Another article on JRC
link Aversives
By: Polyxane S. Cobb
A toddler reaches up toward the handle of the pot on the stove where the soup has just come to a boil. His mother slaps the hand away, turns the handle inward, and then goes to comfort the crying child. What she has just done is employ an aversive technique. No one would fault her intervention, nor the seriousness of the consequence if she had not intervened. But everyone would also acknowledge that the intervention would not have been necessary had the handle of the pot not been within reach of the toddler.
Aversives, quite simply, are negative consequences for undesired behaviors. They can be mild. "if you get your clothes dirty you don?t get ice cream for dessert," or severe, "clean your room or you?re grounded for a month!" They can also be invasive such as spanks or slaps.
When employed as part of a behavioral program for children and adults with developmental disabilities, the matter is rightfully of public interest, The principle question always is: are aversives effective? And what do we mean by effective anyway?
States throughout the US have banned aversives. A number of states such as California, Connecticut, Rhode Island and New York have actually passed legislation banning the use of aversive techniques. In Massachusetts we have failed to ban aversives. One school has been identified with the use of these methods?Judge Rotenberg Center (JRC) and it has successfully fought legislation to terminate its use.
Aversive Therapy promises that dangerous, anti-social, self-injurious behaviors will be eliminated through the use of punishments. It works on the assumption that when people are punished for bad behavior, they will stop it and, instead, do whatever it is the people in control consider desirable. But is there any evidence at all that it works?
The indications that any behavioral therapy is successful are fairly straightforward:
1: The undesirable targeted behaviors are eliminated,
2: The therapy can be withdrawn slowly until it ceases altogether and the undesirable behaviors remain eliminated, and
3: Desirable behaviors are acquired as part of the process
Although the indications that a therapy is successful are straightforward, the process of developing those techniques and applying them to individuals is far more complex. Every behavior must be analyzed. The environment and its components must be scrutinized. The general health and well being of the student must be known and appreciated. Once all that is done, each behavior must be targeted separately so that it is clear to the student what the behavior is that is generating the intervention.
The Judge Rotenberg Center (JRC) has, over the years, employed a variety of techniques it has labeled "therapy." These procedures include electric shocks from a device strapped to the student and activated by a remote control, food deprivation, as well as spanks, water sprayed in the face or nostrils, forcing the student to eat jalapeño peppers or other odious foods, and denial of ordinary comforts.
To my knowledge, neither the school, nor Matthew Israel, the Director, has ever submitted data, with replicatable methodology, demonstrating the success of any of these therapies?none?to any journal for peer review. In light of the highly invasive nature of many of these procedures, that unwillingness to submit the work to peer review is striking. Since JRC so vehemently proclaims the success of its techniques, this unwillingness to share the information with other schools that might wish to test the "success" of these techniques is also notable.
However, the school?s use of aversives and painful techniques directly contradicts the policies of three national organizations: The Arc, AAMR (American Association on Mental Retardation) and TASH (the organization has existed since 1974; the acronym once stood for The Association of Persons with Severe Handicaps). No one can deny that these organizations represent the largest family and professional groups dedicated to individuals with cognitive disabilities. TASH states as the purpose of its resolution on "positive Behavioral Supports," is?"to afford the rights of people with disabilities to receive interventions that are respectful, free of pain and produce changes for the individuals." It?"calls for the cessation of the use of any educational, psychological, or behavioral intervention that exhibits some or all of the following characteristics:
? dehumanization through the use of procedures that are normally unacceptable in community environments for persons who are not labeled with a disability;
? obvious signs of physical pain experienced by the individual;
? physical injury and potential or actual side effects such as tissue damage, physical illness, and/or severe physical or emotional stress."
The Arc and AAMR in a joint resolution state: "Our constituents are frequently subjected to aversive and deprivation procedures that may cause physical and/or psychological harm and are dehumanizing. Furthermore, aversive procedures result in the loss of dignity and inhibit full participation in and acceptance by society." Thus, the organizations call for behavioral interventions or supports that are?"individually designed, positive, help them learn new skills, provide alternatives to challenging behaviors, offer opportunities for choice and social integration, and allow for environmental modifications."
Aversive therapy is still possible in Massachusetts, despite the overwhelming opposition of these organization.
