Treatment of aggression with behavioral programming that includes supplementary contingent skin-shock.

Abstract

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.

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).…”

“…As noted above, several studies demonstrated an immediate and significant reduction in challenging behavior and a reduction in the use of restraint and fewer staff injuries (e.g., Israel et al, 2008). However, there have been several negative side effects indicated as well.…”

“…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.…”

“…It remains unclear why the treatment was even implemented, as there may not have been a need for any treatment for some of their participants. Israel et al (2008) also reported that they implemented CESS not only for severe challenging behavior (e.g., aggression), but also for nondangerous forms of challenging behavior (e.g., noncompliance, yelling) that they believed were precursors to severe challenging behavior. The authors did not provide any evidence that these nondangerous behaviors were related to these individuals' severe challenging behavior.…”