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The Judge Rotenberg Center

1. What is the Judge Rotenberg Center (JRC)?

2. How does JRC differ from other special needs residential schools?

3. What is JRC's policy regarding psychotropic medication?

4. What is JRC's policy regarding behavioral counseling?

5. If there were no JRC, what are the alternatives for the JRC students?

Positive Programming

6. What categories of behaviors does JRC treat?

7. What reward systems does JRC use?

8. How are food rewards used in JRC's behavioral treatment?

9. How many of JRC students can be treated effectively with positive-only programming (i.e., rewards and educational procedures)?

10. How long is positive-only programming tried before supplementing it with skin shock?

11. Does JRC prepare its students to receive high school diplomas?

Supplementary Aversives at JRC

12. What is aversive therapy using the GED?

13. How is aversive defined and which aversives are considered acceptable?

14. What aversive does JRC use and with what policies?

15. What is GED and how is it used?

16. What behaviors are aversives used to treat at JRC?

17. How is skin shock used at JRC and what have the results been?

18. Is skin shock the same thing as electroconvulsive shock?

19. How effective is skin-shock as an aversive?

20. What percentage of JRC's population is treated with supplemental skin shock?

21. For those students who receive skin-shock, how often is the procedure used?

22. Does JRC's skin shock have any negative side effects?

23. What are the different treatment methods for using aversives?

24. What are behavior rehearsal procedures and what support is there for them?

25. What are programmed opportunities?

26. What is negative reinforcement?

27. What safeguards are in place to prevent skin-shock from being misused at JRC?

    1. Sample Court Authorized Treatment Plan

28. Is it true that some programs use "hidden aversives?"

29. Why is there so much opposition to the use of skin shock therapy?

30. Do positive-only schools expel students who are subsequently referred to JRC?

Common Objections regarding JRC's Use of Aversives

31. Does JRC's GED skin shock device cause burns?

32. Do students who receive skin-shock therapy ever "graduate" so that they no longer need this treatment?

33. Can JRC's students be treated in other programs without the use of aversives?

34. Contrast Skin Shock with Electroshock Therapy (ECT)

35. Does JRC analyze the causes (functions) of behaviors and base its treatment upon that analysis?

36. Is it true that JRC uses skin shock to punish minor behaviors?

37. Is the GED sometimes used when a student is restrained?

38. Should skin-shock be used only with lower functioning students?

39. How come all other programs manage without skin-shock?

40. Is JRC out of the mainstream?

41. Is the probate court process to approve skin shock at JRC a sham?

42. Is JRC's Human Rights Committee controlled by JRC?

43. Why has JRC not published on the GED in peer reviewed journals?

Common Objections regarding Skin Shock

44. Is skin shock overkill and are Positive Behavior Support procedures sufficient?

45. Why are not all the other residential programs for special needs children using skin shock aversives?

46. You would not use skin shock on a prisoner or a prisoner of war. Why use it on a handicapped child?

47. What do you say to people who say that the use of skin shock is inhumane?

Common Objections regarding Aversives in General

48. Is there disagreement on the effectiveness of aversives?

49. Can aversives be avoided by a skillful use of rewards?

50. Can the same results be achieved with positive-only procedures?

51. Are aversives only temporary in their effects?

52. Does IDEA require the use of positive behavior supports?

53. Have aversives been banned or restricted in other states?

54. What organizations support the right of parents to choose aversives?

Other Issues

55. Is JRC too expensive?

56. Is it true that five students have died at JRC?

57. What was the controversy regarding JRC's use of the term psychologist?

JRC's Current Controversy with New York State Education Department

58. On June 9, 2006 the New York State Education Department (NYSED) released a very negative report on JRC. Why?

    1. Three MA Agencies Review JRC and Find No Support for the Principle Accusations in the June 9, 2006 NYSED Report

59. Have the new NYSED regulations put a crimp in JRC's use of aversives?

"You would not do this to a prisoner or a prisoner of war. Why, then, should this be done to a handicapped child?"

JRC is a highly specialized and very successful behavioral treatment program, not a prison. It is entirely appropriate to treat persons in a treatment center differently from the way they are treated in a prison. For example, it is perfectly legal when hospitals inject handicapped children with haldol, thorazine or other potent anti-psychotic medications when they are prescribed by a psychiatrist; however, it would not be legal to inject prisoners with these same medications as part of a person's prison sentence. Many of these anti-psychotic medications are much more intrusive than JRC's aversive procedures and have serious and sometimes permanent side-effects. JRC's treatment has no serious side-effects and has a record of treatment success for severe behavior disorders that far exceeds that of anti-psychotic medications.

Society is responsible for providing effective treatment and education to children with severe behavior disorders to help them overcome their handicapping problematic behaviors. This is particularly true when those behaviors are harming the students' bodies and/or their future development. This responsibility is recognized in the federal law that mandates school systems to provide an appropriate education for all children, including those whose handicaps take the form of behavior problems.

When children are given anti-psychotic medications to treat their behavior disorders the only result is to drug the children to the point of near-sedation. This can sometimes (but not always) stop their severe aggressive and health dangerous behaviors but it also severely dulls their minds, rendering them unable to learn. Such drugs have never been approved for use with children, have known harmful side effects and sometimes have unknown, harmful, permanent and irreversible side effects that do not appear until years later.

By contrast, aversive therapy, when used as a supplement to positive and educational programming, has no significant harmful side effects, is an effective treatment that is often required only temporarily, and works without clouding the student's mind and body with harmful drugs. Aversive therapy, used in this way, is a recognized professional treatment that can save, extend and enrich the lives of many children with severe behavior disorders. Parents should have the right to choose this form of treatment for their child if they think that this is the most effective, least intrusive treatment available. This is particularly true when a parent prefers a non-drug, behavioral treatment to the common alternatives of warehousing, heavy psychotropic medication, seclusion, restraint and takedowns.

A procedure is not inhumane simply because it involves the application of something uncomfortable or painful. Inoculations, dentistry, medications and surgery all involve procedures that may be quite uncomfortable or painful. We judge those procedures to be humane, however, because when one weighs the future benefits against the current risks and intrusiveness, the future benefits normally far outweigh the temporary pain and discomfort that is involved. Aversive therapy needs to be seen in the same light. Its intrusiveness needs to be weighed against its significant benefits in the same way.

Unfortunately, those who wish to ban aversives appear to be unwilling to measure aversives in this way. They are unwilling to weigh the benefits of aversives against their intrusiveness. They prefer to simply oppose aversives in a dogmatic, philosophical manner. Aversives, in their view, are just WRONG with a capital "W." They prefer to see these children living in psychiatric hospitals in a drug-induced stupor.

