Ethics for behavior analysts 2nd expanded edition

Running head: CONTINGENT ELECTRIC STIMULATION

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CONTINGENT ELECTRIC STIMULATION

Controversial Punishment Procedure: Contingent Electric Stimulation

Grecia Gaviria

PSY7705

Capella University

Punishment is often considered bad. However, learning from consequences aversive to us (pain, discomfort, loss of reinforcement) has survival value for individual organisms and for the specie (Cooper, Heron, & Heward, 2007). Punishment is a natural phenomenon that teaches us not to engage in behavior that produces harm. In behavior analysis punishment is one basic principle of operant conditioning and behavior analysts design behavior-change programs utilizing punishment procedures that are conceptually consistent with behavior-analytic principal (code 4.01 conceptual consistency). However punishment is poorly understood, often misapplied and its applications can be controversial (Bailey & Burch, 2011; Cooper, Heron, & Heward, 2007).

Punishment occurs when behavior is followed by a stimulus change that decreases the likelihood of that behavior to occur in the future. Positive punishment occurs when the aversive stimuli are presented immediately following the behavior (Cooper, Heron, & Heward, 2007). For example, the pain experienced by a person who fell after running on slippery floor is a form of positive punishment. The aversive stimuli (pain) will reduce the probability of that person engaging in the behavior that caused it (running) under similar circumstances (wet surface) in the future. Negative punishment involves the termination of an already present stimulus following the behavior that results in the decrease of that behavior occurring in the future. For example, a child who is removed from a play area for pushing a peer in which case the child loss access to positive reinforcement for a specific amount of time.

Self-injurious behaviors (SIB) are considered the most persistent form of challenging behaviors in people with intellectual disabilities resulting in negative consequences that impact the overall functioning of the individual. Challenging behaviors such as SIB are also related to reduced access to education, limited social interaction with peers and significant increase in family stress. If left unmanaged these behaviors are likely to lead to more restricted interventions (psychotropic medications, seclusion, physical restraint, and placement in residential care facilities). SIB may also lead to abrasions, bruising, tissue damage hair loss, detached retina, and even death (Minshawi, Hurwitz, Fodstad, Biebl, Morriss & McDougle, 2014; Oorsouw, Israel, Heyn & Duker, 2008).

One punishment procedure surrounding a lot of controversy is the use of contingent electric stimulation. This involves the presentation of a brief electrical stimulus immediately following an occurrence of the problem behavior. One of the most thorough researched and carefully applied procedures for implementing punishment by electric stimulation is the Self-Injurious Behavior Inhibiting System, SIBIS. (Cooper, Heron, & Heward, 2007; Linscheid, & Reichenbach, 2002; Salvy, Mulick, Butter, Bartlett & Linscheid 2004; Oorsouw, Israel, Heyn & Duker, 2008). As a practitioner in the field of behavior analysis I believe this procedure should only be considers when there is short-term discomfort to the client against the potentially long-term relief from pain and risk to the client that may occur if dangerous behaviors are not effectively decreased so that more appropriate skills can be taught.

Various studies have investigated the effects of SIBIS. Children and adolescents in these studies were removed from school and no longer received other services because of the severity of their behaviors (Salvy, Mulick, Butter, Bartlett & Linscheid 2004; Oorsouw, Israel, Heyn & Duker, 2008). Because this type of punishment procedure is considered by many to be one of the most intrusive behavioral interventions, researchers considered this type of punishment procedure for the children and adolescent involved only after several alternative behavior reduction techniques had been implemented and failed to reduce the target behavior. Injury risk associated with SIB and stress levels of the family are also considerations for the need of effective rapid treatment such as SIBIS. Such like in previous studies in which SIBIS has been found to be effective for decreasing SIB, behavior analysis must be skilled in implementing the treatment. They should always provide appropriate training to those involved in the therapeutic process, oversee every procedure and follow up after a criterion for treatment success has been reached to ensure therapeutic effects remain after the removal of SIBIS. These steps are in compliance with several ethical codes such as 2.09 treatment and/intervention efficacy, 4.0 individualize behavior change program, 4.11 discontinuing behavior-change programs and behavior-analytic services, 2.02 responsibility, 2.03 consultation, 4.06 describing conditions that interfere with implementation, and 4.08 consideration regarding punishment procedure of the professional and ethical compliance code for behavior analyst (Bailey & Burch, 2011).

The presentation of aversive stimuli may generate new challenging behaviors that may compete with the acquisition of the target behavior. Some side effects associated with punishment are: elicited aggression or other emotional responses and escape or avoidance. The use of punishment may also be reinforcing for the person using it thus misuse or overuse of the procedure may happen (Cooper, Heron, & Heward, 2007). In a study that addressed the side effects of contingent shock therapy with a group of nine participants with severe SIB and aggressive behavior no negative side effects were observed. The participants’ ether significantly improved or did not show any change (Oorsouw, Israel, Heyn & Duker, 2008).

Studies have also demonstrated the durability of punishment effect when neutral stimuli are paired with punishing stimuli to produce conditioned properties. For example if SIBIS was paired with the word “no hit”, even after SIBIS terminated the effects of it were still seen when only the words “no hit” were used (Salvy, Mulick, Butter, Bartlett & Linscheid 2004).

Overall punishment is part of behavioral sciences, as behavioral analysts we should acknowledge that punishment procedures could be beneficial only in circumstances in which it is necessary and detrimental for the individual at risk. Contingent electric stimulation should be considered after other procedures have failed. Since many ethical issues arise in treatment with the use of punishment interventions, such as ensuring the clients’ rights and dignity and providing treatment that are both appropriate and timely, behavior analyst must make sure they oversee the process. Additionally, behavior analyst should ensure that during the process they are in compliance with the professional and ethical compliance code for behavior analysts.

References

Bailey, J. S., & Burch, M. R. (2011). Ethics for behavior analysts (2nd Expanded edition). New York: Routledge

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Merrill Prentice Hall.

Linscheid, T. R., & Reichenbach, H. (2002). Multiple factors in the long-term effectiveness of contingent electric shock treatment for self-injurious behavior: A case example. Research in Developmental Disabilities, 23, 161–177.

Minshawi, N. F., Hurwitz, S., Fodstad, J. C., Biebl, S., Morriss, D. H., & McDougle, C. J. (2014). The association between self-injurious behaviors and autism spectrum disorders. Psychology Research and Behavior Management, 7, 125–136. http://doi.org/10.2147/PRBM.S44635

Oorsouw, W. V., Israel, M., Heyn, R. V., & Duker, P. (2008). Side effects of contingent shock treatment. Research in Developmental Disabilities, 29(6), 513-523. doi:10.1016/j.ridd.2007.08.005

Salvy S-J, Mulick JA, Butter E, Bartlett RK, Linscheid TR. (2004). Contingent electric shock (SIBIS) and a conditioned punisher eliminate severe head banging in a preschool child. Behavioral Interventions, 19 (2):59–72