursors to severe problem behavior. 
Journal of Applied Behavior Analysis, 46(1), 101–129. https:// 
doi. org/ 10. 1002/ jaba. 27
Hagopian, L. P., Frank-Crawford, M. A., Javed, N., Fisher, A. B., Dil-
lon, C. M., Zarcone, J. R., & Rooker, G. W. (2020). Initial out-
comes of an augmented competing stimulus assessment. Journal 
of Applied Behavior Analysis, 53(4), 2172–2185. https:// doi. org/ 
10. 1002/ JABA. 725
Huntington, R. N., Badgett, N. M., Rosenberg, N. E., Greeny, K., 
Bravo, A., Bristol, R. M., Byun, Y. H., & Park, M. S. (2022). 
Social validity in behavioral research: A selective review. Per-
spectives on Behavior Science, 46(1), 201–215. https:// doi. org/ 
10. 1007/ S40614- 022- 00364-9
Jones, S. H., St. Peter, C. C., & Ruckle, M. M. (2020). Reporting 
of demographic variables in the Journal of Applied Behavior 
https://doi.org/10.1016/S0891-4222(03)00044-1
https://doi.org/10.1016/S0891-4222(03)00044-1
https://doi.org/10.1002/jaba.27
https://doi.org/10.1002/jaba.27
https://doi.org/10.1002/JABA.725
https://doi.org/10.1002/JABA.725
https://doi.org/10.1007/S40614-022-00364-9
https://doi.org/10.1007/S40614-022-00364-9
 Behavior Analysis in Practice
Analysis. Journal of Applied Behavior Analysis, 53(3), 1304–
1315https:// doi. org/ 10. 1002/ JABA. 722
Kern, L., Mathur, S. R., & Peterson, R. (2022). Use of physical restraint 
procedures in educational settings: Recommendations for educa-
tors. Preventing School Failure: Alternative Education for Chil-
dren and Youth, 66(3), 214–218. https:// doi. org/ 10. 1080/ 10459 
88X. 2022. 20347 32
Lennox, D., Geren, M., & Rourke, D. (2011). Emergency physical 
restraint: Considerations for staff training and supervision. In J. 
K. Luiselli (Ed.), The handbook of high-risk challenging behav-
iors in people with intellectual and developmentaldisabilities (pp. 
271–292). Brookes.
Lowe, K., Allen, D., Jones, E., Brophy, S., Moore, K., & James, W. 
(2007). Challenging behaviours: Prevalence and topographies. 
Journal of Intellectual Disability Research, 51(Pt 8), 625–636. 
https:// doi. org/ 10. 1111/J. 1365- 2788. 2006. 00948.X
Luiselli, J. K. (2009). Physical restraint of people with intellectual 
disability: A review of implementation reduction and elimination 
procedures. Journal of Applied Research in Intellectual Disabili-
ties, 22(2), 126–134. https:// doi. org/ 10. 1111/J. 1468- 3148. 2008. 
00479.X
Luiselli, J. K., Sperry, J. M., & Draper, C. (2015). Social validity 
assessment of physical restraint intervention by care providers 
of adults with intellectual and developmental disabilities. Behav-
ior Analysis in Practice, 8(2), 170–175. https:// doi. org/ 10. 1007/ 
S40617- 015- 0082-Z
Magee, S. K., & Ellis, J. (2001). The detrimental effects of physical 
restraint as a consequence for inappropriate classroom behavior. 
Journal of Applied Behavior Analysis, 34(4), 501–504. https:// doi. 
org/ 10. 1901/ JABA. 2001. 34- 501
McDonnell, A. A., & Sturmey, P. (2000). The social validation of three 
physical restraint procedures: A comparison of young people and 
professional groups. Research in Developmental Disabilities, 
21(2), 85–92. https:// doi. org/ 10. 1016/ S0891- 4222(00) 00026-3
Melanson, I. J., & Fahmie, T. A. (2023). Functional analysis of problem 
behavior: A 40-year review. Journal of Applied Behavior Analysis, 
56(2), 262–281. https:// doi. org/ 10. 1002/ JABA. 983
Metoyer, C. N., Fritz, J. N., Hunt, J. C., & Fletcher, V. L. (2020). 
