Sunday, May 17, 2009

Saving autistics and the world: Skin shock at the 2009 ABA convention

The press release for the 2009 Association for Behavior Analysis International convention claims that behaviour analysis "Reveals Methods for Solving Global Issues." There is a list of "major topics at the convention" which include:

How behavior analysis will help save the planet... How behavior analysis will help save the economy... How behavior analysis will help save lives... How behavior analysis will help us understand each other...
Autism is modestly mentioned in the third topic only (lives will be saved), even though claims that behaviour analysis can save the economy by saving children from autism are as common as they are unfounded in existing published evidence.

Looking around the 2009 ABAI convention program, you will in fact bump into the notion that ABA can, and should, save the world. For instance, from Tutorial #287:

This presentation will inspire a reconsideration of how ABA can save the world... the presenter will discuss the relevance of courage and compassion in realizing the potential of ABA to save the world...
Symposium #403 at this year's ABAI convention is chaired by Matthew Israel (Judge Rotenberg Center), and is titled:

The Use of Contingent Skin Shock in Treating Behaviors Other than Aggression and Self-Abuse
The three presenters in Symposium #403 are all from the Judge Rotenberg Center. Nathan Blenkush, BCBA-D (this is the highest status certification for behaviour analysts currently available), describes his presentation this way:

There are a number of topographies of problem behaviors that are intractable to standard behavioral and pharmaceutical interventions that cannot be classified as aggressive or self-abusive behaviors. In this presentation, we will describe the successful treatment of a variety of intractable behaviors using Contingent Skin Shock. First, we will review the literature associated with the use of CSS to treat non-aggressive and non-self injurious behaviors. Second, we will discuss how problem behaviors such as property destruction, major disruption (e.g. yelling, tantrums,), noncompliance or any other behavior in excess can severely harm students and completely interfere with treatment, education, and social development. Finally, we will present a series of case studies that will illustrate the use of CSS to treat these types of behaviors. Finally, we will discuss the treatment of these behaviors within the framework of the right to effective treatment.
Robert Von Heyn, BCBA-D, describes his presentation this way:

We describe the use of supplementary Contingent Skin Shock (CSS) to address intractable behaviors other than aggression and self-abuse. From 2003 to 2006, CSS was added to the programs of 72 students. However, in June of 2006, the New York State Department of Education put into effect regulations that limited the use of skin shock to aggressive and self-injurious behaviors. Subsequently, a federal judge temporarily blocked these regulations at the request of the parents and treatment resumed for most of these students. Here we first describe the initial effect of adding CSS to the students programs. Second, we describe the effect of the temporary suspension of the treatment for behaviors such as major disruption, property destruction, and noncompliance. Third, we describe how the regulations affected the treatment of problem behaviors such as aggression and self-abuse. Finally, we describe the effect of the reintroduction of CSS treatment, following intervention by a federal judge, for destructive, major disruptive, and noncompliant behaviors.
And Nick Lowther describes his presentation this way:

In June of 2006, the New York State Department of Education put into effect a set of regulations related to the use of aversive interventions such as Contingent Skin Shock (CSS). The regulations limited the use of CSS (and other procedures such as mechanical restraint) only to aggressive and self-injurious behaviors. The regulations also placed a number of other restrictions on the use of procedures such as CSS. However, after 9 weeks, in September of 2006, a federal judge temporarily blocked these regulations at the request of the parents. In this presentation, we discuss the impact these regulations had on the students at the Judge Rotenberg Center. In addition, the history of this lawsuit will be discussed. Finally, we will provide an update regarding the current status of the suit.
Symposium #403 comes with a written "Purpose," which adds little to the above except the false information that existing evidence supports the use of contingent electric shock for some behaviours. It is true that the current edition of the major ABA textbook (Cooper et al., 2007) promotes the use of electric shock with developmentally disabled people. But setting aside ethical issues which should not be set aside, Cooper et al. (2007) cite no good quality evidence arising from good experimental design, or anything even close, in support of this practice. In this major ABA textbook, very poor standards of science and ethics, which are known to harm human beings, coincide and are promoted as what autistics and other developmentally disabled people deserve.

In contrast there are scientists who, at least in some instances, have regarded autistics and other developmentally disabled people as deserving the benefit and protection of recognized standards of science and ethics. These scientists have unsurprisingly revealed the extremely well-established and well-recognized (outside of autism and ABA areas) importance of good experimental design (Tyrer et al., 2008; abstract is here, short description here).

I will not be attending the 2009 ABAI convention. The publicly available statements by the JRC presenters, two of whom are BCBAs at the highest level, are provided unedited here to speak for themselves. While the JRC's specific practices are the subject of controversy in some quarters, their stated standards are widely promoted as the only way to save autistics, and are not in any way unique to the JRC.