One reason for their unwillingness to apply a risks/benefits analysis may be that aversives are still relatively new as a treatment and have not been as widely accepted as have inoculations, dentistry and surgery. JRC is one of the few programs in the country that offers this form of therapy. In addition, many persons are still confused as to the difference between the use of a temporary, mild electric skin shock as a behavioral treatment to decelerate specific problem behaviors, on the one hand, and electroconvulsive shock therapy as a psychiatric procedure to induce brain seizures and treat mental problems such as depression, on the other. They also seem to think that JRC applies skin-shock to the students randomly and do not understand that the skin-shock is only applied as an immediate response to specifically targeted aggressive, self-abusive or other serious problematic behaviors that are threatening the individuals' physical well-being or seriously interfering with their education or access to society.

The present lack of information and understanding about the use of skin-shock aversives among the population at large means that opposing the use of such aversives is currently more or less "politically correct." When one goes to the emergency room with a life-threatening problem, one wants the most effective, least intrusive treatment possible, regardless of whether or not that treatment is considered to be politically correct. In the same way, when the parent of a handicapped child finds that his/her child has life-threatening problematic behaviors, that parent should be able to select the most effective, least intrusive behavioral treatment, regardless of whether or not certain uninformed and dogmatic persons consider the treatment to be politically incorrect or even "inhumane."

Usually the persons who oppose the use of aversives do not have children with behaviors as severely problematic as do those parents who wish to keep aversives available as a treatment option. Usually the opponents of aversives do not have children who are routinely rejected from, or even expelled from, treatment programs that employ positive-only treatment procedures. For a better understanding of what it is like to be a parent of a child with severe behavior problems that cannot be effectively treated with drugs or positive-only procedures, please see the group of letters from parents that are found at http://www.judgerc.org/parentletters.html.

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"Electric shock therapy used at JRC sounds barbaric -- like "One Flew Over the Cuckoo's Nest."

In a recent news paper article a New York state official  was quoted as saying something to the effect, "Electric shock therapy [used at JRC] sounds barbaric -- like 'One Flew Over the Cuckoo's Nest.'" This reflects a common confusion that exists in many people regarding two very different treatment procedures.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy, is a psychiatric procedure used for individuals with severe depression, psychotic depressions, intractable mania, or people who are not able to take anti-depressants.  This procedure involves putting a patient to sleep with a barbiturate and administering a drug to temporarily paralyze the muscles so they do not contract during the treatment.  An electrode is then placed above one or both of the temples and another in the middle of the forehead and a small electric current is passed through the brain of an individual for approximately 1 second in order to cause a localized seizure that can last from 30 seconds to more than a minute.  As you can imagine this procedure is done as a last resort and only under the direct supervision of trained medical professionals. ECT is the type of therapy used in the movie "One Flew Over the Cuckoo's Nest," although it has improved dramatically in its administration, safety, and effectiveness since the movie was released back in 1975.

Behavioral Skin Shock

Behavioral skin shock is sometimes added as a supplement to a very common form of treatment referred to as behavior modification, which is based on behavioral psychology.  Behavior modification in various forms is used every day by parents and teachers to help children learn good behaviors and achieve in education.  Simply telling a child that he/she will earn a special reward if he/she stops tantruming or if he/she earns a good grade, is a simple form of behavior modification.  For people who engage in life threatening forms of self-abuse and/or aggression which have been resistant to all other forms of treatment such as psychotropic medication and in-patient counseling, then safe forms of skin shock or other aversive techniques such as time-out, can be added to a reward-based behavioral treatment program. At JRC, for instance,  the student is normally weaned off of psychotropic medication before behavioral skin shock is employed. It has been very successfully used at JRC as a last resort for the treatment of case-hardened problem behaviors that have not responded successfully to heavy and prolonged dosages of psychotropic drugs or other treatment approaches.

The behavioral skin shock procedure employed at JRC involves the passage of a relatively weak electric current through a small portion of the skin of an arm or leg for two seconds. It is used as a consequence for certain pre-defined major problem behaviors that have been targeted for treatment as part of a behavior modification plan.  It causes a level of pain that has been compared to that of a bee sting. It is used as one component of a behavior modification treatment plan for treating major problem behaviors displayed by autistic children and children with other problem behaviors.

The student is first given rewards for not showing the problem behavior to be treated, rewards for engaging in behaviors that are incompatible with the problem behavior, and educational procedures to teach the student how to appropriately and acceptably obtain the things that he/she might otherwise have to engage in problem behaviors in order to obtain. Typically, a student is treated, using only these rewards and educational procedures, for several months to a year before supplementary skin shock is considered. If these rewards- and education-based procedures are not sufficiently effective to treat the behaviors, behavioral skin shock the parent is given the option of  adding behavioral skin shock as a supplement to that ongoing reward/educational program. At JRC, 50% of its population is successfully treated with rewards and educational procedures alone, without having to use the skin-shock procedure.

The purpose of using behavioral skin-shock is to help decrease the frequency of certain target behaviors. Data on the frequency of the behavior(s) in question are collected and charted to measure and evaluate its effectiveness. The procedure is done under the direction of a behavioral clinician.

At JRC, behavioral skin shock is a voluntary procedure that is employed only at the option of a parent. Prior to using the procedure, JRC obtains the written informed consent of the parent and the individualized as well as prior approval of a Massachusetts Probate Court judge. The procedure is incorporated into the individual's Individual Education Plan and into a treatment plan that is approved by the Probate Court. JRC has been licensed to use this treatment by the Massachusetts Department of Mental Retardation and the Massachusetts Department of Early Education and Care. JRC's program is also approved by the Massachusetts Department of Education and is approved as an out-of-state placement for children by the New York State Department of Education.

The procedure is safe and effective. It has no side effects. Often it is only needed for a short period.  The need for it diminishes as the frequency of the problem behavior decreases. For many students, this treatment has been life-saving. Many students at JRC have been able to be "weaned" off of the treatment procedure and graduate from JRC to live a normal and productive life. Parents of students at JRC whose children have benefited from the procedure are strong supporters of the program. Recently current and former JRC students, who had benefited in their own treatment by the use of behavioral skin shock, testified movingly on its effectiveness and value to their own lives before a committee of the Massachusetts legislature.

To distinguish between these two procedures it is helpful to refer to the first procedure as electro-convulsive therapy and to the procedure employed at the Judge Rotenberg Center as behavioral skin-shock, or aversion therapy.

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"The JRC students have to wear the GED device for the rest of their lives, so what's the point?"

In many cases, particularly for students who function cognitively at a medium or high level, the GED is required only temporarily, to suppress the frequency of major problem behaviors. Once those behaviors have been decreased in frequency, the student is much more likely to display and be rewarded for desired behaviors, and much more capable of receive instruction. The new behaviors that the student is able to show, as a result, may now begin to generate for him/her some of the same attention and other satisfactions that he or she previously could obtain only by engaging in problem behaviors.

As the student's behavior improves in this way, JRC's clinicians arrange to "fade out" the use of the GED in gradual steps. Numerous graduates of JRC have left JRC and gone on to college and work environments and have never had to use the GED again.

