"When Discipline Starts a Fight" | Autism PDD

I feel so bad for Isabel and her family, and the place you worked at, cam, sounded just awful.WAUKEE, IOWA -- When Eva Loeffler walked into her daughter Isabel's classroom at Waukee Elementary School on Dec. 15, 2004, she says a male guidance counselor was trying to contain the shrieking 8-year-old by wrapping his arms around hers in a restraint hold.

Isabel, suffering from autism and other disabilities, had a history of aggressive behavior, but Mrs. Loeffler had never seen her so agitated. Her eyes were glazed and her face was red. "She was like a wild animal," says Mrs. Loeffler, who, at the time, felt sorry for the counselor who had to deal with her daughter in such a state.

That sympathy waned as Mrs. Loeffler and her husband learned all the measures the school district used on Isabel. These included restraint holds by three adults at once and hours in a seclusion room that teachers called "Isabel's office." There the girl sometimes wet herself and pulled out her hair, according to documents filed in a 2006 administrative-law case the Loefflers brought against the school district. 

In March, the presiding administrative-law judge ruled that the district had violated federal law by educating Isabel in overly restrictive settings and failing to adequately monitor its methods. The district has appealed. Its lawyer, Ronald Peeler, says it used "established educational principles" in addressing Isabel's problems, and made adjustments when its discipline wasn't working. "We are not dealing with an exact science here," says Mr. Peeler.

As public schools come under pressure to teach more children with behavioral disabilities, the use of restraint and seclusion has become a contentious issue. Faced with laws that make it more difficult to expel or suspend misbehaving special-education students, educators say they need to use harsh tactics sometimes to protect other children and teachers.

The danger comes when schools turn methods designed for extraordinary circumstances into routine disciplinary tools. The result can be a vicious cycle of punishment and rebellion, hurting the very children who were supposed to benefit from attending a mainstream school.

Some states are taking action. Last year, Michigan barred schools from restraining students by holding them face-down on the floor. The move was sparked by the case of Michael Renner-Lewis III, an autistic 15-year-old who died in 2003 after being restrained in that manner at a Kalamazoo-area high school. This year, Kansas and Connecticut have stepped up reporting requirements for school districts using restraint or seclusion.

At psychiatric hospitals that receive federal funds, only licensed medical personnel may order a troubled patient to be put into a restraint hold or locked in a room. The subject must receive a face-to-face evaluation within an hour. Even with these rules, restraint and seclusion result in as many as 150 deaths a year in health-care settings, according to the U.S. Department of Health and Human Services, which is campaigning to eliminate the practices.

By contrast, there is little regulation in public schools. The federal government doesn't gather incident data. About half the states have no standards and most that do have no reporting requirements, says Reece Peterson, a special-education professor at the University of Nebraska-Lincoln who has studied the issue.

Earlier this year, Colorado's federally funded disability advocacy office accused a Colorado Springs-area school district of abuses including allowing students to beat themselves bloody while being held in seclusion rooms. A similar office in Oakland, Calif., recently accused six California schools of routinely using restraint and seclusion in place of proper behavior plans for special-education students.

"Why do we allow the place where children spend the most time to be the place where they get the least protection from these deadly tactics?" says Rocky Nichols, executive director of the Disability Rights Center of Kansas, a Topeka-based advocacy group.

Decades ago, schools often denied enrollment to students with serious behavioral disorders or assigned them to segregated facilities. Conflicts over disciplinary methods often played out far from public view. Then came the 1975 federal law now known as the Individuals with Disabilities Education Act. It requires schools to provide disabled students with individualized education plans and put them in the least-restrictive appropriate setting -- which often means a regular public school. The idea is that children with disabilities will mature and learn more if they have contact with peers in regular schools.

In 2005, 472,000 children were receiving special-education services for emotional disturbances. Of them, 35% were going to school in "fully inclusive" settings -- spending 80% or more of their day in regular classrooms -- up from 17% in 1990.


Eva Loeffler teaching her daughter Isabel at the family home   

Isabel Loeffler's story -- drawn from interviews, school records and court testimony -- reflects the struggle of schools to develop proper disciplinary techniques amid the pressure to "mainstream" disabled children.

When Isabel was three, her parents took her to a specialist to determine why she was not speaking as well as other children her age. Other problems slowly surfaced. Doug Loeffler, Isabel's father, left his job in 2002 managing a Denver-area mutual fund to help sort out his daughter's problems.

