This paper addresses the necessary development of neuropsychologically-informed interventions for special needs learners who exhibit dysregulated, aggressive, and violent behaviour, while focusing on the care of the learner in terms of best practice and the prevention of abuse and neglect. Riaan du Toit, a South African occupational therapist developed the Guardian Programme specifically to address this need, and Melissa Adendorff, a practicing registered counsellor contributed to the programme development through theoretical and practical acknowledgement of the epigenetic and psychoneuroendocrinological risk factors related to central nervous system dysregulation which must be managed in the best interest of the individual in crisis, as well as in the defense of self and others against the potential risk of harm due to dysregulation and decompensation.

The Guardian Programme promotes the maintenance of safe and clear mental and physical space, which includes the maintenance of situational control through crisis intervention and counteracting measures, as primary and preventative treatment parameters, based on the legal and ethical mandate of a clinical professionals in the special-needs educational context “to provide any person requiring mental health care, treatment and rehabilitation services with the appropriate level of mental health care, treatment and rehabilitation services within its professional scope of practice” (Section 6 of the Mental Health Care Act 17 of 2002).

Failure to address the underlying cause of the dysregulation, and punitive management of dysregulation creates an inherently harmful situation, as central nervous system has psychoneuroendocrinological effects on the body, leading to sympathetic nervous system activation, which undermines learning.

Failure to take cognisance of the biopsychosocial and systemic context of the individual while imposing environmental demands which exceed capacity increases the risk of the punishment of behaviour patterns which may be due to physiological and central nervous system dysregulation, which may lead to discrimination, unfair treatment, and abuse, as punitive measures are employed to manage the behaviour without addressing the underlying cause.

Furthermore, punitive action taken against dysregulation in the special needs context may constitute (medical) neglect, which constitutes a harmful act of omission leading to the continued harm of the individual.

The fundamental premise of central nervous system regulation and co-regulation forms the crux of the classroom atmosphere. The school-wide Guardian Programme introduction allows for consistent responses to behavioural patterns, with set procedures and protocols which allows for the establishment of a clear and controlled atmosphere.

Crisis management plans and strategic intervention planning for educators, assistants, caregivers, and school-based support teams allows for effective and immediate intervention in crisis situations which require intervention, containment, referral, and support.

The Guardian Programme sets the following rules in place for the management of dysregulated, violent, aggressive, and dangerous behaviour:

• prevention if possible;
• prediction of foreseeable risks;
• distraction, redirection, regulation;
• verbal and psychological de-escalation;
• physical de-escalation;
• response to provocation;
• control of self in defense of self and others and in the best interest of the child;
• all interventions aim to get back to clear.

Protocols are designed to be employed with the least amount of contact for the least amount of time, with no pain compliance, no restriction of breathing, and mandatory referral for clinical support. Consistent intervention which is reliable allows for routines to be set and continue despite the need for crisis management as the dysregulation behaviour is addressed in such a manner as to maintain the flow of the curriculum and the goals of the educator, with minimal disruption.

The Guardian Programme components may be generalised to all learner interactions, without the need for breach of confidentiality regarding the learner’s diagnosis, with the notable exception of potential drug contraindications if the learner requires sedation following the crisis counteraction of physically securing the learner in a physical restraint.

The use of a safe-hold and/or restraint procedure is based on observable and reported symptoms of distress, not based on the learner’s diagnosis. It is based on a behavioural and contextual assessment of safety of the individual as well as the risk of harm to the staff, therapist, class assistant, and other learners. These acute symptoms of dysregulation are not used as diagnostic criteria, and as such, do not allow for inappropriate access to the learner’s private diagnostic information. Furthermore, the implementation of Guardian Programme requires that at least two professionals perform the intervention, thus allowing for objective verification of observable and reported signs and symptoms of dysregulation. These signs and symptoms include, inter alia:

1. lowered distress tolerance, increased irritation;
2. emotional dysregulation;
3. psychomotor agitation;
4. verbal aggression;
5. inability to self-regulate;
6. non-compliance with verbal de-escalation guidance;
7. medication non-compliance;
8. threat of harm to self and others.

Containment, safe seclusion, and supervised de-escalation are environmental control measures which serve to support regulation and stabilisation. The containment protocol for safe seclusion and supervised de-escalation of special needs learners is based on the Department of Health (2012, p. 6-8) policy guidelines on seclusion and restraint of mental healthcare users. As previously noted, special needs learners are categorised as mental healthcare users due to their LSEN numbers, which are assigned following an assessment by HPCSA-registered professionals to identify barriers to learning, cognitive capacity, and neurodevelopmental disorders (Department of Education, 2014). 

