Behavioral treatment of aggression with contingent skin shock (CSS) has been investigated in relatively few studies and never with cognitively typical individuals. We evaluated CSS during a 3-year period with 60 participants, half to two-thirds of whom functioned at normal or near-normal cognitive levels. Sixty individual charts, arranged in a multiple baseline across participants display, reveal clearly the effectiveness of the treatment. When end-of-baseline data were compared with end-of-treatment data, CSS, as a supplement to positive programming, showed effectiveness (defined as a 90% or greater reduction from baseline) with 100% of the participants. This compares favorably with positive behavior support procedures, which, according to the 1999 treatment outcome review by Carr at al., achieved that effectiveness standard with only 55.5% of the cases (Carr et al., 1999). Higher functioning participants showed from 2 to 6 times more reduction than did lower functioning participants. Psychotropic medications were reduced by 98%, emergency takedown restraints were reduced by 100%, and aggression-caused staff injuries were reduced by 96%. As a result of the treatment, 38% of participants no longer required CSS and some returned to a normal living pattern.

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In the debate over aversives a little-known but significant fact is often overlooked: programs that restrict themselves to positive-only treatment procedures sometimes expel individuals with severe behaviors when their behaviors become too difficult to handle. We review seven such cases of individuals with severe behavior problems who were exp elled from state-of-the-art, positive-only programs and describe what happened to them when they were enrolled in a program that was able to supplement its positive-only procedures with contingent skin-shock when necessary.

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