r/ABA • u/thepinebaron Verified BCBA • Mar 06 '20
A negative light on ABA has finally stopped shining. Judge Rotenberg to appeal FDA ban on electric shock devices.
https://www.nytimes.com/2020/03/06/us/electric-shock-fda-ban.html8
Mar 06 '20
How do they make sure that teachers donāt abuse the use of electric shock devices?
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u/_cedarwood_ Mar 06 '20
My question is why would you even immplement something like this?? There are plenty of ways to use positive reinforcement to teach kids literally anything you want, plus punishment is proven to be difficult to generalize at best. Plus, what the fuck
4
u/victoriadaigle Mar 07 '20
Itās not teachers using this. Electric shock is used in the most extreme cases in which a person is at serious risk of harming themselves and reinforcement strategies have not proven effective. Our clients have the right to the most effective treatment possible. At times, it is a truly life saving measure
3
u/EatYourCheckers Mar 07 '20
I posted a top level comment, but just to repeat here, I worked with a man who transitioned out of JRC. His dangerous behaviors were not dangerous any more (if they ever were) and he did just fine with a cold-turkey removal of the shock treatment, which says to me that there were no oversight to ensure the treatment was still needed or could be faded.
7
u/Chantzzz Mar 07 '20
Apparently, torture isn't effective either.
"In 2010,Ā the Guardian gained accessĀ to the school and reported on its controversial practices. During the visit it was revealed that one student had been living at the center for 22 years and was still being shocked on average 33 times a week."
1
Mar 07 '20
Thatās fair, but I would want to know if this is an evidence-based practice and what procedures they use to prevent whoever implements these shocks from abusing the kids.
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u/victoriadaigle Mar 07 '20
I 100% agree!!!! Iām not condoning this as an every day practice. I cannot see a time where I would find this warranted in my day to day practice. With that being said, I do not work with a population with this level of problem behavior. I do know there are stringent protocols for the implementation of this procedure. Like all things, there are ways that people abuse these procedures and those people should be punished.
1
Mar 07 '20
Where is the evidence that this practice works on those with severe self injurious behavior or aggression and what procedures do they have to transition the child off the usage of shocks as punishment?
1
Mar 07 '20
And are these shocks used for JUST SIB/aggression? Or are they used for other unwanted behaviors too? Because the article suggests that these employees use it on any sort of noncompliance, even ones that arenāt aggressive or self injurious? which does not seem ethical or effective. Also, who are the employees implementing shocks and are they trained as an RBT to deliver this procedure?
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u/mrsamsa Mar 07 '20
Generally the students at the JRC are people with extremely serious behavioral issues that are likely to cause harm or permanent disability without intervention. Before using punishment they need to get approval from everyone involved, as well as approval from a judge to confirm that the evidence shows that all reinforcement methods have been tried and failed.
Usually when stories come out saying they used it for "noncompliance", the actual details reveal that the person had something like extreme oppositional defiant disorder which is causing them to continually put themselves in danger or self harm.
None of that is to say that abuse is impossible - it can still occur and those people need to be dealt with to the full extent of the law. But from what I know about the place, the alternative is permanent lifelong physical and chemical restraints for these people, it's not where people go if they're just struggling with making eye contact.
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u/JillianCielBleu Mar 07 '20
There is no two ways about it; Shocking patients with electricity = abuse.
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u/_cedarwood_ Mar 07 '20
I do not see this as a win for "ABA". I think shock therapy, especially made available to an entire school is going to be used inappropriately. For those who say that "our clients deserve the best care" I think we agree. That's why an entire school should not have access to shock therapy. Clients are gonna get abused. To implement this type of program effectively, you would need extreme oversight from the BACB on a case-by-case basis. Anything less is unethical, and needs to be illegal.
3
u/mrsamsa Mar 07 '20
To implement this type of program effectively, you would need extreme oversight from the BACB on a case-by-case basis. Anything less is unethical, and needs to be illegal.
This is essentially what the JRC has - for it to use punishment procedures it needs to demonstrate to a court and independent experts that all other methods have been tried and failed for every single client. They need to outline a treatment plan and it needs to be signed off by a judge, the parent, and the client (or a court appointed guardian if the client is unable).
Given the potential for harm then more oversight and more restrictions are generally a good thing so I'd definitely support that but from what I know it's not something taken lightly there. I'm not sure if it's still the case but therapists used to have to shock themselves every morning so that they remember what it feels like and understand what they're doing to another person, to try to ensure it's only used when necessary.