There are some lower-functioning students, however, with whom it may be necessary to keep the GED available over a long period of time. In such cases, the GED tends to be needed only very rarely and its use is somewhat similar in function and value to that of an artificial limb or a pair of eyeglasses. With the GED, the student is able to enjoy a quality of life that is far superior than that which the student would have had if the GED were not to remain available.

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"...neither...Israel or his school has ever submitted data on the success of any of these therapies to peer review journals..."

The use of skin shock as a decelerative procedure for inappropriate behaviors is one of the most widely published behavior modification techniques in the psychological literature. Our own bibliography for example contains 111 separate papers on the topic, almost all of which are published in peer reviewed journals.

The behavioral skin shock device that JRC uses (called the Graduated Electronic Decelerator, or GED) is simply a another device that administers a 2-second shock to the surface of the skin. It was designed to be an improvement on the SIBIS device, which has numerous publications in the professional peer-reviewed literature. Dr. Israel has written a paper that explains its advantages over the SIBIS device.

JRC's primary mission is not the conduct and publication of peer-reviewed research, but the application to education and treatment of basic principles and technological strategies that are already well founded in the professional literature. Indeed, for JRC to spend its funds on doing and publishing research would be a disallowed expense under the Massachusetts rules for schools such as JRC.

Most practicing physicians apply the results of research performed by research biologists, physiologists and research physicians. Similarly, JRC is devoted to the practice of behavioral treatment, rather than the conduct of the basic research that practitioners rely on.

JRC has, however, made available a number of papers that describe our treatment procedures, in great detail and that report the data we have obtained. For example, our website includes papers that describe the following aspects of our use of the GED skin shock device: 1. Technical features of the GED behavioral skin shock device 2. Its success in treating one or two of our most difficult clients 3. Its effectiveness as compared with the SIBIS skin shock device  4. Its overall effectiveness in treating the last 36 students who were authorized for its use.

Our website also contains the following: 1. The full text of 14 professional papers, several of them from peer reviewed journals dealing with electric shock 2. A complete bibliography of 111 of articles documenting the effectiveness of skin shock 3. A copy of a summary of the 1987 National Institute of Health Consensus Conference Report, acknowledging that skin shock was a legitimate decelerative procedure with professional support in the literature.

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"Aversives are only temporary in their effect. When you stop using them, they lose their effect. So why bother, if the behavior returns as soon as the procedure is no longer used?"

This statement faults aversives for failing to do something they were never intended to do – i.e., to produce not only response reduction, but also long-term generalization and maintenance. We should first note that many educational and  medical procedures do not produce long-term effects that remain in place long after the procedure is removed. For example, reward procedures produce an increase in the frequency of the behavior that is rewarded; however, if the rewards are removed, the behavior will return to the frequency it was at prior to the introduction of the reward procedures,  (unless some other rewards have come into play to keep the behavior going).  For another example, drugs cause certain effects while they are taken. Those effects rarely, if ever, continue long after the drug is discontinued.

The fact that a procedure may be needed on a long term basis, does not mean it is useless. Artificial limbs, eye glasses and hearing aids may be needed on a long-term basis, but this does not make them useless. When a person uses them, a major improvement in the person's quality of life becomes possible. As a result, most persons consider that the benefits that these prosthetic devices confer far outweighs the inconvenience involved in wearing them. The same is true for the use of aversives with some lower functioning self-abusive and self-mutilating children. Without them, the child is often in danger of losing his or her life or of suffering self-mutilation.  With the occasional use of them, however, lives and limbs can be saved and the student can have a decent quality of life. Click here to see proof in the form of before-and-after films and photos.

Fortunately, JRC's experience shows that in most cases the need of aversives gradually diminishes over time, even in the case of such lower functioning self-abusive children. In most cases fewer and fewer applications of the aversives are required as time goes on. For evidence of this, see the charts we show of students who were started on the GED at some point during the period 2003-2005. These charts show that as time goes on, the number of GED skin-shock applications gradually diminishes to zero or near-zero.

Even though an aversive may reduce a behavior only while the aversive is being applied, this is still a very significant effect, because it creates a window of opportunity for strengthening certain other behaviors which may produce their own natural rewards and therefore keep going after the aversive is removed.  For example, consider the case of a student who  has been refusing to attend school or cooperate with a teacher, and has been languishing at home or in a psychiatric hospital before coming to JRC. This might, for example, be the case of a student who is so aggressive that he fights all the time, and has been excluded from school because of his aggressiveness. If he is enrolled at JRC, and aversives are used to get him to attend school, stop fighting with others,  and cooperate with the teacher, the student may, for the first time in his life, begin to acquire new skills in reading, math, self-care, vocational skills, playing new games and sports, socialization, etc. When the student acquires these new skills, he may begin to be able to do useful and enjoyable things that were never before possible. These new skills, in turn produce their own rewards and therefore may keep going even without any help from aversives. In effect, the student's whole life can be turned around in a positive direction. He or she acquires self-esteem, pride in his accomplishments and hope and optimism for his future.  His parents become proud of his accomplishments and begin to enjoy his company and his home visits for the first time ever. If one reads the letters to the New York legislators and Board of Regents that the JRC parents have written as part of their campaign to keep New York legislators from banning aversives and the Board or Regents from removing JRC from New York's approved list of out-of-state schools, one sees the pattern that I have described here occurring over and over.

In other words, aversives, even if they only produce behavior reduction while they are employed, have an effect similar to training wheels on a bicycle. They can play the role of a temporary support device that enables a student to start acquiring behaviors that were impossible to acquire until the excessive anti-social behaviors were reduced.

This pattern of a student changing his entire orientation to life once aversives have helped him control his excessive anti-social behaviors is particularly found when aversives are employed with higher functioning students. These students can be changed from students who are headed for a wasted, warehoused life in mental hospitals or prisons into productive taxpayers. This is why Deputy Commissioner Cort's objection to JRC's use of aversives with higher functioning students, in her memo to the Board of Regents is particularly unfortunate. To hear some of our higher functioning students tell you how aversives have helped them to turn their lives around, please click here.

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"There is no need for aversives because positive programming can successfully treat problem behaviors."

There has been controversy surrounding the use of aversive procedures for some time. The most recent chapter in this controversy began in 1981 when an organization called The Association for Persons with Severe Handicaps (now called by its acronym TASH) adopted a resolution banning the use of all aversive procedures. Creighton Newsom and Kimberly Kroeger have written a chapter called Nonaversive Treatment[1] in Controversial Therapies for Developmental Disabilities in which they trace the history, contributions and harm done by this movement over the years. They write:

The nonaversive movement has led directly to school and provider policies in many communities of excessive consumer choice and "hands-off behavior support," policies that over time can and have produced individuals who become increasingly self-injurious, routinely damage their homes or classrooms, or intimidate and injure peers and staff. In the name of treating such individuals with "respect and dignity," such providers are condemning them to certain institutionalization or incarceration. Examples of misguided policies occur frequently at meetings about adult clients' problem behaviors in community settings, usually in the context of discharging the client. At one such meeting recently the workshop supervisor mentioned that their new behavior support policy classifies "telling a consumer not do to do something they want to do" as aversive because there's this big push to give people choices and let them do whatever they want to do regardless. The issue under discussion was whether or not the client should be allowed to run out of the workshop into a busy street. The group home manager stated, "We have no consequences. If a person needs hands-on to control his behavior, he's not appropriate for our program." As a result, unintended consequences of excessive client choice and hands-off policies are often the increased use of psychotropic drugs and the frequent use of hospital emergency rooms or developmental centers to deal with crises."[2]

During the early 1980's the leaders in the field of Positive Behavior Supports managed to secure a large multi-year grant from the Department of Education that is now a national network of Rehabilitation Research and Training Centers on Positive Behavioral Support. Many of the professionals and advocates who oppose the use of aversives call their field "Positive Behavior Supports" (PBS). Positive Behavior Supports are sometimes cited as a desirable alternative to punishment procedures such as the GED skin shock used at JRC. 

