The Problem

The Problem

It is estimated that there are nearly 4 million individuals with developmental disabilities in the United States. The largest percentage of these individuals have mental retardation. Other diagnoses grouped under this category include autism, cerebral palsy, and epilepsy. A study in 1988 estimated that 160,000 individuals with developmental disabilities exhibit a significant degree of destructive behavior. "Destructive behavior" is defined as the exhibition of those behaviors that, due to their intensity or frequency, present a danger to the individual exhibiting the behavior, to other people, or to property. One approach to controlling these and other behaviors has been to use what has been called "aversive therapy". Aversive interventions use painful stimuli in response to behaviors that are deemed unacceptable. Aversive procedures are often used as part of a systematic program for decreasing certain behaviors. These procedures have some or all of the following characteristics:

Obvious signs of physical pain experienced by the individual;

Potential or actual physical side-effects such as tissue damage, physical illness, severe physical or emotional stress, and/or death;

Dehumanization of the individual;

Significant discomfort on the part of family members, staff or caregivers regarding the necessity of such extreme strategies or their own involvement in such interventions;

Obvious repulsion and/or stress on the part of observers who cannot reconcile such extreme procedures with acceptable standard practice;

Rebellion on the part of the victim against being subjected to such procedure;

Permanent or temporary psychological or emotional harm.

Throughout history the approach to the management of difficult behaviors has been one of "treat the symptom and ignore the disease". That is, the behavior itself was viewed as the problem. Better approaches include a process for identifying underlying causes for the behavior. Leaders in the field of developmental disabilities now know that even the most dangerous behaviors can be changed without using aversive procedures. This can be accomplished when the people supporting the individual are able to determine the purpose or cause of the behavior. They then can teach new behaviors or provide alternate means for accomplishing the needs that the person is attempting to communicate. As one author states, "Ethically suspect is the notion that it is permissible to attempt to control someone's challenging behaviors through aversives when serious attempts are not being made to understand and address the causes that may be giving rise to those behaviors in the first place".

Many people with mental retardation lead lives of almost total control from cradle to grave. Even such simple daily decisions such as when to wake up, whether to take a bath or shower, what to wear, and when or what to eat are often made for them. Decisions are made with regard to where and with whom people will live, and the manner in which they will spend their days. These decisions are most often made on the basis of convenience and cost effectiveness rather than in response to individual preferences. All people with disabilities have the ability to make and express choices, although it may take a patient and skilled person to elicit and interpret such expressions. It should not be surprising that an individual would respond in frustration, at best, to the lack of opportunity to make major and minor life choices.

It is proposed that behaviors previously viewed as destructive or troublesome are likely the person's attempt to have impact on his or her environment. People with disabilities who have what are thought of as behavior problems, perhaps instead should be viewed as objective critics of society's approach to serving them. Their behaviors, rather than being viewed as maladaptive, should be interpreted as highly adaptive responses to a maladaptive environment.

The application of pain has been considered by some to be a necessary means to control dangerous behaviors. However, as can be seen from the examples in the introduction, painful or aversive procedures are applied not only to dangerous behaviors, but frequently in an effort to force an individual to conform to arbitrary norms, to be more compliant or to appear more "normal". The director of one residential school for children with disabilities, was asked under what circumstances he would approve the use of aversive procedures. He described his criterion as "any behavior that would not be appropriate in a family restaurant". Using this criterion, behaviors such as rocking, biting one's nails, twisting one's hair, stuttering or moaning are punished with water spray, jalapeno pepper to the tongue, spatula spanks, rolling pinches and electric shock at this school.