A slender girl with straight brown hair, Isabel often avoided direct eye contact and walked with an awkward, birdlike gait. Along with autism, her disabilities included mild mental retardation, diminished motor skills and a serious speech impediment. Isabel also touched and grabbed others at inappropriate times. She would pin her younger sister, Victoria, to the floor and play rough with the family's golden retriever, Sika.

In 2001, Isabel started school at the Buffalo Ridge Elementary School, in Castle Rock, Colo. She was assigned to a regular classroom most of the day. Educators simplified her curriculum and gave her individualized help from a special-education teacher. By the end of the 2003-04 school year, she seemed to be making progress. With assistance, she could identify numbers up to 100, and she had begun writing sentences.

Feeling confident in his daughter's progress, Mr. Loeffler took a new job that summer overseeing mutual-fund managers at the Principal Financial Group in Des Moines. The family bought a house near Waukee, about 15 miles west of the city.

The once-sleepy farm and mining town had become a fast-growing suburb, with housing developments rising up beside old grain elevators and a school enrollment that tripled during the 1990s. About 8% of Waukee's 5,000 students qualify for special-education services. Only a handful of them are educated outside regular schools, which is a point of pride for the district.

For advice on educating such students, the Waukee district and 54 others in Iowa rely on the state-funded Heartland Area Education Agency, which has a "challenging behavior team" to help local educators deal with their toughest cases.

Martin Ikeda, an Iowa Department of Education official who helped create the team while at Heartland, says the agency believes it can reduce problem behavior and keep children in regular schools with a slowly intensifying menu of responses ranging from ignoring the behavior to dispatching the student to a closed "teaching room."

As Isabel entered the second grade in August 2004, Waukee initially assigned her for most of the day to a special-education classroom that emphasized functional skills such as identifying coins and going to the bathroom. After she performed better than expected, she was moved a week later to another special-education class that was more academically oriented.

The family communicated with Mirranda Krohn, Isabel's special-education teacher, via a notebook that Isabel carried to and from school. "Isabel is off to a great start," Ms. Krohn wrote on Sept. 1, 2004. "She seems to be making a lot of new friends. She is so polite and fun to work with."

But problems soon surfaced. On Oct. 8, Isabel pulled one student's hair and hit another in the mouth at recess, according to school records. On Oct. 27, she refused to do what teachers asked and yelled "No," for an hour and a half.

A few weeks later, the school put together a formal education plan for Isabel. It called for close adult supervision when she was in general education settings, such as recess, and breaks to let her calm down by, among other things, listening to music. When a break didn't end Isabel's misbehavior, the plan suggested punishing her by making her complete a repetitive task, with a teacher holding her hand and making her do so if necessary.

Such "hand-over-hand" procedures are most often used to teach new skills to those who don't respond to verbal instruction. A child with severe disabilities, for example, might be taught to eat properly by gently guiding his hand as he holds a spoon.

Many specialists say using hand-over-hand as punishment can backfire. "We many times see behaviors escalate when we try to intervene physically," says Lee Kern, a special-education professor at Lehigh University in Bethlehem, Pa.

At a Nov. 22 meeting, the Loefflers agreed to a behavior plan that included hand-over-hand, school records indicate. Mr. Loeffler says if the tactic was discussed that day, "it didn't jump out at us as a significant change."

For Isabel's hand-over-hand task, a teacher seated behind her would grip her hand, in which she held a crayon, and move it across the page until the child indicated she was ready to complete the coloring alone.

Isabel often reacted with rage. In one early incident that November, an adult aide had to hold her in her chair while Ms. Krohn gripped her coloring hand. The next afternoon, Isabel refused to work or play and "tore apart" the classroom, according to school records.

In December, the school transferred her to a newly created special-education class for students with serious behavioral problems. On her second day there, her conduct began to unravel just before noon, according to a classroom log kept by teacher Patti Brinkmeyer, who declined to be interviewed.

After hitting one classmate in the head, Isabel was forced to complete two pages of hand-over-hand coloring. Minutes later, she hit a second student and began throwing crayons and pulling things off walls.

At 12:22 p.m., Ms. Brinkmeyer used a restraint hold on Isabel. The girl spit and tried to bite the teacher, who sought help from Jason Sanders, a guidance counselor and football coach. He and Ms. Brinkmeyer used restraint holds at least seven times that day on Isabel.

Alternately talking gibberish and laughing hysterically, the 8-year-old scratched and kicked the adults. When they tried to restrain her, she attempted to butt their chins with her head.