The paper, Positive Behavior Support for People With Developmental Disabilities, ^[3] published by the American Association on Mental Retardation in 1999,  is the most comprehensive review of the literature on Positive Behavior Supports that has ever been done. The authors of the paper are among the most distinguished names in the field of positive programming. The paper reports on a review of 216 published studies, in each of which positive programming was used, and which appeared in 36 different journals.

The bottom line finding was that positive programming was effective in 50% of the cases. Effective was defined as decreasing the frequency of the behavior by 90% from its "baseline" level (the level it was at prior to the start of treatment). This is commendable, but it raises the question, "What about the other 50% of the cases in which the treatment does not work?" That is where programs such as JRC come in. JRC serves the cases where positive programming alone fails to treat behaviors effectively.

Even the assertion that the positive programming in these studies was effective in 50% of the cases probably gives an exaggerated impression of just how effective the treatment really was, because:

• As Dr. Foxx has shown in his chapter entitled "Severe Aggressive and Self-Destructive Behavior: The Myth of the Nonaversive Treatment of Severe Behavior,"[4] the types of behaviors that the Positive Behavior Support persons do their studies on are generally nowhere near as severe as the case-hardened self-abuse and aggression that JRC is required to treat.

• The standard of effectiveness used - reducing the problem behavior by 90% from its baseline level -- is not really an adequate standard for clinical work with dangerous behaviors. For example, suppose a student was engaging in life-threatening head-banging at the rate of 1000 head bangs per day prior to the treatment and this is reduced to only 100 head bangs per day as a result of the treatment. This would meet the study's criterion of a 90% reduction from baseline; however, from a clinical point of view it would not be rated a success.

• Positive Behavior Supports is not really a scientific discipline. It is a group of persons who are ideologically committed to opposing the use of aversives and supporting certain other related ideologies such as normalization, inclusion, person-centered planning, etc. In a chapter entitled, "Positive Behavior Support: A Paternalistic Utopian Delusion,"[5] by Dr. James Mulick and Eric Butter, the authors note that the field of Positive Behavior Supports is a mixture of three sources: applied behavior analysis (which is a science) plus the two ideologies of the normalization movement in human services and what are called "person-centered values." The authors summarize their findings as follows: ". . .whatever else it may be, PBS[Positive Behavior Support] is not science, but rather a form of illusion that leads to dangerously biased decision making."[6] Because of the ideological allegiance that PBS journals demand of both its authors and reviewers, the quality of peer review that PBS articles receive is not up to standards of the non-ideological journals in the mainstream behavior analysis field[7].

A recent 2005 study^[8] by several prominent PBS practitioners surveyed the opinions of 134 experts in the field of Positive Behavior Supports. The experts were asked what treatment procedures they considered to be acceptable. Surprisingly, 10% of the Positive Behavior Support experts considered contingent skin shock to be an acceptable procedure. All of those who considered it to be acceptable did so because they viewed it as "effective."

We at JRC really wish it were true that there was a technology of positive-only interventions that was so effective that JRC would not need to use its GED procedure any more. If there were such a technology, JRC would certainly want to use it and stop using the GED. After all, why would we want to risk the future of JRC every single day, by using such a controversial procedure as the GED skin shock, if there were a more politically correct and non-controversial way of treating the same behaviors? Wouldn't we be dummies to be continuing to use the GED?

Unfortunately, a careful look at the facilities and programs that profess to use positive behavior supports to control behavior tends to reveal the following:

1. Often, such programs are just not dealing with the level of case-hardened problem behaviors that JRC deals with. And when they do come across such students they sometimes refer them to JRC!

2. In cases where such positive-only programs are dealing with students with difficult behavior problems, they tend to be doing one or more of the following things:

   1. They may just substitute a lot of extra staff to hover near the student at all times, ready to jump in and prevent problem behaviors from occurring when they start. But this is not treatment; it is more like guard duty and warehousing.

   2.  They may not be putting any demands on the student to work, study, or cooperate. They may just let the student do nothing all day. The philosophy is, "If he doesn't bother us, we won't bother him." The result, again, is warehousing.

   3. They may give the student so much psychotropic medication that the individual is in a kind of stupor, is sleepy and has little energy to do anything. Heavy medication that produces that result is not real treatment. It is, again, a kind of pernicious warehousing.

   4. They may be using aversives, but hiding them under nice-sounding names. Five staff members grabbing the student and forcing him to the floor each time he/she is aggressive is called a "reactive procedure" or "containment" or "required relaxation," and is definitely not called a "punishment." Isolating the student in a room alone as a consequence is called "cooling off" or "time out" and is not recognized as the punishment that it often is. Grabbing the student harshly on the shoulder or arm, and squeezing it hard, when the student does something inappropriate is called "redirection" rather than the punishing consequence that it really is. You are safer to have your child in a program that calls a spade a spade and a punishment a punishment.

JRC's professional staff are fully familiar with the techniques that comprise the field of Positive Behavior Supports. Those techniques are essentially the same positive programming procedures that JRC employs when a student first enters JRC. In fact, we know of no program that goes to greater lengths to create a powerful set of positive procedures. Witness our Big Reward Store, the little reward stores in many of our classrooms, the weekly Reward Afternoon, the reward boxes in many of the classrooms, the two Contract Stores, the variety of behavioral contracts that are used simultaneously, the computer based educational system with self-instructional software, etc. It is only if and when such positive and educative procedures are insufficiently effective, by themselves, in decreasing problematic behaviors that JRC supplements them with aversives such as the GED skin shock.

Those professionals who publish in the Journal of Positive Behavior Supports are largely the same behavioral psychologists who have long been in philosophical opposition to the use of aversives. Behavioral psychologists come in many different flavors. Some of them, like many advocates, are simply unwilling to weigh the risks and benefits of the use of aversives and reject their use on philosophical grounds. Others simply realize that their professional life will be a lot smoother if they do not go down the road of using aversives, even if they know in their heart that a combination of rewards and effective aversives may be the most efficient way to treat serious problem behaviors.

