Side effects of contingent shock treatment
W.M.W.J. van Oorsouw(a) M.L. Israel(b) R.E. von Heyn(b) and P.C. Duker(a)
(a)Pluryn Werkenrode Groep (Winckelsteegh) and Radboud University, Nijmegen, The Netherlands
(b)Judge Rotenberg Center, Canton, MA, USA
Received 20 August 2007; accepted 29 August 2007. Available online 22 October 2007.
Abstract
In this study, the side effects of contingent shock (CS) treatment were addressed with a group of nine individuals, who showed severe forms of self-injurious behavior (SIB) and aggressive behavior. Side effects were assigned to one of the following four behavior categories; (a) positive verbal and nonverbal utterances, (b) negative verbal and nonverbal utterances, (c) socially appropriate behaviors, and (d) time off work. When treatment was compared to baseline measures, results showed that with all behavior categories, individuals either significantly improved, or did not show any change. Negative side effects failed to be found in this study.
Research in Development Disabilities is a respectable journal with a well respected editor, Professor Johnny L. Matson. Professor Matson also edits Research in Autistic Spectrum Disorders. So I was surprised to see this abstract. I had assumed that Matthew Israel and the Judge Rotenberg Center were beyond the bounds of acceptable practise in psychiatry. Perhaps their reputation has not reached the Netherlands. Just to make sure I have emailed the lead author.
Dear Sir,
I am a special education teacher in the UK and the parent of an autistic son. I also campaign for rights and services for autistic people and maintain the blog Action for Autism <https://mikestanton.wordpress.com>I was surprised to read of the involvement of the Judge Rotenberg Center in your research, “The side effects of contingent shock treatment.” Are you aware that the JRC is the subject of considerable controversy because of its systematic use of electric shock? See for example this report by the New York State Education Department http://boston.com/news/daily/15/school_report.pdf and this open letter to the American Psychological Association http://canadiansovereignty.wordpress.com/2007/11/01/an-autism-and-mental-health-community-appeal/ Matthew Israel also has a strong financial interest in positive research outcomes for electric shock treatment in his role as proprietor of the JRC, all of which does not inspire confidence in him as an impartial research partner. Perhaps this explains why there were no negative side effects in your study, a truly remarkable outcome for any intervention.
But, surely Professor Matson is familiar with the controversy surrounding JRC? You would expect his journal to take a long hard look at a piece of research supporting electric shock treatment with Matthew Israel’s name on it before accepting it for publication. Yet the entire peer review process was completed in a just over a week. “Received 20 August 2007; accepted 29 August 2007″ I find that remarkable and disturbing.
Action For Autism 
Odd-looking paper. Aside from ethical issues with that treatment approach, surely a short-term study will only measure short-term side-effects; I wonder why that isn’t made clear when they discuss study ‘limitations’ section at the end, especially given that the ‘side effects’ of this treatment after the electrodes and CCTV are removed are also a real concern. In itself, it’s interesting that the research doesn’t view the pain and distress caused to ‘students’ as a negative side effect of the ‘treatment’: most people would take this view when assessing treatment options for themselves, but presumably in this case pain and distress are part of the ‘treatment’ itself.
The research also lacks an effective control: how do the authors know that it wasn’t other aspects of being at the JRC that were influencing the behaviour of ‘students’? Were subjects receiving other ‘treatments’, anything from ‘contingent feeding’ to structured exercise?
The group of research ‘subjects’ also aren’t necessarily representative of those receiving this treatment: there have been reports of JRC using the GED to ‘treat’ behaviour like swearing or partial undress, and by picking out particularly severe cases the researchers may have biased the results of the article (regression to the mean, etc.) I’m surprised they didn’t blind those assessing the ‘subjects’ as to when the ‘subjects’ started receiving the ‘treatment’ (in order to prevent experimenter bias coming in at this point).
