Wednesday, November 08, 2006

Autism advocacy and aversives (part one)

In Sabrina Freeman's well-respected book, "Science for Sale in the Autism Wars", she has a section called "The Classic Aversives Ruse", wherein she takes on "the spurious issue of aversives". Dr Freeman is one of Canada's most important autism advocates. She runs Canada's major FEAT group and was one of the parent petitioners in the Auton case.

Her major point is that aversives are no longer used. They're a relic of the past. This point is frequently made by autism advocates. It was made in the Supreme Court of Canada Auton hearing in 2004, by the Auton parents' lawyer. ABA parents don't want to have anything to do with aversives, which are now ancient history. Everyone knows ABA programs are all positive these days. So aversives are an irrelevant non-issue, and anyone saying otherwise is grossly misguided (at least).

This position is partly right. For a while now, aversives have no longer been part of routine ABA-based autism interventions.

On the other hand, the one published study invariably used by autism advocates to argue for the effectiveness of ABA programs is Lovaas (1987). According to this study's author and its design, its famous result, those 9 of 19 indistinguishable kids, is dependent on the use of contingent aversives.

Autism advocates have also used the Auton trial decision, the US Surgeon's General's report, and the New York State Department of Health guidelines as proof that ABA-based interventions are effective and/or "medically necessary". All three of these favourite lobbying tools are heavily dependent on Lovaas (1987) and its follow-up (McEachin et al., 1993).

Autism advocates also contend that there are multiple replications of Lovaas (1987). There's no evidence to support this claim, not among the very few existing autism-ABA controlled trials, but let's say they're actually right about this. Then they continue to highlight and promote an aversive-based study when alternative, non-aversive studies are available.

This seems like odd behaviour for ABA advocates whose position is that aversives are an irrelevant relic of bygone days.

There are other reasons for not forgetting about aversives, which is in any case difficult to do when Dr Lovaas' famous 47% continues to be a staple of ABA parent lobbying efforts.

One is that aversives continue to be promoted as a necessary part of ABA programs for some autistics in some circumstances. I'm pretty sure Canada's autism advocates would strongly oppose the practices of the Judge Rotenberg Centre, where extreme aversives are used, and the JRC is not generally respected or promoted among behaviour analysts. No one should forget about the "students" at the JRC and what they have to endure. But nor should it be overlooked that some very respected behaviour analysts continue to promote the necessity of aversives in some cases. For example, Richard Foxx recently authored a book chapter about the "myth" of non-aversive treatment for "severe" behaviour (aggression, self-injury; Foxx, 2005). Dr Foxx is one of the best known and most respected behaviour analysts in the world. He was also recently an expert witness in support of ABA parents in a British Columbia legal case. James Mulick, another highly respected behaviour analyst known for his work in autism, recently was an author of a published study using electric shock to treat self-injury. Dr Mulick was an expert witness for the ABA parents in Auton. While those in charge of the JRC may be pariahs in the behaviour analytic and autism advocacy communities, Drs Foxx and Mulick are definitely not.

Another reason not to dismiss any mention of aversives as a "ruse" is that we should learn from the past and from the suffering of others. We shouldn't forget how utterly wrong all those important behaviour analysts--Lovaas, Carr, Risley, Baer, Schreibman, Koegel, etc.--were when they were claiming that without aversives, autistics were doomed. We should all remember that Lichstein and Schreibman (1976), in a review of multiple behaviour analytic interventions using electric shock on autistic children, stated that the main side effect of using electric shock was "positive emotional behavior". They were saying that electric shock made autistics happy, a claim it is hard to imagine being made about typical children. Serious errors in judgment, extreme lapses in ethics, grossly inaccurate observations, etc., have been made and reported throughout the history of behaviour analytic intervention research and this has hurt autistics. We should all remember that.


Auton et al. v. AGBC, 2000 BCSC 1142 (CanLII)

Foxx, R.M. (2005). The National Institutes of Health Consensus Development Conference on the Treatment of Destructive Behaviors: A study in professional politics. In J.W. Jacobson, R.M. Foxx & J.A. Mulick, Eds., Controversial Therapies for Developmental Disabilities. Mahwah, NJ: Lawrence Erlbaum Associates.

Foxx, R.M. (2005). Severe aggressive and self-destructive behavior: The myth of non-aversive treatment of severe behavior. In J.W. Jacobson, R.M. Foxx & J.A. Mulick, Eds., Controversial Therapies for Developmental Disabilities. Mahwah, NJ: Lawrence Erlbaum Associates.

Hewko v. B.C., 2006 BCSC 1638

Lichstein, K.L. & Schreibman, L. (1976). Employing electric shock with autistic children: A review of the side effects. Journal of Autism and Childhood Schizophrenia, 6, 163-173.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

McEachin, J.J., Smith, T., and Lovaas, O.I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97, 359-72.

Salvy, S. J., Mulick, J. A., Butter, E., Kahng, R., & Linscheid, T. R. (2004). Contingent electric shock (SIBIS) and a conditioned punisher eliminate severe head banging in a preschool child. Behavioral Interventions, 19, 1-14.