Should only positive reinforcement be specified or should plans be made to use multiple contingencies that include aversive consequences? With “normal” subjects addition of a mildly aversive contingency will often neither help nor hurt. Hundert (1976) compared giving tokens, taking tokens away for failure to emit the target behaviors a mildly aversive token cost punishment contingency and combining giving tokens and taking tokens away. The goal behaviors were the production of correct finished arithmetic problems and paying attention to the teacher. All procedures produced similar large gains in the elementary school student subjects. During the baseline two period, inattention, but not the production of arithmetic problems, declined to baseline one level. Arithmetic competency appeared to be self-rewarding. Not paying attention, however, may be intrinsically more reinforcing than paying attention to arithmetic lectures.
If one child gets more reinforcement from the attention of
peers than the modifier can deliver for desirable behavior, then not only will
that child’s undesirable behaviors continue, but contingencies applied to other
children will be disrupted. In such cases, aversive controls must be added to
the modification plan to suppress undesirable responses. The mildest technique
is to ignore the undesirable behavior and hope it will extinguish. If this
fails try a token cost plan or remove the subject the situation where positive
reinforcers may be earned (time-out).
If these mild procedures fail, then more extreme punishment contingencies may
become necessary. Physical punishment is rarely advisable because it may be
difficult to use such punishers at a strength that will be effective without
producing severe side effects in the person punished and without exposing the
modifier to potential legal and ethical sanctions. Severe physical punishment
is usually forbidden in most institutional settings including schools.
Formerly, the rules were less stringent and Ivar Lovaas legally used electric
shock to successfully treat institutionalized autistic children.
Ivar Lovaas and a shocking application of conditioning principles
While there no longer seems to be widespread objections to behavioral
interventions when these involve positive reinforcement procedures, a great
deal of controversy has surrounded the use of aversive or restrictive
procedures designed to decrease maladaptive behaviors.–O. Ivar Lovaas, 1987,
p. 311.
Lovaas (Chance and Lovaas, 1974) reported dramatic success in treating
“untreatable” autistic children by using severe physical punishment.
He (in Lovaas, Schaeffer, and Simmons, 1965) listed three ways in which
aversive events can be used as tools in therapy. The first approach used
punishment procedures similar to the aversion therapy approaches (Chapter
Nine). The second used the negative reinforcement paradigm, in which shock is
removed or withheld, contingent upon specified behaviors (Chapter Four). The
third conditions new SDs to pain reduction (negative reinforcement), with the
goal of having these SDs become conditioned, positive reinforcers. These
results replicate Dunham’s finding that his subjects increased alternative
behaviors associated with shock offset. According to Lovaas, the effects of
this third kind of aversive procedure would be an increase in positive
alternative behaviors, as a paradoxical by-product of pain. Let us now examine
Lovaas’s work.
Childhood autism is characterized by self-stimulatory behaviors, which may be
self-destructive, and a general lack of social responsiveness. Autistic
children do not respond well to traditional psychotherapy and shock procedures
were used as a last resort. In the first experiment (Lovaas et al., 1965), two
five-year-old children were placed barefoot on a shock grid floor and escape-
avoidance procedures were initiated. One of the experimenters stretched out his
arms and said, “Come here.” Any movement towards the experimenter
terminated the shock for that trial. If the child did not move, the second
experimenter pushed him in the direction of the first experimenter and
terminated the shock. This escape phase was followed by an avoidance procedure
in which shock was withheld if the child approached the experimenter within
five seconds after the “come here” command.
Shock was also used to punish self-stimulation and/or tantrum behaviors. The
verbal command “No!” was associated with shock and acquired limited
effectiveness as a conditioned aversive reinforcer. It was found that not only
did the children learn to respond to the experimenters to avoid or escape
shock, but the verbal command “come here” became effective in
environments equipped with shock equipment. As predicted by Lovaas, alternative
behaviors did appear. Surprisingly, these included the subjects’ seeking the
experimenters’ company, showing affection, and increasing their alertness to
the environment. Lovaas and colleagues (1965) commented that during successful
avoidance trials the children ”appeared happy.” There was also limited
generalization of the adult-seeking and affectionate behavior to situations
outside the shock-avoidance training environment.