I’d have more concerns (both re. study results, and the ethics of research) as to whether those shocking and ‘teaching’ the ‘subjects’ knew that the research was going on – would staff at JRC modify their behaviour, even unconsciously, as a result of knowing this? Perhaps those shocking ‘subjects’ would use the GED more or less frequently than usual as a result of the ongoing research, or be more attentive and/or aggressive with other ‘treatments’ at the JRC?
Aside from the content of the paper – did any of the authors have competing interests that should have been declared (e.g. if Israel invented the GED device, does he have a patent)?
Anyway, not my area, but the (even putting aside ethical concerns) the paper looks really problematic. Is it worth a letter to the journal in question, laying out some of the problems with the article?
Damn, just noticed the time. Really shouldn’t read this type of nasty stuff when I should be sleeping 😦 And, um, sorry to spew so much text over your comments section…
The Judge Rotenberg Center does not treat Autism or any other disorder per se. The science of a great many disorders has not yet revealed causes for them or given insight into a course of treatment that gives results in treating the underlying condition.
The Judge Rotenberg Center treats dangerous behaviors only. Those who exhibit such behaviors may have any one or more of a number of pyschiatric conditions.
Psychiatry has not yet found cures for many of these conditions. The psychiatry of autism is in its infancy. Accordingly, the Judge Rotenberg Center does what can be done for those suffering from compulsion to dangerous behavior. In other words, like diabetes, we do not yet have a cure, but we have many medicines and regimeins that can treat the symptoms and alleviate the danger to life and limb. The Judge Rotenberg Center does that for people whose mental state makes them a danger to themselves or others. Rotenberg’s treatment is limited in that it affects only certain expressions of an underlying condition. But science, thus far, has not found treatments that rectify the underlying conditions. In that respect, the hope offered to the very few who need it by the Rotenberg Center should not be denied on account of prejudice or a misunderstanding of the electric shock treatment.
-Ted Faraone
I recently did a PubMed search of “Israel M”. There are plenty of articles by Dr. Israel about the use of shocks. Reviewers and journal editors apparently see no problem here.
Sorry, my error, you must search for contingent electric shock, most articles are by other authors.
“You would expect his journal to take a long hard look at a piece of research supporting electric shock treatment with Matthew Israel’s name on it before accepting it for publication.”
How does the man’s name enter into it?
How do you propose to help autistic persons who engage in seriously self injurious behaviour? It is easy to make personal attacks but how do you propose to help autistic teens, youths and adults who bang their heads until they cause brain injury, or bite themselves severely and other harmful behaviour?
IF, and I am only asking IF, the choice is between permitting the continuance of serious injurious behavior and the application of a program involving a two second skin sting type of shock which choice would you make?
A serious answer would be appreciated.
Harold,
Matthew Israel runs a business administering electric shock therapy. That business is the subject of considerable controversy and his methods are being challenged on scientific and ethical grounds. He writes a paper purporting to demonstrate only positive side effects from electric shock. Do the words Conflict of Interest spring to mind? I am not saying that the paper should not be published, only that it should be subject to rigourous peer review first. 9 days is not long enough to deal with that or the questions raised by JH.
As to your IF question, what about the IS question. JRC IS giving electric shock to inmates to control and to punish behaviour. There IS no evidence that it works and plenty of evidence to suggest that there IS serious human rights abuse going on at JRC. What IS your opinion of what IS happening now at JRC?
A serious answer would be appreciated.
Hi Ted,
We are discussong PEER review here, not PR review. BTW is there any reason why Matthew Israel is not listed among the clients on your website? You are still employed by him aren’t you? Or is this pro bono?
Comparing GED to insulin is the wrong analogy. If Matthew Israel was treating diabetes he would dispense with medication and use electric shock every time they looked at a candy bar.
Mr. Stanton
You did not answer my question. It is a serious question.
As for what IS happening at the JRC I believe that the JRC and any treatment/residential centre should be monitored constantly including spot inspections.
I also believe that the JRC has had many residents referred there by US courts because there were no other facilities that could help some of the people sent there.
