A video has been circulating on social media of an autistic teenage girl chained on one leg at a care centre. The Minister of Women, Family and Community Development (KPWKM), Nancy Shukri, has confirmed the authenticity of the video.
She has stated that “Before any action was taken, the parents’ consent was obtained, while her placement was also made under a court order as an alternative arrangement”.
She was also reported as saying that “the ministry found that the care centre had not committed any offence in its handling of the case”.
We do not doubt the distress of the parents, the difficulty faced by the centre, or the good faith of officials trying to keep everyone safe. But the fact that something is lawful, consented to and well-intentioned does not make it right.
We need to say it clearly: chaining a child, whatever her diagnosis, is not a clinical intervention. It is restraint, and restraint of this kind has no place in the care of a person with a disability.
The minister’s statement repeatedly uses the phrase ‘aggressive behaviour’. This is the root of the problem.
International understanding of autism has moved decisively away from describing autistic people, especially those who also have an intellectual disability, in terms of aggression as if it was a fixed trait of the person.
Behaviour that looks aggressive or self-injurious is now understood, across the World Health Organization’s (WHO) Quality Rights framework, the global behaviour support movement, as distress behaviour or dysregulation: a response to pain, sensory overload, unmet communication needs, frightening environments, or trauma, including the trauma of institutionalisation and restraint itself.
Behaviour is communication. When a non-speaking or minimally speaking autistic young woman with intellectual disability repeatedly escalates, the question a rights-respecting system asks first is not “How do we restrain her?”, but “What is she trying to tell us, and what has she been through?”
Framing her as inherently “difficult to manage” and “aggressive” shifts the burden onto the child. It obscures the real question: whether she has access to a comprehensive, collaborative assessment of her needs and sensory experiences, appropriate environmental, communication and emotional support, an updated psychiatric review, focused on treatable co-occurring conditions (pain, anxiety, sleep disorder, or an undiagnosed illness), and an individualised, trauma-informed support plan delivered by trained staff. One evidence-informed approach is Collaborative & Proactive Solutions (CPS).
Chaining a leg is not a plan. It is the absence of one.
The ministry has emphasised that the parents consented and that a Section 30(8) Child Act 2001 court order was in place; that due process was followed. But we must be honest about what consent means in this situation.
Parents who have exhausted every option, who face a child in a psychiatric crisis with repeated hospital admissions, and who are told by an under-resourced system that this is the only available placement, are not choosing chaining from a list of good alternatives.
They are consenting to the least-worst option in a system that is unable to offer a better one. A court order authorising alternative placement in a child’s best interests is not the same as a court authorising mechanical restraint as a method of care, and it should never be read that way.
This is precisely the pattern the United Nations Committee on the Rights of Persons with Disabilities has warned against under Article 15 of the Convention on the Rights of Persons with Disabilities (CRPD), which Malaysia ratified in 2010: the freedom from cruel, inhuman or degrading treatment applies fully to children with disabilities, and restrictive practices dressed up as safety measures or accepted through family or guardian consent do not fall outside that protection.
The joint 2022 statement by the CRPD Committee and the Committee on the Rights of the Child on the rights of children with disabilities is explicit, that so-called disciplinary or safety justifications, including restraint, disproportionately affect children with disabilities and must be prohibited in all settings, not merely regulated.
Malaysia is not being asked to invent something new. Restraint-reduction and restraint-elimination programmes are now standard policy across the United Kingdom’s National Health Service, Australia, New Zealand, and parts of the United States, built on a simple premise: mechanical and physical restraint of people with intellectual and developmental disabilities is a treatable systems failure, not an acceptable clinical tool.
These programmes combine:
- Mandatory needs assessment before any restrictive plan.
- Trained autism support specialists and occupational therapists in every residential care setting.
- Environmental and sensory redesign of care centres.
- Real-time incident reporting and independent review of every restraint event.
- An explicit target of zero long-term mechanical restraint, with time-limited, monitored physical restraint only ever as a true last resort in imminent danger, never as an ongoing means of management.
Malaysia needs to move towards restraint elimination programmes. We are party to the CRPD and the Convention on the Rights of the Child. The Persons with Disabilities Act 2008 speaks of dignity and non-discrimination.
What is missing is an enforceable national standard, applicable to every registered and unregistered care centre, that explicitly bans mechanical restraint of children with disabilities and mandates the clinical alternatives above, backed by funding, workforce training and routine, unannounced inspection, not only investigation after a video goes viral.
What should happen now? First, the chain should come off, immediately, with an interim, properly staffed and clinically supported arrangement put in place for this child – not returned to the same unmodified environment with the same restraint continuing under closer paperwork.
Second, KPWKM and the Ministry of Health (MOH) should commission an independent, disability rights-informed review of this case, including a functional assessment and full trauma and pain screening, not only a psychiatric progress report.
Third, KPWKM should move beyond advising the centre and issue a binding directive prohibiting mechanical restraint in all care centres under its purview, paired with a funded plan to train autism support staff and expand community-based, family-support and respite alternatives so families are never again asked to ‘consent’ to a chain for want of anything else on offer.
This young woman is not an aggressive individual to be secured. She is an autistic teen with intellectual disability whom our systems have, for now, failed to understand and support.
Malaysia can still choose to be a country where the response to that failure is investment in care, not chains.
Dr Amar-Singh HSS, Ng Lai-Thin, and Wong Hui-Min are from the National Early Childhood Intervention Council (NECIC).
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