The Guardian Programme’s neuropsychological ontology supports environmental management as a form of school safety, as a safe space with limited sensory stimuli allow for central nervous system regulation without exposure to other learners. This allows for the protection of the rights of dignity of the learner in crisis, as the contact is limited to a member of the school-based support team, wherein ethical best practice guides the regulatory interaction. Furthermore, in a secluded, environmentally managed space, the dysregulated learner’s right to personal security is protected, as the risk of harm to self through utilisation of weapons, for example, is neutralised, and the sensory room is equipped to manage impact and proprioceptive volatility without endangering the learner.

The Department of Health (2012) notes that safe seclusion and containment are indicated for behavioural emergencies. Behavioural emergencies occur when crises escalate to the point that the situation requires immediate intervention to avoid injury (or death). Direct or intentional behavioural emergencies fall into the general categories of engaging in self-injurious behaviours, perpetrating violent interpersonal behaviour, and being a victim of violence (Atmore, 2022).

In a crisis state, central nervous system dysregulation, disorganisation, disequilibrium, dis- orientation occur leading to the fragmentation of an individual’s coping mechanisms, no matter how conditioned against psychological trauma the person may be. Crisis is universal because no one is immune to breakdown, given the right constellation of circumstances. It is idiosyncratic because what one person may successfully overcome, another may not, even though the circumstances are virtually the same. Universality of procedure and intervention allows for the safe and ethical management of crises with idiosyncratic contexts, such as special needs schools.

Crisis behaviour which is not interrupted and stopped leads to habituation (Amen, 2013; Townsend et al. 2016, Sapolsky, 2017; Purves et al., 2018). This ultimately forms the individual’s behavioural repertoire to meet certain biopsychosocial needs through inappropriate actions, leading to persistent and pervasive behavioural pattern salience, mood modification, stimulus tolerance, stimulus withdrawal symptoms, conflict-seeking, and behavioural relapse (Amen, 2013; Townsend et al. 2016, Sapolsky, 2017; Purves et al., 2018; Atmore, 2022).

Habituation is based on repetitive brain system overactivation or lack of activation in response to signal conduction and stimulus response drivers. Habituation is a form of somatosensory learning which occurs through the formation of neural pathways which condition and habituate reactive behaviour patterns based on a conditioned threat response with little to no cortical strategising, as demonstrated by Benjamin Libet in terms of volitional action under stress (Sapolsky, 2017; Watts, 2017; Watts & Watts, 2023). The neural pathway entrenchment between a simultaneous somatic, visceral, and emotional organisation of information lead to the enforcement of maladaptive response patterns mediated by subcortical structures, presenting with maladaptive and inappropriate biopsychosocial markers which cannot be overcome through discipline and punishment (Krysztofiak, 2017; Sapolsky, 2017; Watts, 2017; Watts & Watts, 2023).

Habituated maladaptive behaviour requires biopsychosocial and neuropsychoendocrinological intervention which addresses the systemic dysregulation which caused the behaviour, thus allowing a bottom-up somatic regulation in a safe space which is free from sensory stimuli and hazards, thus supporting the safe seclusion protocol for the protection of the individual in crisis, as well as managing the safety of other learners and professionals.

Safe seclusion and supervised de-escalation, in addition to restraints, safe holds, and secure holds are never enforced by a single professional and a learner, and a learner is never left isolated in the seclusion space. This is clinically justified through evidenced-based publications and case studies on interpersonal neurobiology and psychoneuroendocrinology, as well as clinical best practice in trauma-informed therapy (Sapolsky, 2017; Watts, 2017; Watts & Watts, 2023).

Behavioural and attachment strategies in the Guardian Programme context focus on the phenomenological experience of the individual, in response to their immediate systems (Crittenden & Landini, 2011; Landa & Duschinsky, 2013; Wang et al., 2013; Patock-Peckham & Corbin, 2019; Baim, 2020). These phenomenological experiences and behavioural adaptations are exemplified based on the following perceptions: perceived danger, perceived distress, perceived isolation, and perceived chaos (Crittenden & Landini, 2011; Landa & Duschinsky, 2013; Baim, 2020). Co-regulation through nervous system safety reinforcement allows for attachment to be retained and sustained, thus preventing trauma and physical abuse of the learner in crisis.

Through the application of the Guardian Programme in special needs schools in Gauteng, South Africa, the rates of violence against dysregulated learners have dropped significantly, while learner behaviour has been more readily co-regulated through the application of neuropsychoendocrinological principles, with positive responses from educators, department heads, and school-based support teams in 10 schools.