Mrs. Loeffler arrived to pick up her daughter for a dentist's appointment around 1:30 p.m. She says Mr. Sanders was sitting in a chair with his feet on the floor. Isabel was standing between his legs, facing away from him, and he had her torso locked between his legs. His arms were wrapped around hers, says Mrs. Loeffler.

In a brief phone interview, Mr. Sanders said, "That wouldn't be the kind of restraint I would use." He then excused himself and later declined to comment further.

According to testimony in the court case, Ms. Brinkmeyer and Mr. Sanders as well as other school personnel were trained and certified to use restraint holds developed by David Mandt & Associates, a Dallas-based company founded in 1975 whose method is used by more than 500 school districts.

Bob Bowen, Mandt's chief executive, says his company's holds weren't used properly in Isabel's case, which he has reviewed. He says Mandt teaches them as last-resort safety measures only and doesn't condone their use for behavior management.

The Loefflers say that when they first realized restraint holds were being used, they didn't know whether it was a good idea. Mr. Loeffler adds that they didn't realize the full extent of the practice until much later, when they gained access to records like a classroom log for Jan. 14, 2005.

It indicates that, during a coloring session that day, Isabel tried to bite a teacher's aide three times, banged her own free hand against the desk and yelled "stupid" at other children. The entry in the notebook that went home that night made no mention of hand-over-hand, saying only that Isabel had a "rough" day and "had a hard time keeping her hands to herself."

Because Isabel's behavior temporarily improved that spring, the Loefflers put off pushing for any changes in her education plan until the following school year, when Isabel and Ms. Brinkmeyer transferred to Walnut Hills Elementary School, a newly built facility only blocks from the family's home.

At home that summer, Isabel urinated in closets and on beds, something her parents had never seen. Thinking their daughter's outbursts were at least partly related to her lack of time around nondisabled children, the Loefflers pressed at an Aug. 19 meeting with school officials for her to be in a regular-education classroom more often.

Isabel was given a new locker outside a regular-education classroom and a promise that she would be in regular classes as often as possible for so-called specials, like music and art.

That fall, her behavior problems continued -- as did the hand-over-hand procedures to punish her. It took as many as four educators to make Isabel complete her assignments. Sometimes she broke free and trashed the classroom. On Sept. 20, 2005, she emptied out drawers, threw a walkie-talkie and dumped soda on the floor.

By then, Waukee educators had documented 17 hand-over-hand interventions with Isabel. Some lasted as long as two and a half hours.

Such punishments are unusual and extreme, says Garry L. Martin, a psychology professor at the University of Manitoba. "If they are doing this for even five or 10 minutes at a time, I would say that is way too long," says Dr. Martin. He and other academics say that unless such measures change behavior they should be abandoned. Otherwise they may induce children to mimic the aggression.

Teachers began experimenting with moving Isabel out of the classroom when she was agitated, school records show. They tried timeouts in a small conference room next to Ms. Brinkmeyer's classroom, but Isabel jumped on tables and grabbed at electrical outlets.

Timeouts soon moved to "Isabel's Office," a former storage room at the end of a hallway. It had a gray linoleum floor, beige concrete-block walls and a door with a small window. Under a new plan that Heartland and the district presented to the Loefflers in November, Isabel would receive one-on-one instruction in the room until she could prove she could obey adults and be around other students without disruption. If she became agitated in isolation, teachers would remove her desk, chair and all other materials and the door would be closed.

To end such timeouts, the plan said, Isabel would first have to sit on the floor perfectly still for five minutes in a yoga-style position the school called "body basics." Then, she would have to complete a so-called "contingent task," which in her case involved pulling apart a pair of folded socks.

The Loefflers protested, saying the plan would make it impossible for Isabel to get an appropriate education. But they weren't happy with the status quo either. They stayed up several nights weeping and talking about what to do. Eva Loeffler says she began to fear Isabel would have to be placed in an institution.

On Dec. 2, the Loefflers agreed to the new behavior plan, provided that the school shorten the number of days Isabel had to behave to get back into the special-education classroom. The school acceded and also agreed to accept help from the University of Iowa's Center for Disability and Development, which had been working with the family.

To help the center get a clearer picture of Isabel's situation, Walnut Hill agreed to make a video of her on Dec. 7, her first day of being isolated in the new room. When Mrs. Loeffler arrived to pick up Isabel that afternoon, Isabel was sitting in the isolation room and had wet her pants. Mrs. Loeffler collected her daughter, changed her clothes and left.

Doug Loeffler dropped the video off at the Iowa center the next day without watching it.

