Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

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46th Annual Convention; Washington DC; 2020

Event Details

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Symposium #568
CE Offered: BACB — 
Ethics
Positive Punishment of Severe Problem Behaviors
Monday, May 25, 2020
3:00 PM–4:50 PM
Walter E. Washington Convention Center, Level 1, Room 103
Area: DDA; Domain: Applied Research
Chair: Nathan Blenkush (Judge Rotenberg Educational Center)
Discussant: W. Joseph Wyatt (Marshall University)
CE Instructor: Nathan Blenkush, Ph.D.
Abstract: We conducted an empirical analysis of contingent skin-shock in the treatment of severe problem behaviors in 191 individual cases between 2002 and 2018. Overall, a 95% reduction was observed in the frequency of severe aggression and health dangerous (e.g., self-injurious) behaviors across a wide variety of psychological diagnoses. Findings provide support for the supplemental use of contingent skin-shock in conjunction with differential reinforcement of alternative and other appropriate behaviors. We present novel findings from (a) the largest clinical sample in the skin-shock literature, (b) planned versus unplanned fading of treatment, (c) reversal of treatment effects, and (d) follow-up data spanning 16 years. The evidence provides support for the assertion that contingent skin-shock is the least intrusive, most effective, efficient, and ethical treatment available for the severe problem behavior of some individuals.
Instruction Level: Intermediate
Keyword(s): aversive, punishment, severe behavior, skin-shock
Target Audience:

Graduate students and practicing professionals interested in punishment procedures (e.g., BCaBA, BCBA, BCBA-D).

 
Positive Punishment of Severe Problem Behaviors: A Review of 191 Clinical Cases
JOHN O'NEILL (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center)
Abstract: We conducted an empirical analysis of contingent skin-shock in the treatment of severe problem behaviors in 191 individual cases between 2002 and 2018. Overall, a 95% reduction was observed in the frequency of severe aggression and health dangerous (e.g., self-injurious) behaviors across a wide variety of psychological diagnoses. Findings provide support for the supplemental use of contingent skin-shock in conjunction with differential reinforcement of alternative and other appropriate behaviors. We present novel findings from (a) the largest clinical sample in the skin-shock literature, (b) planned versus unplanned fading of treatment, and (c) follow-up data spanning 16 years. The evidence provides support for the assertion that contingent skin-shock is the least intrusive, most effective, efficient, and ethical treatment available for the severe problem behavior of some individuals.
 

Positive Punishment to Treat Self-Injurious Behaviors of an Individual With Arnold Chiari Malformation

ELIZABETH A. FITTER (Judge Rotenberg Educational Center), John O'Neill (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center)
Abstract:

In this study, the use of positive punishment was examined with an individual diagnosed with Arnold Chiari Malformation (Type I), autism spectrum disorder, intellectual disability, and personality change due to Viral Meningitis who displayed severe forms of self-injurious, destructive, and aggressive behaviors. Reports indicated the participant had a history of unsuccessful behavioral and psychiatric treatments of their problem behavior. The use of a positive punishment procedure involved a court-approved contingent skin shock in combination with differential reinforcement of alternative, incompatible, and other replacements behaviors. Treatment as usual was compared to treatment plus positive punishment. Results demonstrated clinically significant improvements in quality of life through substantial decreases in the monthly frequency of problem behaviors when positive punishment was in place. The evidence provides support for contingent skin-shock as the least intrusive, most effective, efficient, and ethical treatment available for the severe problem behavior of this individual.

 

Positive Punishment of Severe Problem Behaviors Associated With Anti-Social Personality Disorder

DYLAN PALMER (Judge Rotenberg Educational Center and Simmons University), John O'Neill (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center)
Abstract:

In an effort to decrease severe and persistent problem behaviors that substantially impeded the quality of life in an eighteen year old male, diagnosed with mood disorder not otherwise specified and anti-social personality disorder. The participant had a documented history of unsuccessful treatments (i.e., multiple psychotropic medications, changes of treatment locations, programs utilizing differential reinforcement, and antecedent manipulations) of their problem behaviors (i.e., aggression and self-injury that put their quality of life in jeopardy). A positive punishment treatment plan involved court-approved contingent skin shock in conjunction with differential reinforcement of alternative, incompatible, and other replacement behaviors. Through the course of treatment, a reversal design was implemented over a duration of 11 months and demonstrated the effect of the same treatment plan with and without the positive punishment component. Overall, the treatment demonstrated a substantial reduction of all targeted problem behaviors. When punishment was removed, the monthly frequency increased to pre-treatment equivalent levels. The evidence provides support for contingent skin-shock as the least intrusive, most effective, efficient, and ethical treatment available for the severe problem behavior of this individual.

 

Evaluating Risks and Benefits for Patients With Severe Behavior Disorders in the Present Day

NATHAN BLENKUSH (Judge Rotenberg Educational Center)
Abstract:

A severe behavior disorder is an umbrella term used to describe constellations of problem behaviors that are characterized by several factors such as the frequency, intensity, form, and treatment refractory nature. The effects of a severe behavior disorder are absolutely devastating. Severe self-injury can cause blindness (because of repeated head hitting, head banging, or eye gouging), deformation (because of biting, abrasions), bone fractures, hematomas, head injuries, infection (because of chronic open wounds), and death. Aggressive behaviors result in harm to caregivers, law enforcement involvement, emergency hospitalization, and can be a primary factor in placing a child outside of their natural home. The continued occurrence of such behaviors have devastating effects on quality of life. Thus, professional to consumer, professional to professional, and other statements about treatment efficacy are of tremendous importance. Here, the presentation of such information in science, government, and media are described. In addition, systematic methods to evaluate various statements about risk and benefit are reviewed.

 

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