I’m not about to argue as to what has happened to Andre in the above article is right or wrong, however I would like to share some experience in the matter.
After having taken part in a rather lengthy debate in 2008 on the use of punishers in behavioural modification where the debate centred on the Judge Rotenberg Centre for a time, I feel that I may have an alternate view on the above item.
First up, during the course of that debate it was established that the centre was a place of last resort for the mentally or physically disabled who also displayed behaviours that were either violently harmful either to themselves or their family/carers. Those that attend the Judge Rotenberg Centre, had often either been denied treatment or kicked out of other centres because of their violence or their families/carers wanted them removed because they spent large amounts of time either restrained or sedated. The Judge Rotenberg centre is well known to use what they refer to as ‘GED devices’ to apply ‘Contingent Skin Stimulation’ or electric shocks.
GED stands for Graduated Electronic Accelerator and this device is not mains powered. It’s a battery operated device. I cannot make out in the video in the link whether Andre is attached to any mains power. They mention that he is wearing a helmet...but this is often a protective measure for those Autists who are head bangers. Some have been known to bang their heads with such force that they detach their retinas.
I believe the e-collar that I have used for behavioural modification in dogs is probably in a similar range. The ‘shock’ that the device delivers is surprising, creates some discomfort, but is not painful. I am able to hold my dogtra field pro e-collar on my skin at the top level and it doesn’t hurt. But it would surprise me if I wasn’t expecting the sensation. Those who have experienced TENS (transcellular electric nerve stimulation) as a part of physiotherapy treatment for injuries would be familiar with the sensation.
I believe that, from what I come to know about the centre during the discussion in 2008, the patients’ mother is not being entirely honest when she says that she had no idea that they were going to shock her son at the centre.
They advertise the fact that they do on their website:http://www.judgerc.org/effectsofshock.html
They also rely on no to minimal use of psychotropic drugs.
JRC relies primarily on the use of positive programming and educational procedures to modify the behaviors of its students. If however, after giving these procedures a trial for an average of eleven months, they prove to be insufficiently effective, JRC then considers supplementing them with more intensive treatment procedures known as aversives. These are used only after obtaining prior parental, medical, psychiatric, human rights, peer review and individual approval from a Massachusetts Probate Court. The links below will take the user to complete information about JRC's use of aversives.
There is the possibility though that JRC’s advertised protocol in obtaining consent for the application of aversive treatment for Andre was not followed.
The discussion that I refer to is here and I have linked at the page where the Judge Rotenberg Centre starts to be discussed. On this forum my user name is Rom.http://www.petfriendlyworld.com/chatforum/showthread.php?t=15085&page=305
NB: the above is a largely unmoderated forum, so there is a lot of “noise”
I’m quoting part of the discussion below. The reason why I’m doing this is that while I can’t say for sure why they applied the shock to Andre for his refusal to remove his coat upon request, nor can I judge the treatment based on only the information in the news release, there may be a possible explanation in the below. This part of the discussion is with a member of the forum who works with the disabled in the UK where the use of pain to control or suppress violent behaviours is only allowed if that violence is being expressed.
Originally Posted by Rom
So the more difficult patient would have the 'last resort' applied on a more frequent basis?
The only issue that I have with it is that the timing is incredibly unfair....if a punisher is to be used, the earlier in the behavioural sequence that it is used, the lower the level of intensity needed to affect an outcome and the better the learning outcome.
Originally Posted by cobbsie
I think you have the wrong end of the stick with the documents
They DO NOT outline treatment as in regular use
They outline an emergency procedure which IS a very last resport and not aimed at treating or modifying behaviour just preventing injury to service user and worker.
Kind of like Koehler and head dunking/spanking?
Sure, but whether or not they are used regularly is based on the actions/reactions of the patient.....so a patient that acts/reacts in a way that justifies such measures on a regular basis will have those measures justifiably applied on a regular basis.....if the regularity of use is high, then the only other options available are physical restriction/management or tranquilisation, none of which helps with behavioural modification.....infact it can increase the intensity of the behaviours.
My problem isn't that aversives are used. Its how and when they are used. The anti punishment argument cites all the potential fallout of the use of punishment.....and because of the potential fallout they use it as a last resort. The problem with this is that since it is used as a last resort, it is used at a time and in a way that it is most likely to cause the very fallout that the anti punishment arguments cite. The timing is shyte. The aversives are being applied at a time when a high intensity is needed, where the patient is least likely to be able to learn and modify behaviours to avoid it, when the patient is more likely to make the wrong associations with the punisher, the punisher is less likely to support permanent behavioural adaption.....
The following link cautions against using punishers at the wrong end of the behavioural sequence and mentions some of the potential fallout:
Yet this is precisely the timing in which the use of aversives is justified by the system of treatment of the patients. The only time that the use of aversives is allowed is when it has the greatest potential to do the very damage that the anti punishment arguments talk about.
Yet, if the behavioural sequence is mapped and a punisher is applied earlier in the behavioural sequence, then the fallout is avoided because a degree of clarity of mind is protected to help support learning/behavioural adaption, lower intensities can be used, the threshold to the triggers can be raised, behavioural changes are more likely to be permanent.
