SIBIS, averisves and open minds
Tom=Linsche...@aloha.chi.ohio-state.edu
have occasionally monitored postings with special interest in the opinions of
parents, especially regarding the issue of "aversives". I was involved in
the development of SIBIS and published some of the original research on it as
well as the use of contingent electric shock for the treatment of rumination
as far back as the 1970s so I have to put my two cents worth on the aversives
issue.
First, the isssue is never - aversives vs positive only treatment - the issue
is - does an aversive need to be added to a positive intervention to achieve
the desired success? Anti-aversive advocates would have you believe that you
have to choose between the two - not true.
Second, people often assume that shock treatment means that the person is
shocked on some ongoing basis. Indeed, if contingent shock treatment is
ultimately successful, the person isn't getting shocked. That is, if the
rate of head hitting is zero, no shocks are given. One boy treated with
SIBIS went an entire school year without a shock because he did not hit
himself. His rate had been 120 hits per minute during baseline sessions
prior to treatment. If shock treatment does not result in a dramatic
reduction in SIB then it should not be continued....... deciding on how many
shocks vs how much suppression is the job of parents, clinicians and
oversight committees.
Third, in response to the choice issue, over half of the individuals that I
know of who have been treated with SIBIS show behaviors indicating that they
want the device on. If these people actively went to the refrigerator and
got a glass of soda, we would conclude that they wanted soda, correct?
Stephen Drake's arguement that some choices should never be given (e.g.,
slavery) is ludicrous and irrelevant in this case. Slavery is illegal
because a person is not given a choice. If I want to make an agreement to
serve someone in return for food and lodging, I can do so of my own free
will, the person can't force me - that is the illegal part. Parents or
guardians can legally make informed choices for their children. If that
choice is not illegal and is made in good faith then so be it. It is not a
problem that people have different opinions regarding aversives, it is a
problem when some try to impose their opinions on others through legislation
or intimidation. Sojolan can tell you about that feeling....
Many in the academic and DD community don't give much credence to Syracuse
University Special Education anyway because of the debacle of FC and other
matters (cf. Linscheid & Landau, Going all out pharmacologically: A re-
examination fo Berkman and Meyer's, Alternative strategies and multiple
outcomes in remediation of severe self-injury: Going all out non-aversively,
Mental Retardation, 31, 1-6).
Power to responsible parents who make the efforts to help their children when
the system fails them, let's listen to them and lets also get the facts
before we judge.
The amount of misinformation about SIBIS and aversives is disheartening. I
recently heard a lecture by an anti-aversive advocate who stated that SIBIS
delivers 64 jolts of electricity. This is blatantly false. The fact is that
electricity cycles on and off 16 times during the 0.2 seconds of shock
duration. It is perceived as only one shock, not 16 and certainly not 64
shocks. The cycling on and off was specifically planned to reduce the total
amount of electricity not as a way to make it more aversive. These facts are
contained in the original research article on SIBIS (Linscheid et al, 1990,
Joural of Applied Behavior Analysis)- Clearly this rabid anti-aversive
advocate was wrong, most likely had never even read the research and was
stating things in a way to make the treatment appear in the worst light.
My only plea is to be informed first, decide second but keep an open mind, no
one ever died of an open mind......
jba...@world.std.com
>2. It is true that most persons do not realize how infrequent is the need
>for the use of supplementary skin-schock aversives in an effective
>program. At JRC, about 45% of the students do not require any
>supplementary skin-shock aversives. Of those who do require them, the
>average (median) student receives three 2-second applications per week.
Of the students receiving aversive therapy at BRI:
What is the range of frequency and duration of skin-shock aversives?
For example, are there students who receive applications several times
daily or for durations of much longer than 2 seconds?
For those students that do not receive skin-shock aversives, do they
receive other kinds of aversives? If so, what kind of aversives do
they receive?
Please post your answer publicly as I am sure others would like to
read the answers too. If I receive a private response, I will assume
it was meant for public distribution and act accordingly.
Judy
Matthew Israel
Tom=Linscheid%Psych%C...@ALOHA.CHI.OHIO-STATE.EDU wrote:
> While I am new to this list in terms of being an active participant, I
> have occasionally monitored postings with special interest in the opinions of
> parents, especially regarding the issue of "aversives".
In response to Dr. Linscheidąs three points:
1. I agree very much with your first point. Dr. Leo Reyna has suggested
that the phrase łaversive therapy˛ is inaccurate as applied to programs
such as the SIBIS programs you have overseen or those which take place at
the Judge Rotenberg Educational Center (JRC). A more accurate description
would be łreward therapy, with supplementary aversives, if needed, to
treat those behaviors for which reward therapy alone is ineffective.˛
2. It is true that most persons do not realize how infrequent is the need
for the use of supplementary skin-schock aversives in an effective
program. At JRC, about 45% of the students do not require any
supplementary skin-shock aversives. Of those who do require them, the
average (median) student receives three 2-second applications per week.