Teaching caregivers to respond safely during agitated states before 
aggression using simulation training. Journal of Applied Behavior 
Analysis, 53(4), 2250–2259. https:// doi. org/ 10. 1002/ JABA. 751
Muharib, R., Dowdy, A., Rajaraman, A., & Jessel, J. (2021). Con-
tingency-based delay to reinforcement following functional 
communication training for autistic individuals: A multilevel 
meta-analysis. Autism, 26(4), 761–781. https:// doi. org/ 10. 1177/ 
13623 61321 10655 40
Nicolson, A. C., Lazo-Pearson, J. F., & Shandy, J. (2020). ABA find-
ing its heart during a pandemic: An exploration in social validity. 
Behavior Analysis in Practice, 13(4), 757–766. https:// doi. org/ 10. 
1007/ S40617- 020- 00517-9
Schwartz, I. S., & Baer, D. M. (1991). Social validity assessments: 
Is current practice state of the art? Journal of Applied Behavior 
Analysis, 24(2), 189–204. https:// doi. org/ 10. 1901/ JABA. 1991. 
24- 189
Strohmeier, C., Mulé, C., & Luiselli, J. K. (2014). Social validity 
assessment of training methods to improve treatment integrity of 
special education service providers. Behavior Analysis in Prac-
tice, 7(1), 15–20. https:// doi. org/ 10. 1007/ S40617- 014- 0004-5
Verret, C., Massé, L., Lagacé-Leblanc, J., Delisle, G., & Doyon, J. 
(2019). The impact of a schoolwide de-escalation intervention 
plan on the use of seclusion and restraint in a special education 
school. Emotional & Behavioural Difficulties, 24(4), 357–373. 
https:// doi. org/ 10. 1080/ 13632 752. 2019. 16283 75
Vollmer, T. R., Hagopian, L., Bailey, J. S., Dorsey, M. F., Hanley, G., 
Lennox, D., Riordan, M. M., & Spreat, S. (2011). The association 
for behavior analysis international position statement on restraint 
and seclusion. The Behavior Analyst, 34(1), 103–110. https:// doi. 
org/ 10. 1007/ BF033 92238
Williams, D. E. (2009). Restraint safety: An analysis of injuries related 
to restraint of people with intellectual disabilities. Journal of 
Applied Research in Intellectual Disabilities, 22(2), 135–139. 
https:// doi. org/ 10. 1111/J. 1468- 3148. 2008. 00480.X
Wolf, M. M. (1978). Social validity: The case for subjective measure-
ment or how applied behavior analysis is finding its heart. Journal 
of Applied Behavior Analysis, 11(2), 203–214. https:// doi. org/ 10. 
1901/ JABA. 1978. 11- 203
Publisher's Note Springer Nature remains neutral with regard to 
jurisdictional claims in published maps and institutional affiliations.
Springer Nature or its licensor (e.g. a society or other partner) holds 
exclusive rights to this article under a publishing agreement with the 
author(s) or other rightsholder(s); author self-archiving of the accepted 
manuscript version of this article is solely governed by the terms of 
such publishing agreement and applicable law.
https://doi.org/10.1002/JABA.722
https://doi.org/10.1080/1045988X.2022.2034732
https://doi.org/10.1080/1045988X.2022.2034732
https://doi.org/10.1111/J.1365-2788.2006.00948.X
https://doi.org/10.1111/J.1468-3148.2008.00479.X
https://doi.org/10.1111/J.1468-3148.2008.00479.X
https://doi.org/10.1007/S40617-015-0082-Z
https://doi.org/10.1007/S40617-015-0082-Z
https://doi.org/10.1901/JABA.2001.34-501
https://doi.org/10.1901/JABA.2001.34-501
https://doi.org/10.1016/S0891-4222(00)00026-3
https://doi.org/10.1002/JABA.983
https://doi.org/10.1002/JABA.751
https://doi.org/10.1177/13623613211065540
https://doi.org/10.1177/13623613211065540
https://doi.org/10.1007/S40617-020-00517-9
https://doi.org/10.1007/S40617-020-00517-9
https://doi.org/10.1901/JABA.1991.24-189
https://doi.org/10.1901/JABA.1991.24-189
https://doi.org/10.1007/S40617-014-0004-5
https://doi.org/10.1080/13632752.2019.1628375
https://doi.org/10.1007/BF03392238
https://doi.org/10.1007/BF03392238
https://doi.org/10.1111/J.1468-3148.2008.00480.X
https://doi.org/10.1901/JABA.1978.11-203
https://doi.org/10.1901/JABA.1978.11-203
	Assessment of the Social Validity of Physical Restraint in Behavioral Interventions for Autism with Brazilian Professionals
	Abstract
	Method
	Participants
	Social Validity Assessment Questionnaire
	Data Analysis
	Results
	Discussion
	References