The use of aversives is so controversial that JRC is just about the only program that uses them openly. The controversy has also had an impact on what is published in the journals. Very few articles are now published in the area of aversives and on skin shock. JRC's treatment is so effective, powerful, and humane, however, that we are loathe to give it up in favor of something more politically correct. It has been around since the 1960's and it has enormous support in the professional literature (111 papers in our bibliography for example). It may not be the flavor of the month, but it works marvelously well and saves and enriches the lives of our students.

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How are food rewards used in JRC's behavioral treatment?

First, let me point out that our food programs, which will be explained below, are used with students who have extremely dangerous, often life-threatening, or bodily-injurious behaviors. B.S. is a case in point. Some of the problematic behaviors that he brought to JRC were these: biting off parts of his tongue; biting his cheek to the point of opening a hole in his cheek; refusing to eat or swallow his medication; and ruminating (regurgitating food from his stomach) and the projectile vomiting of this food at others. The biggest problem with the projectile vomiting is that as a result of it, B.S. brought himself close to the point of starvation through the loss of weight.

Behaviors such as those that B.S. showed have sometimes proven to be resistant to all other forms of treatment offered outside of JRC, such as drugs, educational procedures, counseling, and medical treatment. For example, at one point we sent B.S. for two weeks to Boston Children's Hospital to see if the physicians there could find any medical solution to his life-threatening behavior problems. They could not. The facts of B.S.'s case were summarized by the Massachusetts Supreme Judicial Court in its opinion affirming the lower court's decision to approve continued use of JRC treatment program.  The opinion can be found at 424 Mass. 482 (1997).

A common behavioral tool for the treatment of such problem behaviors is to make a "behavioral contract" with the student in which, if he is able to show certain desired behaviors (e.g., not banging his head against hard objects) for a certain period of time, the student earns a reward. For some low-functioning students, the usual rewards that you or I might work to earn, such as money, good grades, etc., may not be effective. B.S. is a case in point. For such a student the mealtime food may be the most effective reward that one can offer.

When JRC employs mealtime food to motivate the students to change their behaviors, the food is used under either of two alternative treatment programs--the Contingent Food Program (in which all food missed through contracts is made up at the end of the day) or the Specialized Food Program (in which the make up procedure is more restrictive). Neither of these programs can be used unless JRC obtains prior informed consent by the parent, prior approval from a physician and prior authorization by the Probate Court as part of an individualized substituted judgment authorization.

Out of our 245 students we are employing the Contingent Food Program with only 22 students (9%) and the Specialized Food Program with only  3  students (1%).

When food is used as a reward, under either the Contingent Food Program or the Specialized Food Program, the student's breakfast, lunch and dinner are divided into "mini-meals" small portions of food that are earned one at a time. Successive "behavioral contracts" are then set for the student, in which, if he can go for a certain period of time without showing some problem behavior, he can earn a mini-meal. For example, we might set a 5 minute contract for not hitting one's head. At the end of 5 minutes, and providing the student has not hit his head during those 5 minutes, the student would earn one portion of his breakfast. After he eats that portion a second 5 minute contract would be set. The student can then earn that second portion of breakfast by going for another 5 minutes without displaying the self-injurious behavior. And so on. These contracts would continue to be set, one after another, throughout the morning. Lunch and dinner would also be divided into mini-meals and handled in the same manner. In effect, the contracts are carried out continuously throughout the day. In a 16-hour day there would be a large number of contracts set for the student, the actual number depending on the length of the contract.

In order for these contracts to be effective, the student must be prevented from obtaining food by any method other than by passing his contract to not hit his head during the 5 minute period. Obviously, if the student were allowed to eat all of his normal three meals at the usual times, regardless of whether or not he was showing any problem behaviors, he would not be motivated by food and he would have no incentive to try to pass any of the contracts by stopping the banging of his head.  He would continue to bang his head.

If the student passes each of the behavioral contracts that are set for him, he will earn all of what otherwise would have been served to him at his breakfast, lunch and dinner meals. In other words, he will earn 100% of the amount of calories that would have been offered to him at those three meals.

If the student fails to "pass" one or more of his contracts, he is not given the food portion(s) that is(are) the potential reward(s) for that contract(s). Whether or not the food that was missed, as a result of those failures to pass contracts, will be made up later in the day depends on whether the student is on the Contingent Food Program or the Specialized Food Program.

The Contingent Food Program

At the end of the day, we offer to students who are on the Contingent Food Program a make-up meal that is composed of chicken and mashed potatoes with liver powder sprinkled on top and that will make up all the calories that the student will have missed by not passing one or more of his contracts earlier in the day. This make-up food is deliberately intended to be an unattractive option, however, because we want the student to be motivated to earn the portions of real mealtime food that can be earned by passing the behavioral contracts.

Despite these procedures, we occasionally find one or two students who seem to prefer the make-up food to the regular menu food that they can earn by passing their contracts. They appear not to mind failing their contracts and then eating one large meal at the end of the day. When this occurs, we cease using this food program and, if we have the parent and court authorization to do so, we switch to the use of the Specialized Food Program described below.

There are a variety of safeguards that are in place before the Contingent Food Program can be employed, including the following:

• The procedures must be approved by the parent (informed consent) prior to their use;

• JRC's consulting physician examines the students and must give medical clearance for use of this procedure;

• The procedures must approved, prior to use, by a probate court as part of an individualized treatment plan that is authorized for that student;

• The student's daily caloric requirements are determined by a registered dietician in consultation with JRC's medical staff;

• The student's menu is designed by a nutritionist;

• The number of calories consumed by the student each day is recorded;

• The students are examined periodically by JRC's nursing staff; and

• The students are weighed daily.

The Specialized Food Program

For students on the Specialized Food Program (currently it is being used with only 3 out of our 245 students) we do not offer make-up food to compensate for food that the student missed by failing to pass his contracts unless he has eaten 25% or less of his normal daily caloric target. If he has eaten 25% or less, he is offered make-up food to bring him up to the 25% level. Normally this provision is never brought into play for two reasons: (1) the typical student passes the vast majority of his contracts during the day; and (2) if the student fails to pass a significant number of his contracts, the clinician may shorten the length of the contract period, thereby it easier for the student to pass the contract.

The medical safeguards in place for the Specialized Food Program include all of the safeguards for the Contingent Food Program plus the following:

• For each student at JRC, the medical staff determines the student's ideal weight based on the student's body frame and height. To do this, the medical staff refers to standardized charts which provide ideal weights based on body frame and height. The ideal weight range is defined as the range from 90% to 110% of the "ideal weight." All students are maintained at or above a so-called "red line" weight which is 87.5% of their ideal weight that is, 2.5% below the lower boundary of the ideal weight range.

