Abstract
We conducted analyses of contingent skin-shock (i.e., positive punishment) in the treatment of severe problem behaviors in 173 individual cases between 2001 and 2019. Overall, a 97% reduction in the frequency of severe aggressive and health dangerous (e.g., self-injurious) behaviors was observed in the first full month of treatment across participants with diagnoses including intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, among other disorders. Findings provide support for the supplemental use of contingent skin-shock in conjunction with differential reinforcement and other behavioral procedures for severe treatment refractory behaviors. We present novel findings from (a) the largest clinical sample in the skin-shock literature (describing approximately 350 treatment years), (b) planned versus unplanned fading of treatment, (c) reversal of treatment effects, and (d) follow-up data spanning 15 years. The evidence provides support for the assertion that contingent skin-shock is the least intrusive, most effective and efficient treatment available for the severe problem behaviors of some individuals.
Highlights
A severe behavior disorder is an umbrella term used to describe constellations of problem behaviors characterized by several factors including frequency, intensity, topography, and treatment refractory nature
By the end of the first full month of contingent skin shock (CSS) treatment, the monthly rates of aggression (M = 12, range 0-627) and health dangerous (M = 13, range 0-294) behaviors decreased by 96% and 97%, respectively, as compared to pre-CSS treatment
In the six months following the onset of CSS treatment, aggression (M = 10, range 0-990) and health dangerous (M = 12, range 0-626) behaviors were observed at low, stable monthly rates
Summary
A severe behavior disorder is an umbrella term used to describe constellations of problem behaviors characterized by several factors including frequency, intensity, topography, and treatment refractory nature. Severe behavior disorders involve physical aggression (e.g. hitting, biting, choking), self-injury (e.g. head banging, head hitting, pinching, eye gouging), property destruction, and other excessive behaviors. These behaviors result in injuries to the person emitting them, injuries to others, and/or completely interfere with the person’s life. Destructive behaviors may be associated with a number of diagnoses such as autism spectrum disorder; intellectual disability; disruptive, impulse-control, and conduct disorders; bipolar and related disorders; among other diagnoses. Zukotynski, & Williams [1] suggested that severe problem behaviors are under researched and under treated.
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