Aversives

In psychology, aversives are unpleasant stimuli that induce changes in behavior via negative reinforcement or positive punishment. By applying an aversive immediately before or after a behavior the likelihood of the target behavior occurring in the future is reduced. Aversives can vary from being slightly unpleasant or irritating to physically, psychologically and/or emotionally damaging. It is not the level of unpleasantness or intention that matter, but rather the level of effectiveness the unpleasant event has on changing (decreasing) behavior that defines something as aversive.

Types of stimuli
Main article: Classical conditioning

There are two types of aversive stimuli:

Unconditioned

Unconditioned aversive stimuli naturally result in pain or discomfort and are often associated with biologically harmful or damaging substances or events. Examples include extreme heat or cold, bitter flavors, electric shocks, loud noises and pain. Aversives can be applied naturally (such as touching a hot stove) or in a contrived manner (such as during torture or behavior modification).

Conditioned

A conditioned aversive stimulus is an initially neutral stimulus that becomes aversive after repeated pairing with an unconditioned aversive stimulus. This type of stimulus would include consequences such as verbal warnings, gestures or even the sight of an individual who is disliked.

Use in applied behavior analysis (ABA)
Main articles: Operant conditioning and Ethical challenges to autism treatment
A patent drawing for the GED, a banned aversive conditioning device

Aversives can be used as punishment during applied behavior analysis to reduce unwanted behavior, such as self-injury, that poses a risk of harm greater than that posed by application of the aversive. Aversive stimuli may also be used as negative reinforcement to increase the rate or probability of a behavior by its removal. The use of aversives was developed as a less restrictive alternative to practices prevalent in mental institutions at the time such as shock treatment, hydrotherapy, straitjacketing and frontal lobotomies. Early iterations of the Lovaas technique incorporated aversives during therapy,[1] though the use of aversives in ABA was not without controversy.[2] Over time the use of aversives has become less and less necessary as less and less restrictive alternative treatments have been developed. Lovaas has since stated his disdain for the use of aversives.[3] Applied behavior analysis permits the use of aversives in limited cases, such as when a behavior is dangerous, especially when the reinforcing contingencies that maintain a behavior are unknown.[4]

A report from the Food and Drug Administration found that "the literature contains reports that when health care providers have resorted to punishers... the addition of punishers proved no more successful than [Positive behavioral support]-only techniques... Reflecting this trend, a 2008 survey of members of the Association for Behavior Analysis found that providers generally view punishment procedures as having more negative side effects and being less successful than reinforcement procedures."[5]

The Behavior Analyst Certification Board (BACB) Guidelines for Responsible Conduct state that participation in an any behavior plan must be voluntary, by the client or their surrogate,[6] and that clients or families have the right to terminate a particular intervention if they see fit,[7] including aversive treatments. The Behavior Analyst Certification Board issues credentials for behavior analysts nationwide, although state regulations vary as to whether or not a person can represent themselves as a "behavior analyst". The use of aversive treatment is something that practitioners of applied behavior analysis are supposed to take very seriously (see Professional practice of behavior analysis) due to the pain and risks involved and the controversy surrounding their use.

Several national and international disability rights groups have spoken against the use of aversive therapies, including TASH and Autism National Committee (known as AUTCOM). Although it has generally fallen out of favor, at least one institution continues uses electric shocks on the skin an aversive.[8][9] A ruling in 2018 supported its continued use.[10] The FDA has made a commitment to ban its use, but as of January 2019 has not yet done so.[11]

Opposition

The use of aversives in applied behavior analysis is opposed by many advocacy groups for people with disabilities. These include:

See also

References
  1. Moser, Dan (1965). "Screams, Slaps & Love: A surprising, shocking treatment helps far-gone mental cripples". Life Magazine.
  2. Jones RS, McCaughey RE (1992). "Gentle teaching and applied behavior analysis: a critical review". J Appl Behav Anal. 25 (4): 853–67. doi:10.1901/jaba.1992.25-853. PMC 1279769. PMID 1478907.
  3. Interverbal: Reviews of Autism Statements and Research: A Less Punishing World: Contradictions in Behavior Analysis, Autism, and Punishment
  4. Lerman DC, Vorndran CM (2002). "On the status of knowledge for using punishment implications for treating behavior disorders" (PDF). J Appl Behav Anal. 35 (4): 431–64. doi:10.1901/jaba.2002.35-431. PMC 1284409. PMID 12555918. Archived from the original (PDF) on 2007-01-01.
  5. "Banned Devices; Proposal To Ban Electrical Stimulation Devices Used To Treat Self-Injurious or Aggressive Behavior". Federal Register. 2016-04-25. Retrieved 2020-08-08.
  6. Behavior Analyst Certification Board, Guidelines for Responsible Conduct for Behavior Analysts, p. 8, The behavior analyst must obtain the client’s or client-surrogate’s approval in writing of the behavior assessment procedures before implementing them. As used here, client-surrogate refers to someone legally empowered to make decisions for the person(s) whose behavior the program is intended to change; examples of client-surrogates include parents of minors, guardians, and legally designated representatives
  7. Behavior Analyst Certification Board, Guidelines for Responsible Conduct for Behavior Analysts, p. 9, respects the right of the client to terminate services at any time
  8. Pilkington, Ed (2018-11-16). "'It's torture': critics step up bid to stop US school using electric shocks on children". The Guardian. ISSN 0261-3077. Retrieved 2019-04-07.
  9. Jacobs, Emily (2018-12-19). "School for the disabled won't stop electrically shocking its students". New York Post. Retrieved 2019-04-07.
  10. Beaudet, Mike (2018-06-28). "Judge sides with school that uses electric shocks on its students". WCVB. Retrieved 2019-04-07.
  11. "School Shocks Students With Disabilities. The FDA Is Moving To Ban The Practice". NPR. January 23, 2019. Retrieved 2019-04-07.
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