• Baseline blood work is done for the student prior to the initiation of the specialized food program;

• JRC conducts a urinalysis to test for positive ketones on every day that follows a twenty-four-hour period when either of the following occurs: (a) the student earned less than 80% of his/her recommended daily caloric intake; (b) if a member of the JRC medical staff determines that such a test is necessary;

• The student is offered unlimited amounts of fluids;

• The electrolyte content in the student's blood is measured prior to the time that he or she enters the specialized food program, to measure the chemical composition of the ions. The electrolyte content in the student's blood is measured every 6 months or more frequently as needed. For example they might be measured when there is a major change in the student's medical status;

• The student's vital signs are measured as needed, by the nursing staff. This includes a measurement of the student's heart rate, respiratory rate and blood pressure. This might be done, for example, when there is a major change in the student's medical status;

• The nurse reports by telephone to JRC's consulting physician every other week (or more often, as necessary) once the specialized food program is instituted for the student, regarding the student's status.  Based on the report, the consulting physician determines whether an examination is necessary, and if so, the examination is also documented in the student's record;

• JRC forwards the status of the student's weight to the consulting physician, each week; and

• The food program is suspended or otherwise appropriately altered if a student's weight dips below the red line value.

We have been employing these food make-up procedures for almost 20 years and have not experienced any problems with their use. One of our clinicians has done a careful study of the Specialized Food Program. He found that the average student on this programs gains, rather than loses, weight.

As noted, the students tend to pass most of their contracts. If a student is having difficulty passing his contracts, the clinician may shorten the duration of the contract to make passage easier (e.g., he could, for example, diminish the period of the contract from 5 minutes to 1 minute). I cannot recall a single case in which a student passed so few of his contracts that we had to bring into play the provisions of the Specialized Food Program that involve the need to bring a student, through the provision of makeup food, to 25% of his normal daily calories .

The overall purpose of these food programs is to make sure that the student is adequately motivated to earn the food that is used in the behavioral contracts. This in turn creates a very effective reward which JRC has used quite successfully to eliminate dangerous forms of health dangerous and aggressive behavior. These are often dangerous behaviors that were resistant to all previous forms of treatment such as psychotherapy and drugs. We regard the use of both of the Contingent Food Program and the Specialized Food Program as less intrusive than the use of our skin-shock punishment procedure. The more effective that we can make our behavioral contracts, through the use of such food programs, the less often we need to employ the skin-shock procedure. In other words, the behavioral contracts, coupled with the two food programs, are part of our strategy to minimize our need to rely on the use of the skin-shock procedure.

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"The program is too expensive"

JRC is a kind of behavioral hospital and has many of the same costs that any hospital has in order to function 24 hours, 7 days per week, 365 days per year. We pay the highest level of wages to our direct care staff of any comparable program in our area in order to ensure that we can have a carefully selected, well trained and supervised treatment and education staff. We employ 1170 staff members for 255 students and maintain 4 office buildings 48 residences, a fleet of vans and trucks, etc. The physical plant of our buildings and residences is unmatched in its beauty, decoration and cleanliness. We have 35 staff members whose only duty is to ensure quality control. For all of this, our tuition is much less than the cost of keeping an individual in a psychiatric facility and is about average for intensively staffed residential treatment programs of our kind.

There are two ways in which, although our tuition is substantial, placing a child with us can save a school district money:

1. Because our treatment is so effective, we have better control over our students' behaviors than most programs have. As a result, we are able to dispense with the costs of extra 1-1 staffing that many schools and programs of our kind charge when they accept difficult-to-treat students. During the 2005 year we calculated the amount of money we were able to save for the programs that place children with us. The total savings were $783,288. A table showing how this figure was calculated is found here.
    

2. Many students go through a succession of ineffective residential placements before they get placed at JRC. If they had been placed with us at the beginning of their placement history, our ability to accomplish rapid and effective change in the students' behaviors could have saved many years of costs of the prior ineffective residential placements. Recently we calculated the savings that could have been accomplished for one of our successful graduates of our GED treatment. The table showing the savings is found here.

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"Skin shock is cruel and inhumane."

The GED behavioral skin shock treatment procedure is dramatically effective in saving lives and in rapidly turning around the lives of our students so that they can be happier, healthier and more productive. In some cases it enables them to return to public school, to competitive job or to being able to live normally in an independent fashion. The procedure involves 2 seconds of discomfort and the average student receives one two-second application per week. There are absolutely no negative side effects. The principal side effects are that the student behaves better and better, makes more of his behavioral contracts, enjoys more rewards, becomes happier and develops a better self-concept. What is cruel or inhumane about that?

What is really cruel and inhumane are the alternatives to the use of the GED skin-shock, which tend to be these:

1. psychotropic medication. For the students that are referred to JRC such medication has not worked. If it had, the student would never have been referred to JRC. If you fill a student with enough medication, he/she can become a kind of drooling zombie, with little energy and with a tendency to sleep much of the time. The medication may also have permanently disabling effects on the body, including on the nervous system. To us at JRC, that is cruel and inhumane. Why are the anti-aversive advocates so upset about a harmless skin-shock but hardly upset at all at largely ineffective and permanently injurious psychotropic medication?
    

2. manual and mechanical restraint. Some problem behaviors can be controlled and prevented by putting the student into continual manual or mechanical restraint. To manually restrain a vigorous young man can take the efforts of many staff members and is inevitably a dangerous exercise. Putting a student in continuing restraints is much more cruel than changing his/her behavior quickly with a powerful positive reward program that is supplemented with occasional two-second skin shocks.
   
   It is important to note that there are some behaviors that cannot be prevented even with manual or mechanical restraint. For example, the behavior of biting off parts of one's tongue, biting a hole through one's cheek with one's teeth, refusing to swallow food or medication, breaking one's own arm, and rubbing a leg against the inside of a plaster cast until the skin is infected, are all behaviors that cannot be controlled with manual or mechanical restraint. They are, however behaviors that can be (and have been, at JRC) successfully treated with the GED treatment program of rewards supplemented with skin shock.
    

3. warehousing. Another alternative that is used frequently is to simply not place any demands on the student at all. Just leave the student alone, feed and house him/her, but do not try to get the student to do anything that he/she does not want to do. Don't try to teach the student new skills and don't try to decrease the problem behaviors. This abdication of any responsibility to provide education or treatment and is clearly inhumane, because it treats the individual in some respects like a caged animal.
    

4. intense 1-1 staffing. A very popular alternative is to assign one or two persons to stay close to the individual at all times, ready to jump in and prevent any problem behaviors when they start to occur. This strategy may temporarily prevent problems, but it is also an abdication of the responsibility to provide education and treatment. Throwing a lot of staff into a room into close proximity with a student who has major problem behaviors is not the same as treating those behaviors so that they no longer are problematic.

There have always been persons of good will and good intentions who are strongly opposed to aversives. They oppose aversives with the same passion and mission as those who strongly oppose the use of animals in research (animal rights advocates) and the procedure of abortion. A notable characteristic of those who oppose aversives, whom some have termed the "anti-aversive advozealots," is that they are unwilling to evaluate aversives by scientifically weighing their pros and cons, or by evaluating their benefits against their risks. They believe that these practices, regardless of what practical benefits they may give to individuals or to mankind, are simply Wrong (with a capital "W") philosophically.