Murray Sidman, often called the father of modern behavioral analysis has researched just this question. He writes:
Many retarded and autistic children are ordinarily ignored because they are considered to be emotional and intellectual vegetables, unable to appreciate or adapt to their environment. But they sometimes discover that if they damage themselves, hitting, scratching, clawing, lacerating themselves and drawing blood, they bring the whole community down on them; they make themselves the center of attention. These children have been taught, albeit unknowingly by their teachers, to administer pain to themselves as the only way to gain attention. The proof comes when we then provide the same attention for constructive acts; the self-abuse ceases.
The effects of prolonged punishments as a behavioral tool are pronounced. First, punished people become acclimated to punishments. The procedures thus begin to lose effectiveness. The severity of the punishment must then be increased in an ever-increasing spiral. Proponents of aversives such as JRC argue that self-injurious behaviors are so destructive and inexplicable that analyzing the behavior is unlikely to illuminate its cause. Proponents acknowledge that punishments must be continued indefinitely, but they argue, the few young people who engage in these behaviors are fundamentally different than other people. One cannot analyze why they are doing what they are doing, one can only respond.
A second side effect of prolonged punishments is that the student begins to focus on nothing except his stress. He cannot acquire new and useful skills because he is always in a state of fear and apprehension.
A third side effect is that instead of viewing teachers and staff as helpers, they are transformed into negative reinforcers. An approach by the staffer, no matter how benevolent that person?s intentions at the moment, is viewed by the student as a threat and the action as the onset of a cycle of punishment. The very people who should be seen as helpful are, instead, seen as hurtful.
Eventually a state of behavioral depression overtakes the student. He becomes lethargic, anxious, and is often described as zombie-like. An important sense of freedom and personal security has been driven out of his world by the unrelenting fear of punishment.
This is the bleak, unrelenting future for students treated with such aversive procedures. Since their undesired behaviors are only suppressed, they cannot graduate to less intrusive programs where the suppressed behaviors will re-surface absent the punishments. So organizations employing aversives proclaim a stasis effect: a low level of punishments keeps these students controlled, it maintains, the way insulin controls diabetes.
Students in other programs which do not use aversives and with successes that include progressing to less restrictive environments are regarded by organizations such as JRC as less "involved" than their students. By applying ciurcular reasoning, proponents oof aversives claim that: if a student can live outside of the initial program he was not as challenged in the first place. The proof, therefore, that aversives "work" is that JRC students can never leave the program!
So What Does Work?
Severe behaviors always have a rational, if sometimes complicated root. As Sidman pointed out, the young person might simply be trying to get attention but doesn?t have a constructive way to do it. He may be in pain or other distress and not have the communicative powers to describe his predicament. He may be trying to do something else entirely and not have the physical refinement to achieve his goal. Whatever the reason, the destructive behaviors focus the attention of caregivers with a power few other actions hold.
The non-aversive techniques to resolve these negative behaviors and replace them with constructive behaviors are varied, but all contain many of the same elements. Techniques such as Gentle Teaching (see
www.inala.org.au/behaviour/strategies.htm), the ABC method and others all promote:
? a careful analysis of the targeted behaviors,
? systematic interventions that include ignoring the behavior (but not the person),
? activities that redirect the attention of the person, providing alternative behaviors, and, most critically, numerous and generous rewards for exhibiting desired behaviors.
The rewards are the critical element simply because we all are more willing to engage in behaviors if we are rewarded for them. The most important reward is approval?not candy, not money, not a trip to the mall?approval. And when instituting a behavioral program, the generous use of approval for all desired or acceptable behaviors creates a positive atmosphere that stimulates the young person to engage in ever more frequent positive behaviors.
If Positive techniques are so great, how come they don?t work on JRC students?
Positive techniques do work on JRC students and elsewhere.. The few who have been moved to other facilities where positive approaches are the norm have flourished. Some have found jobs and become taxpayers. Others have moved into community residences and day programs where positives only approaches are used. None have been transferred back to a program that uses aversives. Indeed, schools like JRC maintain that they do use positive techniques and their students still engage in self-destructive and aggressive acts. In the example of JRC, it?s true, the offer rewards in the form of chits that students can cash in for time in the Big Reward Store and rewards delivered to the students? workstations, but the backbone of the program is the use of aversives. Positive approaches, however, must be comprehensive. The initial approach, the constant motivator, and the underlying theme of the program must be positive.
States throughout the US have banned aversives. California, Connecticut, Florida, North & South Dakota, Pennsylvania, Arizona, Rhode Island, New York, New Jersey, and Colorado have all passed legislation banning the use of aversive techniques. Some are more comprehensive than others, but all have shown a strong inclination to promote the dignity and personal autonomy of people with developmental disabilities. It is a step Massachusetts has yet to take.