3. I think many persons on this list would be interested in a simple and
readable summary of the Linscheid & Landau paper you refer to, and your
comments on its significance. Could you post one?
Stephen N. Drake
> First, the isssue is never - aversives vs positive only treatment - the issue
> is - does an aversive need to be added to a positive intervention to achieve
> the desired success? Anti-aversive advocates would have you believe that you
> have to choose between the two - not true.
>
That's not exactly correct. So-called "anti-aversive advocates"
generally hold that individuals have the right to be free of certain
kinds of "treatment" - ones involving pain, deprivation, humiliation, etc.
> Second, people often assume that shock treatment means that the person is
> shocked on some ongoing basis. Indeed, if contingent shock treatment is
> ultimately successful, the person isn't getting shocked. That is, if the
> rate of head hitting is zero, no shocks are given. One boy treated with
> SIBIS went an entire school year without a shock because he did not hit
> himself. His rate had been 120 hits per minute during baseline sessions
> prior to treatment. If shock treatment does not result in a dramatic
> reduction in SIB then it should not be continued....... deciding on how many
> shocks vs how much suppression is the job of parents, clinicians and
> oversight committees.
>
I see. So, guidelines for appropriate use is up to the team. Are you
saying that there is no place, in your opinion, for identifying certain
guidelines for differentiating "therapy" from abuse? In other words, I
think that most people would agree that giving someone a hard slap every
time they picked their nose would be abusive (at least I hope so). If
you agree that something like that is clearly abusive, then, in
principle, you have agreed that there *are* general paramaters that can
be drawn, even for those who believe that harsh punishment is justified
in some cases.
> Third, in response to the choice issue, over half of the individuals that I
> know of who have been treated with SIBIS show behaviors indicating that they
> want the device on. If these people actively went to the refrigerator and
> got a glass of soda, we would conclude that they wanted soda, correct?
>
Interesting. What are the behaviors that indicate that desire? Do you
advocate limiting use of the device to those who self-initiate its use?
> Stephen Drake's arguement that some choices should never be given (e.g.,
> slavery) is ludicrous and irrelevant in this case. Slavery is illegal
> because a person is not given a choice. If I want to make an agreement to
> serve someone in return for food and lodging, I can do so of my own free
> will, the person can't force me - that is the illegal part. Parents or
> guardians can legally make informed choices for their children. If that
> choice is not illegal and is made in good faith then so be it. It is not a
> problem that people have different opinions regarding aversives, it is a
> problem when some try to impose their opinions on others through legislation
> or intimidation. Sojolan can tell you about that feeling....
>
Perhaps another example might be more agreeable. Many parents of
children with severe disabilities in the 50s and 60s were given a choice:
Placement in a large custodial institution or nothing. Fortunately, this
started to change in the 70s, with little help (but a fair amount of
opposition from) the professional community.
> Many in the academic and DD community don't give much credence to Syracuse
> University Special Education anyway because of the debacle of FC and other
> matters (cf. Linscheid & Landau, Going all out pharmacologically: A re-
> examination fo Berkman and Meyer's, Alternative strategies and multiple
> outcomes in remediation of severe self-injury: Going all out non-aversively,
> Mental Retardation, 31, 1-6).
>
The response (by Meyer and Berkman) to the article you cited would also
be illuminating. I can post some excerpts if you like.
Syracuse has a long history of being involved in research and activities
not popular in the field of developmental disabilities. Burton Blatt,
the late Dean of Education here, broke the professional silence on the
hellish conditions in custodial institutions in the book _Christmas in
Purgatory_. Many academics and professionals were, of course, publishing
study after study in these ready-made "laboratories" - none of these
peer-reviewed articles ever alluded to the conditions of squalor, neglect
and abuse that Blatt exposed to the world.
Syracuse has also actively advocated and supported inclusion of people
with disabilities in public schools and the community. The successful
efforts toward integrating students with disabilities have been going on
for about a quarter century here. SU was also active in the beginnings
of deinstitutionalization, parent advocacy, and self-advocacy of people
with disabilities.
I guess I would have to agree that there are many in the academic and DD
community who don't give credence to these developments or organizations
that support them.
By the same token, it should be noted that "radical" organizations like
the Arc, as evidenced by their position statement on behavior
programming, don't give much credence to researchers who focus on pain,
deprivation, etc. as behavior modifiers.
> My only plea is to be informed first, decide second but keep an open mind, no
> one ever died of an open mind......
