Sunday, February 26, 2006

A Less Punishing World: Contradictions in Behavior Analysis, Autism, and Punishment

Abstract

This paper reviews the research in punishment for specific behaviors of autistic children. I propose that the rationale for punishment contradicted previous behavior analytic research. I will juxtapose these against the arguments of B. F. Skinner who advocated against punishment.

Introduction

In 1972 the American Humanist Society awarded B. F. Skinner, their “Humanist of the Year” award. It was dedicated for his efforts to show how “a less punishing world” was possible. It was a controversial choice to say the least. Skinner was after all, the man who had authored a book called “Beyond Freedom and Dignity” that had come out just the previous year (Skinner, 1971).

Skinner (1953) was strongly anti-punishment. He opposed it for five reasons. (1) Its ineffectiveness in decreasing inappropriate behavior (Skinner, 1953; Skinner 1971; Skinner, 1974; and Skinner, 1985). (2) Considerations that the negative behavior being punished is not operant, but caused by some other process (Skinner, 1953). (3) The production of side effects (Skinner, 1953). (4) The ethics of using punishment when other techniques are viable (Skinner. 1953; Skinner 1971; Skinner, 1974; and Skinner, 1985). (5) The quality of life that aversives adversely affect (Skinner, 1953; Skinner 1971; and Skinner, 1974).

With apologies to the opinion of many, B. F. Skinner was not THE behavior analyst; he was however the first among his peers to provide ethical precedent and not just the pragmatic consideration in his analysis of punishment. I argue that knowledge of the history of behavior analytic research into punishment is important as it discloses inconsistancies, in particular when compared to the ethical based arguments of Skinner.

Punishment in the behavior analytic sense, is not the same as in the broader English sense. In behavior analytic sense, punishment is: Any stimulus event or condition, who’s immediate response contingent presentation results in a decreased frequency of that response. So, that is the key, it has to immediately follow a behavior and it must be shown to decrease the behavior. Punishment in the broad sense of the word, might be to take a toy away. However, if that doesn’t decrease the behavior, it isn’t punishment in the behavior analytic sense. On the flip side if a teacher showers a child with praise, and that praise decreases the response that delighted the teacher, then the praise is punishment, in that case.

Review of Literature

Skinner’s argument that punishment doesn’t work has largely been rejected by the behavior analytic community, based on other research. It has been informally noted that Skinner disliked punishment based operants and he may have overlooked relevant facts. This might be so, but it is also a psychogenetic fallacy, to imagine Skinner’s thoughts and use this to explain his actions away. In any case the behavior analyst quickly adapted and adopted punishment.

Nate Azrin, one of the most prolific behavior analysts ever, was at the forefront of this shift. In fact psychology in general is in debt to him as he was part of a cohort of young psychologists from various schools of thought who were forcing psychology towards science and away from armchair analysis.

An early example was Azrin (1956) with pigeons. An early human example was Azrin (1958). Later he researched "time-out" which is easily (although anecdotally) the most popular punishing technique used for any sort of child (Azrin, 1961).

Azrin was not the only one looking at aversives. Todd Risely, is another famous old guard behavior analyst. Risley (1968) came on the scene for the first edition of the brand new
Journal of Applied Behavior Analysis with a study of the effects and side effects of punishment for an autistic child. However, he wasn’t quite the the first to use punishment for autistic children. One earlier example was Lovaas, Schaeffer, & Simmons (1965), who used electric shock to build repertoires of social behavior in children who were diagnosed as childhood schizophrenics and who today, would have likely been diagnosed on the autism spectrum.

This
research got into the media and caused a bit of a stir. Even Bettelheim has a few things to say about this on pages 410-411 of “The Empty Fortress” (Bettelheim, 1967) Moreover, an early cognitive/behavioral psychologist attacked this on ethical grounds. Bregar (1965) congratulated Lovaas et al. (1965) from freeing themselves from Skinnerian dogma, in terms of effectiveness of punishment, but attacks the ethical integrity of non-consent for use of aversives in this study.

Another problem pointed is the production of side effects. Thanks to the research of Ulrich & Azrin (1962) we knew early on that punishment induces temporary aggression in rats and gerbils (although not guinea pigs). There is a big step from pigeons to humans and humans do not necessarily instantly attack the nearest person when they are punished. However thanks to the efforts of another set of Doctors we know that seeing aggression can lead to aggression in children. The first (and no surprise) is Bandura (1961), but the second doctor whom we must credit and who also published in the same year, was Lovaas (1961).

Punishment based research on animals continued, but now the shift was towards a variety of human problems such smoking (Powell, & Azrin, 1968) and poor posture (Azrin, Rubin, O'Brien, Ayllon, & Roll, 1968). However punishment for autistic children also picked up steam. (Tate & Baroff, 1966; Azrin, Kaplin, & Foxx, 1973; and Koegel, Firestone, Kramme, & Dunlap, 1974).

A late occurrence was Lichstein (1976). This sparked some rejoinders. Most notable were from two a husband and wife who again addressed the ethics of non-consent and who also questioned the need for aversives in when other interventions were possible (Shea & Shea, 1976). This just preceded Wolf (1978), this was about the time when behavior analysts were figuring out that social validity was highly important in our research.


So, aversives were causing problems in terms of social validity for behavior analysts, but we knew via research that aversives were quite effective. Other alternatives were investigated.. Tanner & Zeiler, (1975) used noxious aromas. Moore & Bailey (1973) used social punishment delivered by the mother of the child. Foxx & Azrin (1973) used overcorrection. This is the concept that a person more than corrects (more than restitution) the relevant ill behavior. Friman, Cook, & Finney, (1984) compared a sprayed water mist spray to vinegar and lemon juice and found it just as effective. It looked like the perfect aversive for a while. It didn’t cause pain. It was just annoying. However, it too did not pass the test of social validity.