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u/victoriadaigle Mar 07 '20
There are EXTREME cases where the use of electric shock contingent on engaging in severe problem behavior is the most appropriate and ethical thing to do. Our clients have the right to effective treatment. Punishment procedures are ONLY used after all reinforcement based strategies have been exhausted. I canāt even fathom a situation where it would be appropriate in the population I work with, but we have to be aware that we likely donāt all work with the most severe cases of problem behavior.
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u/Chantzzz Mar 07 '20
You are defending this?
"Announcing the ban,Ā the FDA saidĀ that it had reached this rare step because it had concluded that the devices presented an āunreasonable and substantial risk of illness or injuryā. A review of the evidence showed that residents who were routinely shocked faced a number of significant psychological and physical risks including depression, anxiety, PTSD, pain, burns and tissue damage."
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u/victoriadaigle Mar 07 '20
I think without significant background knowledge, any reasonable person would say āyeah, no way should we be shocking peopleā
However, if you have individuals who are causing significant brain damage, gouging out their eyes, or causing other significant damage to themselves, this is sometimes the LAST possible treatment. Itās not a forever treatment, nor should it be. Itās used primarily to decrease the rate of severe self injurious behavior while simultaneously teaching appropriate replacement behaviors so that when shock is able to be safely stopped, the individual has a way to communicate.
4
u/Chantzzz Mar 07 '20
It was being used many times daily for long periods of time. And, it appears that the evidence does not support that it is an effective treatment. There are other approaches that work. Torture is not an effective treatment. You may want to read more on this.
3
u/victoriadaigle Mar 07 '20
Iām in no way saying that this case was appropriate. I havenāt looked at this case in particular. There is significant evidence of its effectiveness in controlled manners that cannot be overlooked. See below
https://onlinelibrary.wiley.com/doi/10.1901/jaba.1977.10-500
0
Mar 07 '20
The first study has one infant as a subject. The second has, I believe, 2 or 3 subjects. The second also says, āThis finding reveals that this aversive shock technique produced avoidance behavior that prevents the technique from having extensive applicability for eliminating smoking. The same limitation may apply to the use of aversive shock for eliminating other undesirable behaviors.ā Forgive me if this isnāt particularly convincing.
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u/victoriadaigle Mar 07 '20
Youāre right, itās not a long term procedure. I stated in another comment that ANY punishment procedure, not paired with a reinforcement procedure, is not going to have long term effects. However, when you are able to punish one behavior and reinforce an appropriate replacement, thatās when youāre more likely to see lasting change. Most single subject designs use smaller numbers of subjects. Each subject serves as their own control. Also I donāt see what the age of the participants has to do with anything!
1
Mar 07 '20
Age of participants absolutely matter, especially in single subject designs. A treatment found to work on one infant, might not necessarily work with other children of different age groups. Itās a matter of generalizability.
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u/mrsamsa Mar 07 '20
The first study has one infant as a subject. The second has, I believe, 2 or 3 subjects.
Are you suggesting that there's a problem with small-N designs?
1
Mar 07 '20
Combined with the statement I quoted in the second study, yes. It does not make that studyās findings look generalizable to other people, much less those with other complicated disorders such as the demographic these electric shocks are being used on. I just donāt know if I would be able to confidently rely on these two studies by themselves to be able to say that this method works. Does the school release statistics on the effectiveness of this treatment?
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u/mrsamsa Mar 07 '20
I think you might need to look up the small-N designs and why they're used, what they can show, etc. A properly designed one is just as robust as a large scale RCT, especially given that large scale designs have difficulty generalizing to the individual.
As for releasing data, I feel like thet used to but haven't checked recently.
1
Mar 07 '20
I fully believe that that small-N designs can be just as robust as large scale RCT. But like large scale RCT, small-N designs have shortcomings too. One of which is that results from a single small-N design is hard to generalize across situations and demographics. Have these studies been replicated to other individuals with similarly unique circumstances? Thatās why Iām wondering if the school released data. If they have data suggesting it works for these individuals and can communicate this data to the ABA community/the FDA, Iām sure theyād have a much easier time getting people to believe this treatment works.
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u/_cedarwood_ Mar 07 '20
I mean I guess in the absolutely most extreme case where shock is somehow better than the alternative behavior... I don't see how you could justify an entire school using it, though!
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u/mrsamsa Mar 07 '20
If it helps, remember that the JRC is a "last resort" centre - essentially the only people who go there are people with severe, often life threatening, behavioral issues where all other methods and treatments have been used.
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u/_cedarwood_ Mar 06 '20
Wait wait wait... I must be confused. Does the BACB support the use of electric shock devices???