Lovaas tested the hypothesis that the adults who had been associated with safety from shock following avoidance trials and who had hugged and fondled the children when the children approached would become conditioned positive reinforcers. The children were taught to operate a candy dispenser, which gave them both candy and a view of the experimenter’s face. During extinction trials the photograph of the face of the experimenter (associated with shock reduction) was more effective in slowing down the rate of extinction than photographs of other faces. In addition, ward nurses reported that following the shock avoidance training, the children began, for the first time, to come to them for comfort when they were hurt in play. On the negative side, Lovaas and colleagues (1965) noted that the positive shock-produced changes in behavior often showed limited generalization to new environments and people and extinguished rapidly. The aversive techniques helped manage autistic children but did not “cure” autism.
Lovaas (1974), was deeply concerned with the ethical and practical issues surrounding the use of extreme aversive techniques such as shock. First, he recommended using shock only for dealing with extreme behavior such as self-mutilation. Some autistic children have literally chewed off fingers and total lack of responsiveness to others. In these cases, shock inhibited destructive behavior that formerly had been reinforced by adults who had let the child have his or her own way to avoid temper tantrums or self-mutilation. Second, he recommended that therapists using aversive techniques have a deep love for children, be patient enough to provide large doses of affection for positive behavior and be willing gradually to shape desired behaviors that can compete with the destructive behaviors. Third, he suggested training the parents of autistic children in operant control procedures including aversive techniques. The goal was for these parents to overcome their own feelings of inefficacy and frustration until they could successfully manage the behavior of their autistic children. This involved showing the parents how acknowledging tantrums and self-mutilation may have reinforced these behaviors and coaching the parents to “load the child up with love” for positive behavior. He taught the parents that suppressing bizarre behavior (such as self- mutilation) through aversive control provided the opportunity to begin building up appropriate behaviors (Lovaas, 1974). Fourth he advocated such treatments only if they were the least restrictive effective treatment. That is, to be used only after all nonaversive treatments have failed and the only alternative is physical or chemical restraints. Finally, he recommended that extreme aversive consequences only be used by doctoral level professionals or other highly trained persons working under supervision (Lovaas and Favell, 1987).
Ethical codes require a balancing test of the benefits and costs of research or therapy techniques. Lovaas notes that the costs of NOT effectively treating severe aggressive or self-mutilation behaviors are high. He concluded that the high benefits produced by his treatments justified the discomfort suffered by the subjects (Lovaas and Favell, 1987). Urged on by child’s rights advocates, the California legislature came to the opposite conclusion. New laws made it impossible for Lovaas to continue his shock treatments at the University of California at Los Angeles. Currently, California laws forbid such treatments on the theory that they constitute abuse. Many states have adopted stringent procedures to review and monitor the use of aversive control in therapeutic settings and others have banned some treatments altogether (Repp, & Singh, Eds., 1990).”
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Author, Mom, Founder, and President of The Cherab Foundation
Lisa Geng is an accomplished author, mother, founder, and president of the CHERAB Foundation. She is a patented inventor and creator in the fashion, toy, and film industries. After the early diagnosis of her two young children with severe apraxia, hypotonia, sensory processing disorder, ADHD, and CAPD, she dedicated her life to nonprofit work and pilot studies. Lisa is the co-author of the highly acclaimed book “The Late Talker” (St Martin’s Press 2003). She has hosted numerous conferences, including one overseen by a medical director from the NIH for her protocol using fish oils as a therapeutic intervention. Lisa currently holds four patents and patents pending on a nutritional composition. She is a co-author of a study that used her proprietary nutritional composition published in a National Institute of Health-based, peer-reviewed medical journal.
Additionally, Lisa has been serving as an AAN Immunization Panel parent advocate since 2015 and is a member of CUE through Cochrane US. Currently working on her second book, “The Late Talker Grows Up,” she also serves as an executive producer of “Late Talkers Silent Voices.” Lisa Geng lives on the Treasure Coast of Florida.