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.


48th Annual Convention; Boston, MA; 2022

Event Details

Previous Page


Symposium #196
CE Offered: PSY/BACB — 
Response Patterns for Individuals Receiving Contingent Skin Shock to Treat Self-Injurious and Assaultive Behaviors
Sunday, May 29, 2022
9:00 AM–9:50 AM
Meeting Level 2; Room 257B
Domain: Applied Research
Chair: Nathan Blenkush (Judge Rotenberg Educational Center)
Discussant: W. Joseph Wyatt (Marshall University)
CE Instructor: Nathan Blenkush, Ph.D.

A small proportion of patients with intellectual disabilities (IDs) and/or autism spectrum disorder (ASD) exhibit extraordinarily dangerous self-injurious and assaultive behaviors that persist despite long-term multidisciplinary interventions. These uncontrolled behaviors result in physical and emotional trauma to the patients, care providers and family members. A graduated electronic decelerator (GED) is an aversive therapy device that has been shown to reduce the frequency of severe problem behaviors by 97%. Within a cohort of 173 patients, we have identified the four most common patterns of response: (1) on removal of GED, behaviors immediately return, and GED is reinstated; (2) GED is removed for periods of time (faded) and reinstated if and when behaviors return; (3) a low frequency of GED applications maintains very low rates of problem behaviors; and (4) GED is removed permanently after cessation of problem behaviors. GED is intended as a therapeutic option only for violent, treatment-resistant patients with ID and ASD.

Instruction Level: Intermediate
Keyword(s): aggression, punishment, self-injury, treatment refractory
Target Audience:

The audience should be familiar with treatment options for severe problem behaviors.

Learning Objectives: At the conclusion of the presentation, participants will be able to: 1. Describe response patterns that could result from CSS. 2. List alternative treatments that are considered prior to CSS. 3. Weight risks and benefits based on potential results.
Response Patterns for Individual Receiving Contingent Skin Shock
NATHAN BLENKUSH (Judge Rotenberg Educational Center), Miles Cunningham (Harvard Medical School; McLean Hospital), Golnaz Yadollahikhales (Neurology, University of Illinois Hospital at Chicago)
Abstract: Severe aggression and self-injury are devastating conditions. The primary treatments utilized to address severe problem behaviors include applied behavior analysis (ABA), psychopharmacology, and various forms of restraint. n addition, ECT and deep brain stimulation have also been utilized. Taken together, these treatments are not always effective. Some patients do not respond sufficiently to years of function based behavioral treatment. While psychopharmacological treatments are used extensively to treat severe problem behaviors, many patients are drug-refractory. Restraint often only serve to minimize harm rather than to treat the problem behaviors. Finally, ECT and deep brain stimulation are not always indicated or effective for various forms of severe behaviors. Although controversial, contingent skin shock (CSS) is often extremely effective in reducing the frequency of severe, treatment refractory problem behaviors. The risks and benefits associated with skin shock must be weighed against the risks/ benefits other treatments and the risks/benefits of taking no action. Here four common response patterns are presented and discussed.
Case Presentations of Contingent Shock Response Patterns
NICHOLAS LOWTHER (Judge Rotenberg Educational Center)
Abstract: Four individual individual cases that exemplify one of four different response patterns to contingent skin shock are presented. For each case, a complete history and summary of previous treatment interventions are described. For pattern 1 (P), the introduction of GED was remarkably effective; however, GED was prosthetic in that it could not be discontinued without recurrence of problem behaviors. For pattern 2 (L), treatment was required over the long term (105 months) as well, but he was able to control his behaviors for various periods of time with the absence of a GED device. For pattern 3 (M), problem behaviors improved initially when GED was added. However, GED lost efficacy and the GED-4 (a stronger stimulus) was required to reduce the frequency of his aggressive behaviors. For pattern 4 (J), GED successfully eliminated severe problem behaviors and was withdrawn without a major acceleration or relapse.



Back to Top
Modifed by Eddie Soh