References:

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied behavior analysis: Second edition. Upper Saddle River, N.J.: Pearson Prentice Hall.

Tyrer, P., Oliver-Africano, P.C., Ahmed, Z., Bouras, N., Cooray, S., Deb, S., Murphy, D., Hare, M., Meade, M,, Reece, B., Kramo, K., Bhaumik, S., Harley, D., Regan, A., Thomas, D., Rao, B., North, B., Eliahoo, J., Karatela, S., Soni, A., & Crawford, M. (2008). Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: A randomised controlled trial. Lancet, 371, 57-63.

10 comments:

daedalus2u said...

Anyone doing medical research on humans needs to ensure that the research conforms to the Declaration of Helsinki:

http://www.wma.net/e/policy/b3.htm

unless what you are doing isn’t medical, isn’t research, or < sarcasm >isn’t done on humans< /sarcasm >.

Michelle Dawson said...

Here is a working link to a pdf of the Declaration of Helsinki, a document I'm familiar with.

Socrates said...

I'm quite sickened by this and feel powerless to make a difference.

Nix said...

Socrates, that's an entirely appropriate reaction to the Judge Rotenberg Center.

You'd think they'd grasp that if 'treatment' is indistinguishable from torture, it is not treatment... but it seems to escape them. Or perhaps they just don't care, as long as they get paid.

Anne said...

Good lord, it's worse than I thought.

At least the State of California has refused to certify JRC as a school because its use of CSS violates California law, so special education funds can't be used to place California students there.

Judge Rotenberg Educational Center v. Office of Administrative Hearings, unpublished opinion of the California Court of Appeal for the Third Circuit here.

They have a lot of nerve calling themselves an "educational center."

hollywoodjaded said...

Hi, Anne :-)

California, however, does pay for schools not much different. Schools which use ABA/PBS that ever-so-stealthily employ all manner of abuse. **LAUSD, btw, has put into place mandated PBS[ABA]. I have the memo stating this plan posted around in a few places.

Once mandated PBS is in place, this kind of thing mentioned in the blog post ultimately has the potential to be walked right in. (Hello, LAPD ;-/ )

Scarily, things get renamed, like I've mentioned before. Thera-bands become restraints; observation booths become isolation closets. Petitions to end schools abuse in reality have fine print that includes support for mandated PBS, which I find so disturbing. It's as if the only thing being promoted to end school abuse is ... ABA and more ABA!! Please be mindful about the bottom-line of these petitions. Thanks.

BTW, one particularly bad set of schools here in So Cal is run by an old grad student of Lovaas from the 70s who worked with him on authoring the *ME Book, wherein they recommended the 'single slap' method (!!) of learning. They still are using this slap method (in the forehead) at at least one of the schools here. The local school districts (LAUSD in particular) pay for area students to attend this school. LAUSD is aware of the abuse and simply just move the more vocal students out (if they're lucky). Since they have mandated ABA/PBS, the district seems not to want to 'criticize' in any way...even if it violates the Geneva Convention, I guess.

/rant

*PS Another of the author(s) of the ME Book are those who went on the develop PBS.

** Los Angeles Unified School District/2nd Largest in US

Michelle Dawson said...

Thanks Anne for the unpublished opinion re the JRC's attempt to invade California. Strange to see the JRC's practices described in economic (incentives, disincentives) rather than behaviour analytic (reinforcement, punishment) terms. Nick Lowther's abstract mentions not only skin shock but "other procedures such as mechanical restraint."

And thanks to hollywoodjaded for your comments. I agree that the strong trend towards mandatory PBS/ABA in schools is cause for a lot of concern (see ASAN recommending mandatory PBS/ABA in all schools here and here).

Anne said...

Thanks for the additional info, Hollywoodjaded.

I'm waiting to see how the judge rules in JRC's "civil rights" case in federal court in New York, Alleyn, et al. v. New York State Education Department, et al., in which a bunch of JRC students are also named as plaintiffs through their parents.

This is the case that was referred to in the ABA conference brochure. JRC is trying to get a permanent injunction against the NYSED regulations prohibiting the use of aversives except to prevent aggressive or self-injurious behaviors. The judge issued a preliminary injunction, which freed JRC from the regulations temporarily. The NYSED filed a motion for summary judgment in its favor, which the judge will take under submission tomorrow.

Valethar said...

Don't judge all of ABA based on the Judge Rotenberg Center's techniques, please. I know not everyone will, but I just want to make sure that people don't generalize. If you do it's like deciding that all of psychotherapy is subjective and made up just because psychoanalysis is. ABA is a hugely general group with varying practitioners, schools of thought, techniques and treatment groups.

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