Even if one were to point out the fact that the use of aversives treatment procedures, as a supplement to other reward procedures, have saved persons' lives that otherwise would have been lost (something that is clearly true), that would not convince such persons to allow aversives to be used. Conversely, even if the removal of aversives leads to a child's death, that would not be enough to convince them that there might be a legitimate place for the careful, controlled judicious use of aversives in such severe cases.

In fact we had just such a case at JRC. A severe self-abusive student who had come to us in a wheelchair had, with the help of aversives, as a supplement to his program that was otherwise overwhelmingly positive in nature, managed to stop his scratching and even attend public high school in Attleboro Mass. However, the anti-aversive advozealots managed to convince the young man's mother to remove the student from our care and to allow her son to be transferred to an anti-aversive service organization who placed the young man in an apartment in Brooklyn that he shared with another student. (The story of this young man, named James Velez, was told by reporter Sonny Kleinfeld on two straight major front page articles in the New York Times.) Within about 9 months of James' departure from JRC, however, I was reading the obituary of this young man in the same New York Times. He had scratched himself to death (the scratching had led to blood poisoning and eventually, to paralysis). Nonetheless the anti-aversive advozealots still claimed that they had "liberated" him from JRC and to this day probably still believe that he represented a shining example of the fact that handicapped persons can live a normal life and do not have to be treated with aversives.

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"Aversives and the GED skin-shock are overkill. Recent developments in the field of Positive Behavior Supports show that even severe behaviors can be successfully treated with positive programming only."

Positive programming is often cited as an alternative to punishment procedures such as the GED skin shock used at JRC.  The paper, "Positive Behavior Support for People With Developmental Disabilities[1]," published by the American Association on Mental Retardation in 1999,  is the most comprehensive review of the literature on positive programming that has ever been done. It is a review of 216 articles in which positive programming was used, and which appeared in 36 different journals. The authors of the review are among the most distinguished names in the field of positive programming.

The basic finding of this paper, however, was that positive programming was effective for only 50% of the  cases. The question is, "What about the other 50% of the cases that cannot be treated successfully with positive programming?"  Other treatment options must be available that can reduce the frequency of dangerous behaviors to a level where the individual is no longer a danger to him/herself or others.  Behavioral skin shock is a well established treatment that can accomplish this goal.

At JRC, we employ all of the available positive programming methods in an attempt to decelerate problem behaviors.  We believe that our positive only programming is stronger and more varied than can be found in any other program in the country.  Witness our big reward store, contract stores, classroom reward stores, reward boxes in classrooms and reward activities (such as field days).  Positive only methods are used continuously throughout treatment, even when supplementary aversives are part of an individual's treatment plan. 

In 2005 an article appeared in the Journal of Positive Interventions -- a key journal of those who support positive-only interventions reporting a survey that was taken among 134 persons who are considered to be experts in positive programming. These experts were asked to evaluate the acceptability of a number of treatment techniques. The paper reported the surprising result that 10% of these experts in positive programming found the use of behavioral skin shock to be an acceptable form of treatment.

What makes this result even more interesting is the fact that the 134 experts were gathered from fields that would be the least likely to support intrusive procedures. Indeed one of the authors has testified in two of JRC's court hearings against ever using contingent shock for anyone and is a member of TASH, is an organization that would like to close our facility.

[1]  Carr, E. G., Horner, R. H., Turnbull, A. P., Marquis, J. G., Magito McLaughlin, D., McAtee, M. L., Smith, C. E., Anderson Ryan, K., Ruef, M. B., & Doolabh, A. (1999). Positive behavior support for people with developmental disabilities: A research synthesis.       Washington, DC: American Association on Mental Retardation.

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 "In 1997 the Individuals with Disabilities Education Act (IDEA) was amended to explicitly require the use of positive behavioral supports and services for students with disabilities"

The above statement that IDEA "explicitly requires the use of positive behavioral supports and services" implies that aversives are prohibited by IDEA. However, that is a serious misrepresentation of what the IDEA really says.

In a recent book, Controversial Therapies for Developmental Disabilities,[1] James Mulick and Eric Butter wrote an excellent chapter entitled, "Positive Behavior Support: A Paternalistic Utopian Delusion." They write that:

"PBS [Positive Behavior Support -- my insertion] leaders even managed to use their inside status with the U.S. Department of Education to insert a vague and somewhat ungrammatical reference to the following in the 1997 reauthorization of IDEA (Public Law 105-17, p.57):

(B) CONSIDERATION OF SPECIAL FACTORS- The IEP Team shall:

(1) in the case of a child whose behavior impedes his or her learning or that of others, consider, when appropriate, strategies, including positive behavioral interventions, strategies and supports [italics added] to address that behavior (Public Law 105-17, p.57)

and later:

(C) REQUIREMENT WITH RESPECT TO REGULAR EDUCATION TEACHER--

The regular education teacher of the child, as a member of the IEP Team, shall, to the extent appropriate, participate in the development of the IEP of the child, including the determination of appropriate positive interventions and strategies [italics added] and the determination of supplementary aids and services, program modifications, and support for school personnel consistent with paragraph (1)(A)(iii). (Public Law 105-17, p.57).

. . .There is no other reference even vaguely related to PBS in the law." [2]

Note that in section B, dealing with the IEP team, positive behavior supports are not mandated. What is mandated is simply that the IEP team should consider them. Also notice that the phrase "positive behavioral interventions, strategies and supports" are said to be included in what are referred to simply as "strategies," implying that there might be other types of strategies to be considered as well. Also note that there is absolutely no prohibition against the use of aversive therapy procedures.

Note that in section C, positive behavior supports again are not mandated. The regular education teacher is simply to participate in determining the "appropriate positive interventions and strategies." The regular education teacher is also to participate in determining "supplementary aids and services, program modifications, and support." Supplementary aversives could easily be considered to be included in "supplementary aids and services, program modifications, and support." Again, there is no prohibition against aversive therapy procedures.

There is nothing problematic for JRC in the fact that the 1997 reauthorization of the law encourages positive programming. JRC believes in positive programming and has an unusually strong component of positive programming. JRC tries positive programming first, usually for a substantial period of time, before considering the adding of supplementary aversives. Fifty percent of JRC's students are successfully treated with positive programming alone.

JRC received a very favorable review after a 2 day visit by NYSED staff in September, 2005. No mention was made in that report of any concerns that JRC was violating the IDEA due to its use . Similarly, an extensive review of JRC was done by NYSED in 1999, at the conclusion of which JRC continued to be fully approved. No mention was made in the report associated with that visit, either, that JRC was in any violation of the IDEA.

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[1] Jacobson, J.W., Foxx, R.M. and Mulick, J.A., Controversial Therapies for Developmental Disabilities,  Lawrence Erlbaum Associates, Publishers, 2005.

[2]  Ibid, p. 398

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"The GED skin shock may be alright to use with lower functioning students but should not be used with students who have higher levels of cognitive functioning."

