Do Aversive Procedures Work?Do Aversive Procedures Work?
Without question, aversive procedures are likely to have a measurable, if temporary, impact on the frequency and/or severity of the behaviors to which they are applied. Most of us would change our behavior if pain were used as a consequence. However, "if our criterion of 'effective' includes long term behavior change which maintains in a variety of normalized and integrated community environments, educative approaches are by definition more effective than aversive ones". The initial suppression of behaviors is commonly reported in the literature but the reported effects of generalization and long term maintenance are not impressive. This is true because aversive procedures by their nature:
do not teach replacement behaviors, do not address the functions of the behaviors, do not leave the learner with new skills for dealing more appropriately with his or her frustrations and, perhaps most importantly,do not require that environments and expectations be modified to be more responsive to the preferences and needs of the individual. In addition to the resulting compromises of human dignity, the use of aversive procedures has inherent problems and side effects. When aversive procedures are used:
Behavior change is often only temporary. When punishment is stopped, the behavior is likely to return.Behaviors other than those being punished can be inhibited.The effects can be very situation-specific.Social withdrawal (the person being punished avoiding the punisher) can result.Aggression on the part of the person being punished can result.Emotional side effects, such as anger, anxiety, depression, and lack of trust can be produced.Physical side effects, such as high blood pressure, muscle tension, increased respiration, and heart palpitations can occur.Their use can become "addictive" to the punisher, particularly because the use of aversive procedures often has immediate short-term effects.It is very likely that there will be escalation of techniques used or that techniques will be applied to non-dangerous, non-disruptive behaviors.Although aversive procedures often result in a decrease of problem behaviors, this is not always the case. One reviewer of this paper, a national expert in the humane treatment of people with disabilities wrote:
I personally know eighteen children and adults who have been in cattle prod "programs" for 3-9 years and the shock continues. Only those cases that work are reported in the literature. I recently worked with a little boy on whom a well known and well published researcher had used a cattle prod. He told the boy's mother to go to a farm implement store and buy a prod and use it for P.'s self injury. He trained her and consulted with her over the days, weeks, and months. When it did not work, he said, "Increase the shock". When it still did not work, he said, "Do it on more sensitive parts of the body!". When it still did not work, he urged her to shock the child between his legs, under his arms and behind his knees and to increase the shock some more. This went on for over a year. By the time I saw the child he had over 400 burn marks on his tiny body. Worse, he walked like a robot, kept his gaze down like a submitted being and, when he did look up, his eyes were empty. The behaviorists are bent on control and when not gotten they are driven to escalate their arms. This past year I also worked with a young woman receiving "faradic therapy" via a remote control device. Her "staff" had placed electrodes between her legs and when she became aggressive they simply zapped her. She too was machine-like. The first time I saw her she got up from her bed in a padded suit and a masked and locked helmet. She walked with her arms outstretched saying over and over, "Go home? Go home? Go home?"
One must ask, as one author does, at what point do therapy and cruel and unusual punishment part company? "Aversive therapy is arguably in a class of its own. It aims directly to produce pain in an individual, and from the individual's experience of acute pain flows all of the treatment's supposed 'therapeutic' merits, namely, the cessation of an unwanted behavior". Though other treatments and procedures (surgery, dental work or physical therapy, for instance) can cause pain, the pain is an undesirable by-product of a beneficial procedure. The surgeon, the dentist or the physical therapist does not deliberately set out to cause pain. The use of aversive procedures in the modification of behaviors is the singular example of professionals choosing to inflict pain in an effort to provide treatment.
When an individual is at imminent risk of hurting him/herself or others, brief physical restraint to prevent injury may be necessary. Brief physical restraint under these circumstances is not treatment. It is used to assure safety in an urgent situation. Treatment is meant to reduce or prevent further occurrence of the behavior by increasing the individual's competence in dealing with the circumstances that provoke the endangering behavior. Individuals with disabilities who act in ways that are dangerous deserve the same protections afforded prisoners against cruel and unusual punishment. Additionally, they have a right to treatment that is both humane and effective.
The reduction of dangerous or disruptive behavior can be achieved without sacrificing the development or maintenance of self-esteem, the development of relationships with others, or the preservation of human dignity. We cannot afford to define success as simply the reduction of a behavior without considering the sacrifice in terms of quality of life and the well being of the people who are subjected to these techniques.