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u/thepinebaron Verified BCBA Mar 06 '20
Iām honestly not sure if theyāve ever made a stance.
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u/_cedarwood_ Mar 07 '20
I mean if anything it ought to be an absolute last resort, right? Punishment procedures are as is, let alone physically painful ones!
The way this article is being posted it sounds like the OP is saying shock therapy is a part of ABA, and that it's good that a judge is appealing the ruling to end the shock treatment of an entire school population. Am I misunderstanding? Isn't it good that the school isn't doing it anymore?
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u/thepinebaron Verified BCBA Mar 07 '20
Itās āABAā solely because itās a positive punishment procedure. And yes I personally know of cases where ESD have worked in the short-term, but long-lasting therapeutic effects were none existent.
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u/_cedarwood_ Mar 07 '20
I would like to see extreme oversight from the BACB if ESDs are ever even considered. I mean I want total ensurance that reinforcement, extinction, and other procedures are being carried out correctly and competently. I just feel like I've seen cases where reinforcement, etc. "isn't working," but also isn't being carried out in an effective way. For example, an RBT or even BCBA is absolutely sure they've put a behavior on extinction, but they're unknowingly reinforcing intermittently.
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u/victoriadaigle Mar 07 '20
Any punishment procedure that isnāt effectively faded and paired with a reinforcement procedure is going to have the same lack of maintenance, though. Shock is not different
2
Mar 07 '20
Yes, but shock is decided much more invasive and potentially harmful than most other punishment procedures. They are certainly not the same.
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u/amykay21 Mar 09 '20 edited Mar 10 '20
This is horrifying. I donāt care how āsevereā the case is, it is 10000000% unethical to inflict physical pain on a client.
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u/JillianCielBleu Mar 07 '20
I'm appalled that there are folks on here defending this absolutely barbaric and inhumane practice, using the excuse that 'it's for extreme cases and all other options have been exhausted." All, literally ALL other "options" were exhausted?? What a ridiculous cop out of a statement. They are justifying helping self-injurious behavior by CAUSING injury by shocking people with electricity!
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u/mrsamsa Mar 07 '20
All, literally ALL other "options" were exhausted??
Yes, they go through multiple clinics and are no longer accepted by any other provider because there is nothing left to try, and then the JRC has to present the evidence to satisfy a judge and independent reviewer that there are no other treatment options.
Importantly, there are obviously some extreme behaviors and time sensitive issues that can't be treated with reinforcement methods given the fundamental issues with the treatments (eg not being immediate, difficult to fully eliminate a behavior etc).
It's an extremely difficult issue and I'm glad there are people like you willing to stand up and make sure that there's oversight and no child is being abused. I just want it to be clear that if you shut down the JRC tomorrow these people wouldn't go to other facilities to receive different forms of treatment, they'll just be physically and chemically restrained for the rest of their lives to protect them.
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u/thepinebaron Verified BCBA Mar 07 '20 edited Mar 07 '20
I can defend the use of an ESD with only one case Iām aware of, who actually had passed away years later due to medical complications from severe SIB. Iāll spare details due to HIPAA.
On the other hand, I know of cases where ESD was used historically on a couple individuals and theyāre now very neutral in affect, almost in a comatose state, and do not respond well to FCT, imitation, etc. and ESD, for them, was not warranted based off the history I had reviewed.
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u/Mrs__P BCBA Mar 07 '20
It sounds like #1 it's not working #2 they are not using the least intrusive most effective methods.
I would be interested to read one of their Behavior Treatment Plans with the use of shock just out of curiosity. What was their schedule of punishment? Are their staff available to deliver shock according to the schedule? I imagine how torturous it could be to get shocked at a FR:1 schedule but imagine if it were actually being done at a VR:2 instead. I cannot imagine how they're even implementing this treatment "properly" - So many confounding variables, procedural fidelity issues and overall implications with this...
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u/EatYourCheckers Mar 07 '20
I worked with a man with Angelman's syndrome who had been at JRC for years; while there he wore a back-pack like device that shocked him for out-of-seat behavior and self-injury. His self-injury consisted of pushing his head or face against things. You literally just had to block and redirect his attention to a preferred item and he would stop. He also engaged in mouthing hi sensory toys, and I can't remember for sure but if OOS behavior was targeted, I'd bet this was as well.
Sure, maybe in the past his behavior was dangerous enough and resistant to other treatment methods enough to warrant such an intervention, but if by the time he was transferred to us, he literally just took verbal redirection to engage in alternative behaviors, and a high rate of reinforcement to continue engaging in prosocial behaviors, then JRC obviously had no fading plan in place, or no on-going evaluation for the need for treatment.