Association for Behavior Analysis International

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

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.

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.

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.