JRC's belief is that if a treatment procedure is effective, JRC should make it available to the parents of all of our students who wish it for their child and not limit its availability to those who function at a low cognitive level. To do so would be to discriminate against the higher functioning students.

The GED skin-shock procedure, when applied to higher functioning students is even more effective than it is with lower functioning students. Dr. Israel, JRC's Executive Director, reported this in a paper he presented at the 2002 annual convention of the Association for Behavior Analysis. The paper is can be found here.

As noted there, in some cases higher functioning students stop their problematic behaviors as soon as they are informed that we have secured court approval for the use of the GED, and we never actually have to make an application. In other cases, the behavior decreases in frequency much faster and more precipitously than it does when the GED is applied to lower functioning students.

Higher functioning students sometimes even request that the GED skin shock be added to their treatment programs. This is because they clearly see how much it has helped other students who function at their level, and who have obviously benefited once they started on the treatment. They see that other students (who have started GED treatment) do one or more of the following things: avoid being restrained; advance from spending time in one of our Small Conference Rooms, or in one of our Alternative Learning Centers, to being able to work in a regular classroom; earn more rewards; go on field trips; advance to a higher level residence with fewer staff and more privileges; and generally be happier and have a higher quality of life.

Higher functioning students are able to tell others how much it has benefited them. The testimony of such students at a recent legislative hearing for an anti-aversives bill in Massachusetts was extremely compelling. Two of the higher functioning students who testified were former students who had benefited from GED treatment while they were enrolled at JRC and who appeared at the hearing voluntarily to help JRC deal with the proposed legislation.

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"there is extensive research and disagreement as to the efficacy of the use of aversives."

This is not true. An event, when used as a consequence for behavior, is called an aversive if it decreases the future frequency with which that behavior occurs. If it does not, it is not even called an aversive.  Aversives, in other words, are by definition effective in decreasing the frequency of the behaviors they are used to consequate.

Even supporters of nonaversive treatment acknowledge the effectiveness of aversives when used to decrease the frequency of problem behaviors. Michaels, Brown and Mirabella, in their important review article surveying what procedures are acceptable to a group of nonaversive experts, all of whom were strong supporters of nonaversive treatment, acknowledge that the professional literature shows that both nonaversive and aversive treatments are effective.

"As the literature base reveals, there is supportive literature demonstrating the effectiveness of the full range of decelerative consequence-based procedures (e.g., Ricketts, Goza, & Matese, 1992; Wiliams, Kirpatrick-Sanchez & Iwata, 1993), and literature that supports the use of alternative [nonaversive] procedures (e.g., Horner et al., 1990; Jackson & Panyan, 2002; Koegel, Koegel, & Dunlap, 1996). If the literature is available to support any position, then likely other factors contribute to professionals' decisions concerning the use of the procedures."[1]

Critics of aversive procedures sometimes acknowledge that aversives are effective when used to decrease the frequency of a behavior. But, they point out, the behavior sometimes returns to its pre-treatment level when the aversives are withdrawn from use. The problem with this argument is that it is faulting aversives for something they were never intended to be able to do  "i.e., to continue to cause a behavior to be low in frequency long after they are no longer used as consequences for behaviors. As I have pointed out in my Letter to Bob Frank behavior tends to adjust to whatever the current contingencies are in the individual's environment. Expecting an aversive consequence to keep having its effect long after we have stopped using it is to criticize aversives for something that we have no right to expect them to do.

The same criticism can be made of positive rewards. They, too, can be said to be temporary in their effect. They increase the frequency of a behavior when they are used; however, when they are discontinued, we do not expect them to keep having their accelerative effect long after we have stopped using them.

I have also pointed out in my letter to Bob Frank that  letter that even though aversives may be temporary in their effect, they nonetheless can create a window of opportunity during which rewards and educative procedures can be used to teach new skills. If those new skills produce their own rewarding consequences and therefore keep going, then the aversives have played a very important role in making permanent changes in the student's repertoire of behaviors.

Crighton Newsom and Kimberly Kroeger make the same points in their review of the nonaversive treatment movement: (bracketed material supplied)

The original TASH [The Association for the Severely Handicapped] resolution [banning aversives] was based in part on the board's belief that evidence for the effectiveness of aversive interventions was 'questionable' and 'on the observations among board members that these procedures were being both abused and misused in a variety of settings that serve persons with disabilities.' (Guess, 1990). However, even Guess own literature review (Guess, Helmstetter, Turnbull & Knowlton, 1987) like those of other reviewers, actually showed that punishment procedures were generally effective in reducing behaviors. The evidence was 'questionable' only in the sense that punishment was faulted for failing to do more than it was ever intended to do, that is, produce not only response reduction but also long-term maintenance and generalization. (There was, however, no acknowledgment that reinforcement also does not automatically produce maintenance and generalization of treatment gains.) The main issue was actually the second mentioned, the misuse of punishment procedures. But instead of addressing what is a regulatory, credentialing , training and oversight problem with a proposal for better controls, the TASH board chose to eliminate aversives as an option altogether.[2]

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[1] Ibid, p. 107

[2]  Crighton Newsom and Kimberly Kroeger, "Nonaversive Treatment" in Jacobsen, J.W., Foxx, R.M. and Mulick, J.A., Controversial Therapies for Developmental Disabilities, 405-423

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"How come all the other [treatment centers] in the country are able to manage without [the use of skin shock]?" (Question asked by Ed Carr, Ph.D. Professor of Psychology SUNY Stony Brook, in an article about JRC in People Magazine, April 17.

1. Many of the programs Dr. Carr refers to have handled their difficult-to-treat students without skin shock in a simple way. They have referred them to JRC.
   
   We have compiled a list of all prior placements of all of our current students who are receiving treatment with the GED skin shock. An examination of the list, which is shown by clicking here, shows the following:

   • Students usually come to JRC only after they have been tried in several other programs. The average student has been in 3.23 other programs before being referred to JRC. In one case a student was in 18 different programs before coming to JRC. He was re-admitted to a few of those programs on multiple occasions. So actually he had a total of 29 separate admissions before he was placed at JRC. For a student-by-student analysis showing how many programs each student was in before coming to JRC, please click here. Although students sometime leave a program for reasons other than the program's lack of effectiveness, in most cases if a program is serving a student effectively, he will remain in that program.
      

   • The programs listed here include many well known programs that have reputations for not using aversives. Click here to view the list of these programs and number of current GED students who attended each. Click here to view the same information given here but displays it in alphabetical order by name of program.
      

   • On the recent CNN program about JRC's treatment, psychiatrist Bennett Leventhal made the following claim:

     There are centers, for example, such as the Kennedy Krieger Institute at Johns Hopkins which uses a positive reinforcement center and in six to eight weeks has children reduce these very behaviors. They disappear, the patients are discharged, and rarely need to be continued with the treatments like -- and never need to use aversives like shock treatment.
     
     The information on this page proves this to be false. Two of JRC current GED students were treated at Kennedy Krieger before being placed at J