A long-term follow-up of treatment for severe self-injury

Report of the ABAI Task Force on Contingent Electric Skin Shock

As a task force appointed by the Executive Council of the Association for Behavior Analysis International (ABAI), we investigated the clinical use of contingent electric skin shock (CESS) in behavior analytic treatments for severe problem behavior. We studied how CESS is used in contemporary behavior analysis, reinforcement-based alternatives to CESS, and current ethical and professional guidelines for applied behavior analysts. We recommended that ABAI uphold clients' right to receive CESS when it is restricted to extreme cases and used under rigorous professional and legal oversight. Our recommendation was rejected by a vote of the full members of ABAI, who instead endorsed an alternative recommendation, developed by members of the Executive Council, that opposed the use of CESS under any condition. Here we present for the record our report and initial recommendations, the formal statement that was rejected by the members of ABAI, and the statement that was endorsed.

Response to ABAI Task Force on the Use of Contingent Electric Skin Shock

In this article, the authors provide their response to the Association for Behavior Analysis International (2022) position statement on the use of contingent electric skin shock (CESS). In this response, we address concerns raised by the task force regarding limitations of the Zarcone et al. (2020) review article in which both methodological and ethical concerns were raised about the quality of research in the use of CESS with people with disabilities in the treatment of challenging behavior. We note that with the exception of the Judge Rotenberg Center in Massachusetts, no state or country currently supports the use of CESS as it is not recognized as the standard of care in any other program, school, or facility.

Side effects of contingent shock treatment

In this study, the side effects of contingent shock (CS) treatment were addressed with a group of nine individuals, who showed severe forms of self-injurious behavior (SIB) and aggressive behavior. Side effects were assigned to one of the following four behavior categories; (a) positive verbal and nonverbal utterances, (b) negative verbal and nonverbal utterances, (c) socially appropriate behaviors, and (d) time off work. When treatment was compared to baseline measures, results showed that with all behavior categories, individuals either significantly improved, or did not show any change. Negative side effects failed to be found in this study.

Multiple factors in the long-term effectiveness of contingent electric shock treatment for self-injurious behavior: a case example

This report describes the effective treatment of self-injurious behavior (SIB) using contingent electric shock in an adolescent. Data are presented to document the initial dramatic reduction in SIB and the ongoing effectiveness of the treatment over a 5-year period. Positive side effects of the intervention are documented, as is information on the interaction of a medical condition (e.g., ear infections, fever), psychoactive medication status, and staff changes that served to effect the rate of SIB across 4 years of treatment. Recognizing and attending to these various factors has served to insure the success of the aversive intervention with very low rates of SIB and, consequently, very low rates of the administration of electric shock. Keeping the rate of administration of shock low serves to decrease the chances of habituation to the shock thereby emphasizing the importance of attending to the individual's total medical, social, and administrative environments.

On the status of knowledge for using punishment implications for treating behavior disorders

In this paper, we review basic and applied findings on punishment and discuss the importance of conducting further research in this area. The characteristics of responding during punishment and numerous factors that interact with basic processes are delineated in conjunction with implications for the treatment of behavior disorders in clinical populations. We conclude that further understanding of punishment processes is needed to develop a highly systematic, effective technology of behavior change, including strategies for improving the efficacy of less intrusive procedures and for successfully fading treatment.

Long-term maintenance of a behavioral alternative to surgery for severe vomiting and weight loss

A 34-year-old woman with severe mental retardation suffered from gastroesophageal reflux, projectile vomiting, weight loss, and a prepyloric ulcer. Despite the implementation of non-intrusive behavior treatment procedures involving simple correction and differential reinforcement (Treatment A), fundoplication surgery with implantation of a gastrostomy feeding tube had been recommended. A descriptive functional analysis suggested that the woman's vomiting was maintained by escape. Revised treatment was implemented throughout her waking hours. Treatment B consisted of the addition of escape extinction and antecedent control procedures. Treatment C added to these procedures food choice and additional differential reinforcement procedures. Results showed the respective mean frequency of vomiting and mean weight were: Treatment A--1.4 episodes/day and 118 lbs; Treatment B--1.1 episodes/day and 105 lbs; Treatment C--0.2 incidents/day and 133 lbs. The woman's progress has been maintained for nearly 2 years.

Long-term use of electrical aversion treatment with self-injurious behavior

Twelve severely and profoundly mentally retarded individuals with life-threatening self-injurious behaviors were exposed to electrical aversion treatment using a remotely controlled device. Long-term effectiveness was assessed for periods ranging from 2 to 47 months for the 12 individuals, respectively. The degree of imposed physical restraint was used as the major dependent variable. With two individuals, the treatment failed to suppress self-injurious behavior. With seven individuals, however, suppression was nearly complete in that physical restraints were no longer necessary. With three individuals moderate effects were obtained, in that, although a substantial decrease of imposed physical restraint had been achieved, they still needed daily administrations of electrical aversive stimuli. The results are discussed in terms of the practical application of this procedure.