On my blog site I received comments from parents who were thankful that the JRC was able to help their autistic children when no one else could, help prevent serious self injury.
Thus my question which I hope you will answer in a straight forward manner.
Ted,
Previous stories about the JRC let us know that CES is used for behaviors as ‘dangerous’ as leaving ones seat or speaking out of turn. I find your claim that only dangerous behaviors are addressed to be a falsehood, likely based on ignorance of other publications about this facility.
Patrick,
Ted knows all about the JRC. He is employed as a PR consultant by Matthew Israel.
Harold,
is it fair to conclude from your remarks that you approve of the methods used by the JRC?
Regarding your hypothetical question to me, what do you mean by “a two second skin sting type of shock?” Is that a GED1 or a GED4? How many milliAmps is an acceptable level of pain? And how long should this take? Israel reports inmates being on the GED for between 1 and 9 years with a “surprising rare” frequency of one shock every two days.
Mr Stanton
You did not answer my question, again. Playing diversion games adds nothing to the discussion.
I take it then you feel it is best to let some autistic persons continue to hurt themselves, to the point of brain injury, self mutilation or self starvation, rather than use an aversive in modifying their dangerous behaviour.
Harold
I do not support the use of aversives. Do you?
Those great America heroes John Wayne and Clint Eastwood wood have sorted it. Do you feel lucky Mr Israel you punk, you come walking down my street and I tell yer now, it ain’t an electric shock nor a gun you gotta fear, I shall beat you down mano a mano.
First off I’d like to say I have personally reviewed some of the paperwork for the several of these children who are students right now. There are certain court procedures which must be instituted first before this could even get initiated. That is, they must first try a certain level of regular behavioral modification, which is actually the strong point of the program. Unfortunately, many children with behavioral disabilities, especially serious ones, do not respond well to simple contracts and rewards, and often will bang their heads against tables/walls, hit others, themselves, throw things, push others, scratch their eyes out, their skin out, etc. etc. The short term here is very important. While I believe the treatment is not quite effective in the long term, it is, however, powerful in the short. Why? Because these students get rejected from other, more “psychiatric” residential schools in a heartbeat. They would often require the students to adjust doses of medication in the upward sense just to warehouse these children. Now, if an autistic child with a severe violent and self-injurious tendency begins to gain weight rapidly (which often happens as a side effect of some of these psychotropic medications), then more problems occur. These kids mostly sleep all day. Judge Rotenberg at least teaches them the damn ABCs and takes them on field trips to petting zoos and stuff like that (Go visit yourself if you don’t believe me). The fact is, the JRC is simply the last resort measure for many of these kids. 50% of them receive this intervention, so it’s obviously for the lower half of the children with the absolute most difficult manifestations of disabilities.
I somehow fail to see how people see the fact that “psychiatric residential schools” toss out “difficult” young patients/students as a reason not to blame these schools, but to accept JRC and the methods used there.
If there were no JRC, what would be done with these young people?
Self injurious or violent behavior isn’t even the majority of the cases where the GED is being used (not that its acceptable even in those cases). So to constantly use that as an excuse for what is happening at JRC is simply a way to try and justify an obscene practice. Has anyone even bothered to look at Dr. Worsham’s presentation on the use of GED at JRC? There is even video showing JRC staff using the GED for non-violent non SIB behavior for god’s sake.
To anon: I also encourage you to look at the video because if your looking at paperwork of these students, you should know that Dr. Worsham even admits in that presentation that he has been creative in describing behavior to the court so as to get permission to use the GED. Behavior such as a “student” saying to a teacher “you stink”. Can you imagine if public schools could strap a 25 lb. sack on a child with three electrodes and could shock a student for simply being disrespectful?
Is this the “last resort measure”? I don’t think so.
Anon,
in what capacity did you have access to these students’ records. Your email address suggests you are an attorney and not qualified to make clinical judgements. Is Matthew Israel paying you as well?