School records show that for the rest of the month, Isabel was sometimes in the isolation room for up to five hours a day. At times, she screamed, spit and rolled on the floor of the room. On Dec. 12, she also pulled out a chunk of her own hair, according to an email Ms. Brinkmeyer sent to a Heartland psychologist.

Isabel attended classes at Walnut Hill for the last time on Dec. 21, 2005. The Loefflers kept her home after the holiday vacation while pondering what to do. Late on the evening of Jan. 11, 2006, they watched the video of Isabel for the first time to prepare for a conference the next day with school officials.

Clad in a white top and black pants, Isabel moves across the screen for more than three hours. Put into the isolation room for refusing to complete a reading exercise, she doesn't appear particularly angry, although at times she bangs her forehead with her fist and tries to climb the walls.

At several points in the film, Isabel drops into the "body basics" position and stares at the teachers watching her through the window. But each time, before the mandatory five minutes are up, Isabel fidgets, pulls at her fingers or rocks backwards onto the floor.

Mrs. Loeffler says watching Isabel struggle to come into compliance left her heartbroken and feeling like the school's tactics were fueling her daughter's misbehavior. "That's when I knew we could not send her back," she says.

State-sponsored mediation efforts failed to produce a new education plan for Isabel, although the school district did agree to provide support to Mrs. Loeffler as she tried to educate Isabel at home.

On Aug. 21, 2006, the Loefflers filed an administrative-law case against the district, seeking to force it to provide a less restrictive education for Isabel at a school other than Walnut Hill. Federal law provides for such proceedings as an avenue for special-education parents unhappy with their child's education plan.

On March 29, after 10 days of hearings, presiding administrative-law judge Susan Etscheidt found that Waukee and Heartland had not tried hard enough to put Isabel in a regular classroom and used "highly intrusive interventions" that were not acceptable or beneficial to her.

The administrative-law judge ordered the educators to seek outside expertise, come up with a new education plan for Isabel and provide her with compensatory summer classes. In dealing with such students, the judge wrote, schools must "focus on positive behavior supports and not punitive techniques such as restraint, extended isolation, or time out."

The district and Heartland appealed the ruling last month to the U.S. district court in Des Moines, saying it wasn't supported by the preponderance of the evidence. Mr. Peeler, the district's lawyer, says missteps are inevitable when dealing with troubled children, but the district made adjustments such as reducing the five-minute rule to one minute after viewing the video.

Ms. Brinkmeyer, in her testimony, said she never did anything to intentionally hurt Isabel. School officials say they tried hard to encourage good behavior in positive ways, such as urging Isabel to take breaks when she appeared stressed.

Heartland fears that the ruling may restrict options in handling students with severe behavior disorders. "We are trying to find ways to keep kids in schools and keep them in classes with their regular-education peers," says Sue Seitz, Heartland's lawyer.

Mr. Loeffler recently decided to accept a job with an investment firm in the Los Angeles area. "We had so much baggage, I just think it was a good time for us to have a clean start," he says.

While making plans for the move, Eva Loeffler has continued teaching her daughter at home in a brightly painted basement room lined with posters and bookshelves. One recent morning, Isabel scampered in toting a pink backpack, said the Pledge of Allegiance to a tiny American flag and rang a cowbell to start the school day.

Early on, certain gestures or the mention of words like "timeout" sparked angry outbursts from Isabel but more recently, with the help of a psychologist, such behavior has faded, Mrs. Loeffler says. These days, the 10-year-old talks about wanting "to go back to regular school," her mother says. "She wants to know the date when she can start."

Write to Robert Tomsho at rob.tomsho@wsj.com4
That is a really scary reality for some. I had to FIGHT to get Payne a BIP and FBA - they are not allowed to TOUCH him at all unless he is at a risk to himself or someone else directly. No isolation. Timeouts are limited to 10 minutes with supervision. My son had his thumb broken at the hospital just 3 weeks ago.  The were trying to restrain him.   The hospital keeps giving me the run around about getting the acident report.

I began my psych career in a facilty/quad that had various "houses" for different age groups and to separate the sexes (though there was a locked "unisex" Adolescent unit).

The modality was strict Behavioral Modification.  I had a tussle with administration when I tried to convince them that this was like painting over the cracks and that the symptoms were merely part of the underlying problem.  This did not go over well and I left citing "philosophy differences" (forced).

Within a month they were doing a "take-down" of a kid who was being "aggressive."  He was about 6'2" and would not go to the "quiet room." 

From what I heard it took Five people to take the kid down and by the time they got off of him...he was dead.  Asphyxiation.

So many horror stories from that place.