Mild shock can be tremendous hea

Mild shock can be tremendous healing force

By MATTHEW ISRAEL

First published: Sunday, August 13, 2006

Clarence Sundram's July 16 Perspective article "Unlearn Shocking Behaviors," and Lawrence Dana's July 22 follow-up letter to the editor perpetuate misleading information about the use of aversives.

Aversives such as a two-second, mild shock to the surface of the skin should not be confused with the psychiatric "electro-convulsive" treatment of "One Flew Over the Cuckoo's Nest." Instead, they are an important component of behavior modification treatment for the small number of unfortunate individuals who have severe self-mutilating, aggressive or destructive behaviors -- individuals who punch their faces and eyes to the point of blinding themselves, bite off part of their own tongues, chew a hole through their cheeks, cut off their ears with a scissors, eat their own fingertips, bang their heads against the wall to the point of brain damage, scratch their skin to the point of blood and bone infection and resulting death, vomit and regurgitate food to the point of starvation, pull out their own teeth, break their own bones or aggressively threaten the lives of those around them, even loved ones.

Each of these examples is the actual behavior of a student whose parents brought him or her to the Judge Rotenberg Center in Canton, Mass., for help after it became clear that all other positive-only treatment approaches and psychotropic drugs had failed.

If you give a student enough psychotropic drugs, you can put him into a drugged, lethargic stupor in which he is half asleep throughout the day, falls face first into his food and cannot even recognize his own parents. These drugs have dangerous side effects. The known ones include major weight gain, greater likelihood of diabetes, liver and kidney damage and irreversible damage to the nervous system such as tardive dyskinesia (uncontrolled shaking movements). The unknown ones are those that you hear about five or 10 years after the drug has been introduced, when the damage has already been done and cannot be reversed.

Restraint is also not a solution. You cannot use restraint to keep a student from vomiting to the point of starvation or biting off the end of his tongue.

Behavior modification, on the other hand, does work and is supported by thousands of scientific articles. At the Judge Rotenberg Center, we begin the treatment of self-abuse by taking the individual, under the direction of our psychiatrist, off of the psychotropic medication that he or she has been using.

Next, we set up a treatment in which powerful rewards are administered for desired behaviors. We try to catch students during moments when they are not engaging in self-abuse, and give them their favorite reward -- even using a bit of ice cream or other food.

If the children can understand some speech, we make a contract with them to the effect that if they can stop banging their heads for five seconds, they will earn the food treat. If they succeed, we make the contract progressively longer and longer. At our center, such rewards alone are effective in about 50 percent of the problem cases.

If rewards alone do not work, we give parents the option of allowing us to supplement the rewards with a treatment plan that includes aversives, or in lay terms, punishments. Aversives are not used until approved by a judge after appointing an independent lawyer to represent the interests of the child. We use a brief two-second application of electric shock to the surface of the skin. It is temporarily painful -- much like a bee sting -- but has no significant side effects. When combined with rewards, it often eliminates problem behaviors rapidly.

At the Judge Rotenberg Center (the only program in the country where such treatment is presently available), the average student who has skin-shock in his court-authorized treatment plan receives only one two-second application a week. As the student's behavior improves, we are eventually able to remove the skin-shock entirely in many cases.

Is this, as Sundram says, a "regime of unrelenting abuse" or a case of "the intentional infliction of pain and humiliation under the guise of 'aversive therapy?' " Not any more than your dentist is deliberately inflicting pain under the guise of "dentistry," than your surgeon is deliberately inflicting pain under the guise of "medical treatment," or than a nurse is deliberately inflicting pain under the guise of "inoculation."

The matter is simple. As with any medical, dental, nursing or surgical procedure, we need to weigh the risks against the benefits. Is a two-second shock to the surface of the skin worth it if it can keep a child from going blind, from starving to death, or from beating his head to the point of brain damage? Isn't it preferable to the physical restraints, isolation, physical "takedowns" and the stupefying drug "cocktails" to which children with these symptoms are so often subjected?

Different parents might answer these questions in different ways. The important thing is that parents (with judicial approval, as is the case at the Judge Rotenberg Center) should be the ones to choose, and not bureaucrats or legislators who may be unduly influenced by what is politically correct or politically advantageous.

Matthew Israel is the founder and executive director of the Judge Rotenberg Center in Canton, Mass. He has a doctorate in psychology from Harvard University, where he studied under behavioral psychologist B.F. Skinner.