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Evaluating the use of Aversive Techniques in the Treatment of Challenging Behaviour in Response to the Statement: 'Aversives should never be used in treating challenging behaviour'

Evaluating the use of Aversive Techniques in the Treatment of Challenging Behaviour in Response to the Statement: 'Aversives should never be used in treating challenging behaviour'

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An essay for the 2011 Undergraduate Awards Competition by Eamon Doyle. Originally submitted for PS317 History of Psychology and Current Issues at National University of Ireland Galway, with lecturer Triona Tammemagi in the category of Psychology
An essay for the 2011 Undergraduate Awards Competition by Eamon Doyle. Originally submitted for PS317 History of Psychology and Current Issues at National University of Ireland Galway, with lecturer Triona Tammemagi in the category of Psychology

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Published by: Undergraduate Awards on Aug 29, 2012
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03/16/2014

 
Evaluating the use of Aversive Techniques in the Treatment of Challenging Behaviour inResponse to the Statement: 'Aversives should never be used in treating challenging behaviour'
The use of treatment procedures which intentionally inflict discomfort, distress, and often pain upon subjects has generated great debate surrounding the nature of the treatments, the efficacy of those methods, and the well-being of those subjected to them. Needless to say we may all agree as psychologiststhat an individual should have the right to treatment, moreover the right to a treatment that will alleviate negative symptoms as quickly and as painlessly as possible. However few of us explicitly denote the infliction of pain and discomfort to reach these goals. This discourse derives from modern society’saffiliation to human rights, protection of the weak, and the general softening of attitudes towards the sick that has developed over the last century. This liberal, ethical perspective is all well and good. But are we willing to use drastic measures in the treatment of seriously challenging behaviours? If all else f ails should we apply restrains and electric shock to a child, who left alone would proceed to mutilate himself? Or should we continue our less intrusive treatments regardless of their efficacy? Perhaps a short sharp shock is more ethical than the drawn out suffering of the patient.
This point of view is supported by Butterfield (1990) who argues that a treatment is ethical insofar as the treatment itself and the resulting condition cause less physical and psychological harm than if the patient received no treatment. Butterfield is far from alone in this fieldof thought as there are many who posit that not using punishment in situations where other treatments have been utilised unsuccessfully withholds a potentially effective treatment, and kee ps the patient in a dangerous or painful state (Cooper, Heron & Heward. 1987). In this way, avoidance of aversive techniques is the unethical choice, not the use thereof. By aversive technique we mean that upon presentation of a challenging behaviour, a stimulus is introduced thatupon its arrival depresses the behaviour, and upon its contingent removal positive behaviour are strengthened (Cooper, Heron & Heward. 1987, p411). In this way, behaviour can be managed by use of (or relief from) unpleasant or uncomfortable stimuli. However, for the purpose of this paper we may focus on the effect aversive have upon behaviour rather than slip into thetrap of dealing with the subjective interpretations of ‘unpleasant’ or ‘uncomfortable’ as theymay vary from person to person. Now we must decide whether the efficacy of an aversive procedure can determine whether or not it may be deemed ethical. In his paper, Butterfield (1990) concludes that serious s
 
elf-injurious behaviour (SIB) such as eye-gouging can be treated ethically and scientifically in a manner that will yield great rewards of knowledge for future treatment programs. More saliently for this paper, he notes that ‘ethically unimpeachable’ treatments may be developed, even those treatments that are punitive and coercive in nature (Butterfield, 1990 .p255).In this article we shall explore the validity of Butterfield’s assumption in light of recent debate. More specifically, we will examine contemporary research into the use of aversivetechniques in the treatment of challenging behaviour. The controversial use of aversive techniques in the Judge Rotenberg Centre will be examined as an example of the implementation of aversive methods in an organised and modern setting; and also as a medium through which toexamine the long-term efficacy of aversive measures. Through this inquiry we hope toestablish whether or not aversive procedures can be used effectively and ethically in managing such behaviours, and furthermore to what degree empirical research support the view that aversive techniques should be avoided in the treatment of challenging behaviour; therebydetermining the validity of the statement:
‘Aversives should never be used in treating challenging behaviour’ 
  __________________________________________________ Duker & Seys (1996) conducted a study into the long term effectiveness of ElectricalAversion Treatment (EAT) on patients exhibiting life-threatening SIB and aggressive behaviour. The treatment was given to a sample of 12 patients, with an equal ratio of male to femalechildren, all of whom demonstrated challenging behaviours (11 SIB, 1 aggressive). The dependent variable under examination was the degree to which physical restraints were necessary(i.e. fewer restraints needed signify a decrease in challenging behaviours). Less intrusive treatments such as extinction procedures, Differential Reinforcement of Other behaviour, and gentle teaching had failed to eliminate SIBs along with various pharmacological interventions such as antipsychotics and opiate antagonists. EAT was therefore a last resort for both parents and practitioners. Electrical charge was administered via remote control to the upper thigh of the child upon occurrence of SIB or other unwanted behaviour. This was first applied in a contr olled lab by a psychology practitioner to determine response, and was then further administer 
 
ed by those in charge of the natural environment of the child. This treatment was combined with positive reinforcement of extended intervals of cooperative behaviour (Duker & Seys, 1996). Duker & Seys (1996) found that treatment was wholly successful in the cases of seven par ticipants who no longer needed physical restraints; three individuals experienced moderate results; and the remaining two exhibited no decrease in SIB. From this we may conclude that administration of EAT resulted in improvements to the majority of the sample group, and therefore was more effective than ineffective. However we must examine the limitations of this study in order to get a more 3-dimensional view of the actual efficacy of the program. Firstly, the sample size of 12 is much too small to make any statically significant claim as to the efficacy of EAT. Secondly, the authors note that of the seven successful results, four of those are of inadequate follow-up length (Duker & Seys, 1996 .p300). Given that the long-term effects of aversive techniques are most debatable, this is a substantial flaw. Thirdly, the actual application of EAT can be problematic for the practitioner in that decisions as to what constitutes a tar get response may be arbitrary as the nature of SIB can fluctuate between and within subjects.Finally, EAT was initiated at 12 separate points in time, and decreases in SIB were most significant at these points. This abrupt nature of the decline may suggest that EAT treatment is notcompatible with long-term, consistent benefits.We can see from the work of Duker & Seys that the use of aversive techniques was far from a complete success. However, it is a dated study, and there are those that still argue thatonce positive-only behavioural interventions have been exhausted, more aversive techniquesare necessary to succeed in alleviating challenging behaviours. A more recent study seems toclearly demonstrate the longitudinal efficacy of an electric shock treatment program on decreasing the occurrence of aggressive behaviours in participants (Israel, Blenkush, von Heyn &Rivera. 2008). Israel et al. (2008) conducted research into the use of Contingent Skin-Shock (CSS) as a supplement to a comprehensive behavioural program in the treatment of aggressive behaviours over a 3 year period. CSS is similar in manner to the previously mentioned EATsystem; in that electrodes shock the body contingent on unwanted behaviour. It was administered by means of a Graduated Electronic Decelerator (GED) which allowed shocks of two levels to be executed, GED-1 and GED-4. This differential allowed the administrator to switch toGED-4 if the lower level shock was not sufficient. The subject could wear between one and fi

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