When you are looking at a particular problem behaviour in a child (student), the big question is, “Is it really a problem?” “Problem” does not mean it’s unusual, or that some people are uncomfortable because it’s a “stereotypical autistic thing”. “Problem” means someone is getting hurt, or in danger, or poses a considerable social issue. Rocking is not a problem, head-banging is. Lining toys up is not a problem, biting people is.
A great many of people’s responses can be categorised as trying to get something or to get away from something. If you’re trying to get rid of a problem behaviour, then you need to figure out what’s going on. If you can figure out what the stressor is, then you can avoid or reduce it. If you can figure out what the behaviour provides to the person, then you can figure out a more suitable replacement behavior that will provide a benefit, without the problematic issues also associated with it.
Let’s say you have a student (client, child) who is hurting themself. What is our goal here? The proximate (immediate) goal is for the child to stop the self-injurious behaviour (SIB). The ultimate (long-term) goal is for the child to find a better way of fulfilling whatever need they have that is causing the behaviour. Of course, we need to identify what it is that the child is trying to get or to avoid by doing the SIB. Obviously the child needs better coping skills. But as part of that skills teaching, we must also figure out what it is that the child is reacting to, and what need the SIB fulfills, no matter how badly that need is addressed. In other words, we have to figure out the function of that behaviour.
This is important for several reasons. The major reason is that unless we can figure out why the problem exists, we don’t have a reasonable hope of truly solving it. Sometimes one dangerous behaviour gets eliminated, only to be replaced by a different, but equally dangerous behaviour. Another reason is that these harmful responses communicate to us that there is something seriously wrong going on in the child’s life, possibly (if not probably) several somethings. It’s imperative that we figure out what those are, so we can address them. Although SIBs are indeed very important behavioural concerns, they can be symptoms of other problems, not the main problems themselves.
We also need to remember that SIBs, like other big problems sometimes seen in students with autism or other developmental disabilities, are not really “caused” by autism or bipolar disorder or mental retardation (cognitive disabilities) et cetera. Very few autistic children have SIBs, and not all children who injury themselves are autistic. Of course, it’s also important to rule out reactions to organic problems such as ear infections, seizures, or whatnot.
The reason we do all this is because it is bad to hurt yourself.
We don’t want our children hurt. We don’t want them hurting themselves, or other people. We don’t want them to believe that hurting themselves (or others) is a good way of dealing with stresses. We want them to be able to learn to identify when they are stressed, and to learn different, effective, safe ways of dealing with those stresses.
Given all that, I truly cannot find any rational justification for the use of painful aversives as a means of training individuals to not harm themselves, or anyone else. If hurting yourself is bad, and hurting others is bad, how is it then okay to use intensely painful aversives on someone? Repeatedly, hundreds of times, under inescapable circumstances, for weeks and months on end?
Certainly, zapping someone with unavoidable, painful electrical stings on bare skin will stop them in their tracks. It stops the self-injury by that default. Punishment will stop people from doing something, at least while the threat of punishment still exists.
But it doesn’t help us figure out why the person was hurting themself. It doesn’t teach them how to identify when they are stressed, and to learn different, effective, safe ways of dealing with those stresses. There are students who have been incarcerated at the Judge Rotenberg Center for years past their legal majority. That system does not provide them much in the way of tools to live successfully outside of the institutional environment. All the students are given their educational content by way of sitting through computerized programs, and regardless of their problems, are taken off all psychiatric medications. They live at the center full time, and about half of them spend their waking hours wearing battery backpacks and electrodes of the GED device, so they may be shocked at a moment’s notice, for any immediate or past infringement of the rules. One hates to even contemplate how this kind of approach further traumatises a child who suffered from Post-Traumatic Stress Disorder even before they got there. So far, six children have died while attending this institution.
Some supporters of the JRC will assert that using the GED is the only way to stop these disturbed children from hurting themselves, as the methods at their previous placements didn’t work. But this is a false dilemma — it’s not a question of “painful electric shocks or nothing”. And while it’s true that a few students are over-medicated, and that some people do react badly to some medications, this is not the same thing as saying that no one should ever use psychiatric medications.
If hurting yourself is bad, and hurting others is bad, how is it then okay to use intensely painful aversives on someone? We don’t even use things like this in prisons. Why is it deemed “okay” by school districts and courts for children with learning disabilities and emotional problems to be subjected to this kind of treatment?
People who injure themselves have a very painful set of problems. But we as a society have an even greater problem. Allowing such treatment to happen and continue is unconscionable.