Aversive Intervention - Electric Shock Therapy

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AVERSIVE INTERVENTIONRESEARCH AND REFLECTION

DEANNA K . RIC EPATTY KÖHLER

University of Central Arkansas

From the beginning of time, there has been a pervasive interestin getting some members of the human race to conform to thewishes of other members of the human race. The use of positiveas well as not so positive methods have been utilized, researchedand espoused upon. The current paper presents a review of the

vast literature on the history of aversive intervention. Aversiveintervention is defined and deeply explored. This paper exam-ines the course of such treatment through human history andends with a provocative reflection that delves into some of themysteries surrounding this topic.

IntroductionAnyone who has watched the police

drama NCIS Navel Criminal Investiga

tive Service on the CBS network haswitnessed aversive intervention (Bellis-ario, 2010). Mark Harmon's character,Jethro Gibbs, as a course of practice, swatshis team mem bers on the side of the headwhen he judges them to have engaged inwrongful thinking or action. One does notknow his intent but can assume the swatis a punisher, used to stop the action or

thinking and prevent it from happening inthe future. In many forms, people engagein aversive intervention as they interactwith their families and friends: removingaccess to gaming systems, grabbing achild's hand to prevent her from getfingburned, or withholding affection fromone's partner.

At first glance, aversive intervention

may seem benign, but one does not haveto look very far to see the need for concernwhen clinicians choose to use aversive

definition is the systematic use of stimuli or other treatment which a [person] known to find painful or unpleasant for t

purpose of discouraging undesirablbehavior on the part of the [person](Washington School for the Deaf 2004).Methods used when implementing avesive intervention include but re not limitedto electric shock, aromatic ammonia, noious tastes, physical aversives (e.g., spanslaps, and hair tugs), water mist, overcorrection, time-out, contingent exercis

visual screening, response cost

and extinc-tion (Gerhardt, Holmes, Alessandri, anGoodman, 1991, p. 267). This paper willreview literature on aversive interventioused to modify human behavior and coclude with a reflection on the use oaversive intervention.

A Look at istoryIn 1247 the oldest psychiatric hospit

in the world was founded. Priory of SMary of Bethlehem became a royal ho





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recipients of corporal punishment. Suchwas the case for an Alabama ninth graderwith a hearing impairment. He turnedaround in his desk .

to assist a classmate. When he didnot hear and, thus, comply with histeacher's instruction to face forward,the teacher head-butted him .... [The]

federal trial court in Alabama dis-missed the substantive due processclaim in light of available civil andcriminal remedies in the host state.Interpreting the Sec. 504 and ADAclaims as asserting harassment, thecourt summarily concluded that theplaintiff-parents had failed to allegefacts that sufficiently supported a

charge that the teacher's decision tohead-butt the student was based onhis disability (Lohrm ann-O 'Rourke& Zirkel, p. 111).

In their article The Case Law on Aver-s ive In tervent ions for S tudents withDisabilities, L ohrm ann-O 'Rourke andZirkel (1998) discuss numerous cases

where parents filed suit where they believedaversive interventions were administeredin such a way that their children's dueprocess rights had been violated. Casesvaried from a teacher using hot sauce tocurb pica to the spanking of student witha socia l -emotional d isorder. Paren tsreceived a favorable ruling in 35% of thecases docum ented in the article, where the

court judged studen ts' rights had been vio-lated under the protecfion of the law.

Much of the research in the last twen-ty years has focused on the use offunctional behavioral analysis (FBA) asthe basis for developing intervention plans.When the results of the EBA are appliedin the development of the non-aversiveintervention p lan, the probability of successis increased becau se the conditions w hichmaintain the inappropriate and appropriate

behaviors are addressed, while treatmentis designed to maintain the appropriatebehavior (Wacker, et al., 1990). Non-aver-sive interventions include providing apredictable, individual schedule for stu-dents. In a case of a student with severeautism, not only did his self-injuriousbehavior decrease when provided a sched-ule of activities, but his level of engagement

increased (O'Reilly, Sigafoos, Lancioni,Edrisinha, & Andrews, 2005). Anotherstudy found that a change in the instruc-t ional model f rom discre te- t r ia l toembedded instruction decreased a student'sself-injurious behavior w hile also increas-ing cor rect responses to ins t ruct ion(Sigafoos et al., 200 6).