In the case of dog aggression or stock chasing, the earliest behaviour in the sequence is when the dog gives the trigger the 'hard stare', when you can use an intensity that is the equivalent of a flea bite.
Earlier in the thread mention was made of a boy who was stimmed if he vocalised when walking to the toilet....if the behavioural sequence had been mapped and this was the earliest behaviour in a sequence that led to a violent/dangerous behaviour, then this was the kindest time to apply an aversive.
The other thing that bothers me apart from the poor timing of the application of the aversive is that those that have a history of engaging in violent/dangerous/self harming behaviours are highly adapted to pain (according to stuff I've read somewhere but can't find just now).....and the justifiable 'last resort' use of aversives is being applied at a time in the behavioural sequence when the individual patients threshold to pain is likely to be at its highest, and its being applied using physical force.....at a time when the risk of injury is at its greatest because a high threshold to pain is no protection against injury.
Originally Posted by Rom
So, perhaps this demonstrates a concept that was touched on earlier in the thread.....those that work with self harmers sometimes allow the self harmers to cut themselves because it provides for relief and helps keep them manageable. It was questioned whether or not the GED (by Erny I think) could also provide for that relief. Patience or LL (or somebody....I'm losing track) suggested that if it did, the behaviours would be protected rather than being diminished by the GED stim.
Cobbsie:You may never be able to control the trigger in all circumstances. However, with a dog, we take them through the progression of teaching, training, proofing. In the teaching phase you have the trigger at the lowest possible intensity and start the behavioural adaption at that point....the behavioural sequence is mapped and the aversive is applied at the earliest identified behaviour in that sequence. In moving through the training and proofing you are gradually increasing the intensity of the trigger, but at the same time still applying the stim at the earliest behaviour in the sequence. So you're basically increasing the threshold to the trigger and at the same time preventing the dogs usual response to that trigger.
I think what you have to consider is what you are trying to achieve by giving a shock.
In the case of self harming average intelligence teens who self harm often the 'cause' is tension within the home, inability of them to talk to anyone, so in a sense how do you target an antecedent when the trigger is often an event outside their control?
Think about it this way, if the triggering stimulus causes the dog stress and it was stress that produced the behaviour, when you raise the dogs threshold to the triggering stimulus, you also raise his threshold to stress......so you get a calmer dog in the face of the triggering stimulus....
Kids with Learning difficulties (inc Autism) where the behaviour is frustration surely it is better to understand and work on reducing the response to the trigger rather than shocking. producing a shock may prevent the immediate behaviour but wont in the long term alter the response to the trigger, the behaviour will often come out in another way.
dunno about all the stuff with peptides am afraid
interesting thoughts though
The study of peptides and neuro peptides, as far as this conversation is concerned, draws links between thoughts/emotions/behaviours and shows us how they all interact.
Basically put, you can control which peptides/neuro peptides are released in your body by your thoughts. Which peptides are release then affect/effect your emotions and your emotions affect/effect your behaviours. By interrupting a thought process, you can prevent those peptides being produced that may lead to negative emotions and negative behaviours. In behavioural modification, finding the earliest behaviour in a sequence and interrupting the sequence at that time, you are essentially getting as close as you can to the beginning of a thought process that leads to the unwanted behaviour and preventing the production of the peptides that support the unwanted emotion and therefore the unwanted behaviour.
So, in many cases, simply diverting the patients attention will get (or using de escalation techniques I think it was called?) will prevent the behavioural sequence from playing out. But where it doesn't then the kindest thing to do is to punish the earliest behaviour in the behavioural sequence because that will prevent the patient from feeling the stress or frustration that leads to the unwanted behaviour, it will raise the patients threshold to the triggers of the behaviour....and raise the patients threshold to the emotions that the triggers produce the unwanted behaviours......prevent the patient from engaging in the violent/destructive/self harming behaviours.
After interrupting the thought process, if you then get the patient involved in wanted behaviours and reinforce those, then the original triggering stimulus can become a trigger for a new thought/emotion/behaviour pattern through conditioning. In changing the thoughts, you change the peptides that are released in the body.
This will work for some without the use of aversives, but if it doesn't the kindest time to apply the aversive is as early as possible in the behavioural sequence.......not late in the behavioural sequence...even if it is used as a last resort.
Applying aversives in behavioural sequences is kind of like the treatment of disease.....the earlier the disease is detected the greater the chance of a favourable outcome, the lower the risk of invasive procedures protocols that might have unfavourable side effects.
So, when I watch the video and see that a stim was applied to Andre when he refused to take his jacket off upon request, I have to wonder if a refusal of a simple direction is one of the earliest elements in the behavioural sequence that has reliably predicted that this particular patient is about to engage in a violent episode? Perhaps the staff need to pin him down because he is a violent self harmer?
I initially made the assumption that Andre was screaming because he was stimmed (shocked) but what we can’t know for sure because we can’t tell from the video is whether he was being stimmed because
he was yelling and this behaviour had been mapped as a reliable predictor that Andre was about to act violently. And if this is the case, then the safest place for him to be at that time would have been to be restrained.