>
Not quite accurate. Your plea also involves keeping these "treatments"
available for others no matter what we as individuals decide.
****************************************************************************
Stephen Drake snd...@mailbox.syr.edu
Facilitated Communication Institute snd...@sued.syr.edu
Syracuse University
370 Huntington Hall Phone:(315)443-3702
Syracuse, NY 13244 r
u v
*The bell-shaped c e is a metaphor*
****************************************************************************
Trogrann
Tom=Linscheid%Psych%C...@ALOHA.CHI.OHIO-STATE.EDU writes:
> While I am new to this list in terms of being an active participant,
I
>have occasionally monitored postings with special interest in the
opinions of
>parents, especially regarding the issue of "aversives". I was involved
in
>the development of SIBIS and published some of the original research on
it as
>well as the use of contingent electric shock for the treatment of
rumination
>as far back as the 1970s so I have to put my two cents worth on the
aversives
>issue.
>
>First, the isssue is never - aversives vs positive only treatment - the
issue
>is - does an aversive need to be added to a positive intervention to
achieve
>the desired success? Anti-aversive advocates would have you believe that
you
>have to choose between the two - not true.
And pro-aversive advocates would have you believe that no treatment is
complete unless it includes an aversive component. Also not true.
Pro-aversive advocates would also have you believe that aversives are a
safe and highly effective form of therapy that is important to have
available as a last resort. Yet these are all myths. There is no research
literature to support these claims.
>
>Second, people often assume that shock treatment means that the person is
>shocked on some ongoing basis. Indeed, if contingent shock treatment is
>ultimately successful, the person isn't getting shocked. That is, if the
>rate of head hitting is zero, no shocks are given. One boy treated with
>SIBIS went an entire school year without a shock because he did not hit
>himself. His rate had been 120 hits per minute during baseline sessions
>prior to treatment. If shock treatment does not result in a dramatic
>reduction in SIB then it should not be continued....... deciding on how
many
>shocks vs how much suppression is the job of parents, clinicians and
>oversight committees.
So you agree with the anti-aversive side that cases where aversives and
restraints are used long term (in some cases, 15 years or more) are an
outrage? I am pleased to hear there is a maximum time limit on the use of
the SIBIS helmet. Now, will you please state publicly what the limit is,
so that we can use that information to identify professionals who are
abusing the device?
>
>Third, in response to the choice issue, over half of the individuals that
I
>know of who have been treated with SIBIS show behaviors indicating that
they
>want the device on. If these people actively went to the refrigerator
and
>got a glass of soda, we would conclude that they wanted soda, correct?
People who work in the child abuse field, like me, know that it is not at
all unusual to interview children who have been abused and have the
children tell you that they did something to deserve the abuse and their
parents were right to inflict it. By your reasoning, such cases should not
be prosecuted, because the child consented to the abuse.
>
>Stephen Drake's arguement that some choices should never be given (e.g.,
>slavery) is ludicrous and irrelevant in this case. Slavery is illegal
>because a person is not given a choice. If I want to make an agreement
to
>serve someone in return for food and lodging, I can do so of my own free
>will, the person can't force me - that is the illegal part. Parents or
>guardians can legally make informed choices for their children. If that
>choice is not illegal and is made in good faith then so be it.
Ah, but what if the choice *is* illegal, as, for example, the use of SIBIS
helmets here in my home state of Pennsylvania? (We have severely disabled
people here in PA, but somehow we get along without your device.)
>It is not a
>problem that people have different opinions regarding aversives, it is a
>problem when some try to impose their opinions on others through
legislation
>or intimidation. Sojolan can tell you about that feeling....
You contr
Matthew Israel
few of the principal issues and questions which have been raised about JRC
in this and other forums. I hope to complete it and to post it sometime
within the coming months. It should answer some of the questions that have
been posed to me in this thread. I have noted the interest that has been
expressed in certain topics. Information about some or all of these topics
may eventually be presented within material I prepare for this forum or
for our home page. I would second Dr. Linscheid's recent suggestion that
readers should not form opinions about JRC based on newspaper articles.
If you are a reader of messages in this forum, and would like to obtain
accurate information about any aspect of JRC immediately, I suggest that
you telephone me or visit our program. I would also be happy to put you
in touch with past or current parents of students at JRC. Also, as I have
noted in an earlier post, we have an open door policy, and welcome all
visitors, with or without notice. I would welcome the opportunity to speak
to you about your concerns or questions.
--
Matthew L. Israel, Ph.D.
Executive Director
Judge Rotenberg Educational Center
240 Laban Street
Providence, Rhode Island 02909
E-mail:Jud...@aol.com
Home Page:www.tiac.net/users/judgrc