Even w ith the shift away from aversive

interventions, there are still cases where itis being used. An 8 year old boy with a 5year history of self-injury to his headunderwent e lectroconvuls ive therapy(ECT) treatments to reduce his self-inju-rious behavior. He struck himself withopen-hand slaps or closed fists; he alsostruck his head on his knees and shouldersat a documented rate of 109.3 times perhour, based on a 24-hour data collectionschedule (Wachtel et al., 2009). D., as heis referred to in the article was non-ver-





768 / Edueation Vol. 132 No. 4

understanding of what is happening tothem. The before mentioned girl had anIQ of 50. She was terrified of the bath-room. D id she understand that her teacherwanted her to clean-up the mess or did shedraw the conclusion that her teacher wasplacing her in danger? The authors thinka gentle voice and hand-over-hand supportto teach her how to clean would have beenmore effective and would have had greaterfuture results. Aversive vs. non-aversive;mean vs. kindness. The authors knowwhich they w ould choose.

Aversive intervention is a very broadterm. It includes m any different interven-tions, some of which the authors have usedin their own practice. One of the authorsused extinction with a seventh grade stu-

dent who w as non-verbal. He w ould pinchthe teacher working with him on the fore-arm or under the upper arm. After aninformal FBA, the author determined thepinching was the student's way of com-municating anxious feelings. The authordecided to ignore the behavior w hile teach-ing h im more app ropr ia te ways o fcomm unication. As the student gained trust

and developed communication skills, hispinching behavior decreased dramatical-ly. The author's arms went from beingpurple, black, and yellow, to normal skincolor. This author believes the correct inter-vention strategy was chosen. But what ifinstead of pinching , the student was grab-bing hands and breaking fingers duringevery teaching session? What intervention

would have been appropriate? Some sortof restraint? Restraints are aversive. Areth it ti h h i

Dr. Alan Repp (1990) began his chap-te r, N onav er s ive and Aver s iveInterventions: Overview, in Perspectiveson the Use of Nonaversive and AversiveInterventions for Persons with Develop-men tal Disabilities, with a quote from Dr.Donald Baer Not to rescue person froman unhappy organization of his behavior isto punish him, in that it leaves him in a

state of recurrent punishment (Baer, 1970,p. 246) (p . 17). Some would argue that itis never acceptable to used ECT treatment,or any other aversive intervention, with aperson with a developmental disability(Freagon, 1990). But what about D ., whoblooded his own nose and caused multi-ple areas of erythema, edema and callousformat ion on h is forehead and

cheeks (Wachtel et al., 2009, p. 459) by hisconstant self-injury? The authors cannotimagine the distress of his paren ts, watch-ing their son cause such bodily harm, everyhour of every day for 5 years. After allother interventions had been tried, whichis more dehum anizing, ECT or a prison ofself-injury?

One of the authors worked with a stu-

dent who had an IEP goal of obtainingskills to safely cross a thoroughfare of traf-

fic. Social stories, modeling, and role-playwere used as teaching strategies. Instruc-tion was also given in the community. Asverbal prompts were being given to lookboth ways in a grocery store parking lot,the student started to step into oncomingtraffic. The author's reaction was aversive;

the student's nam e was said loudly and thestudent's arm was grabbed to pull her backto safety The student became upset The



Aversive Intervention /7 6 9

she drew the conclusion that the authorwas being mean for no apparent reason.Was it wrong for the author to use aversiveintervention to save the student from bod-ily harm?

The authors close this paper w ith heavyhearts. As educators, the authors' plan isto never use aversives. The authors desireto create a safe, caring comm unity of learn-

ing for all students. The authors believe inpositive behavior interventions and willcontinue to study human behavior so thelives of their students will be impacted ina positive manner. However, the authorswill not judge D.'s parents for choosingECT treatment for their son. The authorswill always support and recommend non-aversives when planning interventionstrategies, but in severe situations like D.'s,the authors will not pass judgem ent. T heauthors tend to be on the side of Dr Baerin this case. But if the ECT had not beenso successful, would the authors stillbelieve that trying ECT was the right hing?Should we always err on the side of cau-tion? If that were the case, then D . wouldstill be in his personal prison , uneducatedand unable to interact with his family. Wemust k p asking the tough questions whileseeking the best outcomes for all students.The autho rs believe it is important to startwith the least intrusive intervention andproceed from there. But what if the behav-ior is so severe there is no time? We mustdiligently search for answers as we pro-tect due process rights while insuring thesafety and well-being of individuals with

developmental disabil i t ies . For theseauthors, every answer poses a new ques-

ll h d

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O'Reilly, M., Sigafoos, J., Lancioni, G., Edrisin-ha, C , Andrews, A. (2005). AnExamination of the Efects of a ClassroomActivity Schedule on Levels of Self-Injury andEngagement for a Child with Severe Autism.Journal of Autism and Developmental Disor-ders, 35, 305-311. Retrieved on March 25,2010 from Springer Science+Business Mediadatabase.

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Effects of embedded instruction versus dis-crete-trial training on self-injury, correctresponding, and mood in a child with autism.Journal of Intellectual Developmental Dis-ability, 31 , 196-203. Retrieved on March 25,2010 from Infonnahealthcare database.

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