Seven case studies of individuals expelled from positive-only programs.

Abstract

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.

Contingent Electric Shock as a Treatment for Challenging Behavior for People With Intellectual and Developmental Disabilities: Support for the IASSIDD Policy Statement Opposing Its Use

“…In addition, very few studies collected information on whether CESS was acceptable to those implementing or overseeing the treatment (e.g., families, staff). Finally, as with Duker et al (2002), several studies included other treatments in combination with CESS (e.g., differential reinforcement of other behavior, physical guidance, verbal reprimands, functional communication training), making it difficult to evaluate the isolated effects of CESS on behavior change (e.g., Israel et al, 2008Israel et al, , 2010Williams et al, 1994;Williams, Kirkpatrick-Sanchez, & Iwata, 1993).…”

“…The extant CESS literature provides inconsistent information regarding the immediate and long-term effectiveness of CESS, as well as whether treatment gains were maintained once CESS was removed. Regarding the immediacy of effectiveness, several studies (e.g., Linscheid, Iwata, Ricketts, Williams, & Griffin, 1990;Salvy, Mulick, Butter, Bartlett, & Linscheid, 2004) demonstrated that CESS significantly reduced challenging behavior in only a few brief sessions (e.g., 10 min), whereas other studies demonstrated that CESS was only effective after numerous months of all-day implementation (e.g., Israel et al, 2008Israel et al, , 2010. Regarding long-term efficacy, some studies showed that CESS remained effective for many months (e.g., Mudford, Boundy, & Murray, 1995;Williams et al, 1993), while other studies showed that CESS lost its effectiveness over longer periods of time (e.g., Ricketts, Goza, & Matese, 1993).…”

“…Across the 101 participants with whom CESS had been examined in the scientific literature in the last 30 years, researchers reported that previous treatments had failed for 75% of people. But for 42% of these participants, no data from previous failed treatments were reported, and of the two studies that did report data on previous failed treatments (i.e., Israel et al, 2008Israel et al, , 2010 neither reported baseline levels of challenging behavior prior to the failed treatment nor provided technical information regarding the failed treatment(s) beyond general terms (e.g., describing it as differential reinforcement). These reports do not make us confident that alternative treatments had been adequately considered.…”

“…Another methodological concern that arose from the review was that several of the CESS studies utilized single‐case experimental designs that did not demonstrate sufficient experimental control, making it difficult to determine a functional relationship between the treatment and its effects on behavior (e.g., Israel, Blenkush, von Heyn, & Rivera, 2008; Israel, Blenkush, Von Heyn, & Sands, 2010; Williams, Kirkpatrick‐Sanchez, & Crocker, 1994). Israel et al (2008, 2010) examined the effectiveness of CESS by reporting levels of challenging behavior prior to and following CESS implementation using a simple AB design with 60 individuals where the start of treatment was staggered. Unfortunately, this design does not provide repeated demonstration of the effects of the treatment with the individual, and thus does not provide evidence for experimental control (Horner et al, 2005; Johnston, Pennypacker, & Green, 1993).…”

“…Williams et al (1993) were able to maintain treatment gains after fading CESS and, similarly, Salvy et al (2004) reported a single 10‐min session in which low levels of target challenging behavior were maintained without the repeated use of CESS. However, several studies either did not attempt to fade CESS (e.g., Mudford et al, 1995) or demonstrated that withdrawing CESS resulted in an immediate increase in challenging behavior (e.g., Israel et al, 2010; Linscheid et al, 1990). Overall, the type and number of treatments for long‐term effectiveness, and the length of time treatments remain effective either with CESS in place or after it has been withdrawn, are not well demonstrated, and indeed are sometimes contradictory, in the available literature.…”