Klier & Harris (1977) did some truly fascinating research using three autistic children to see if an inverse relationship existed between self-stimulatory behavior and learning; that is, the authors tried to see if self-stimulatory behavior got in the way of a leaning task. For two of the three children the answer was no. The authors concluded that maybe we don’t have to get rid of self-stimulatory behavior. That seems like a doubly good thing, autistic persons
write that self-stimulatory behavior is important as it allows autistics to cope with difficult or uneasy situation. That looks like the quality of life issue that Skinner brought up. One of Dr. Harris’s next research projects involved looking at ways to suppress self-stimulatory behavior in autistic children (Harris & Wolchik, 1979).

Sandra Harris later went on to investigate the relationship between allowing staff to use mild aversives and allowing them to strong aversives. They found that staff who were allowed to use strong aversives were more likely to remain with the center and had reported that they felt that they accomplished more. Harris, Handleman, Gill, & Fong (1991) write “Allowing staff to use a range of interventions including strong aversives may diminish job stress and enhance their sense of personal efficacy.” However, this article did not establish if such aversives truly were effective or justified in terms of helping the students.


In the mean time Dr. Lovaas was not idle and was still working with autistic kids as well as with effeminate boys. Rekers & Lovaas (1974) and Rekers, Lovaas, & low (1974) used spanking to modify the behavior of the effeminate boys to make them more masculine. Part of the critique offered by Nordyke, Baer, Etzel, & LeBlanc, (1977) concerned the use aversives.

Flashing forward, Lovaas, Ackerman, Alexander, Firestone, Perkins, Young,
Carr, & Newsom (1981) came out with “The Me Book”. This book was simple, straightforward and readable. It also advised aversives; generally (but not only), a single slap to the thing or buttocks. However, this still preceded the landmark study Lovaas (1987) in which following two years of treatment based on “The Me Book” 47% of the experimental group became indistinguishable from typically developing peers. I will not comment further on this study except to say that it is still the source of great controversy and that the active ingredient in it was contingent aversives.

Conclusion

Many of the late greats mentioned in this post like Baer, Wolf, and Skinner have shuffled off for the big experimental space in the sky. Nate Azrin is still teaching in Nova Southeastern University in Florida. Risley is now an advocate for exclusively positive practices and Lovaas has repudiated his use of aversives. Behavior analysts have almost entirely abandoned the use of physically aversive techniques for autistic children. Is this a happy ending then?

I would submit that the answer is “no”. Skinner argued five reasons exist that show punishment should not be used. One was shown to be false. The other four remain.



References

Azrin, N. H.(1956); Some effects of two intermittent schedules of immediate and non-immediate punishment. Journal of Psychology: Interdisciplinary and Applied, 42, 3-21.

Azrin, N. H. (1958). Some effects of noise on human behavior. Journal of the Experimental Analysis of Behavior, 1, 183-200.

Azrin, N. H. (1961). Time-out from positive reinforcement. Science, 133, 382-383.

Azrin, N. H., Hutchinson, R. R., & Hake, D. F. (1966). Extinction-induced aggression. Journal of the Experimental Analysis of Behavior, 9, 191-204.

Azrin, N. H., & Hutchinson, R. R. (1967). Conditioning of the aggressive behavior of pigeons by a fixed-interval schedule of reinforcement. Journal of the Experimental Analysis of Behavior, 10, 395-402.

Azrin, N. H., Rubin, H. B., O'Brien, F. J., Ayllon, T., & Roll, D. L. (1968). Behavioral engineering: Postural control by a portable operant apparatus. Journal of Applied Behavior Analysis, 1, 99-108.

Azrin, N. H., Kaplin, S. J., & Foxx, R. M. (1973). Autism reversal: Eliminating stereotyped self-stimulation in retarded individuals. American Journal of Mental Deficiency, 1973, 78, 241-248.

Bandura, A.; Ross, Dorothea; Ross, Sheila A. (1961). Transmission of aggression through imitation of aggressive models. Journal of Abnormal & Social Psychology, 63(3), 575-582.

Bettelheim, B. (1967). The empty fortress: Infantile autism and the birth of the self. Oxford: Free Press of Glencoe.

Bregar, L. (1965). Comments on “Building social behavior in autistics children by use of electric shock. Journal of Experimental Research in Personality. 1, 110-113.

Friman, P. C., Cook, J. W., & Finney, J. W. (1984). Effects of punishment procedures on the self-stimulatory behavior of an autistic child. Analysis and Intervention in Developmental Disabilities, 4, 39-46.

Foxx, R. M. & Azrin, N. H. (1973). The elimination of autistic self-stimulatory behavior by overcorrection. Journal of Applied Behavior Analysis, 6, 1-14.

Harris, S.L., Handleman, J.S., Gill, M.J., and Fong, P.L. (1991). Does punishment hurt? The impact of aversives on the clinician. Research in Developmental Disabilities, 12, 17-24.

Harris, S. L. & Wolchik, S. A. (1979). Suppression of self-stimulation: Three alternative strategies.. Journal of Applied Behavior Analysis, 12, 185-198.

Holz, W. C., & Azrin, N. H. (1962). Interactions between the discriminative and aversive properties of punishment. Journal of the Experimental Analysis of Behavior, 5, 229-234.

Klier, J. & Harris, S. L. (1977). Self-stimulation and learning in autistic children: Physical or functional incompatibility? Journal of Applied Behavior Analysis, 10, 311.

Koegel, R. L. Firestone, P. B. Kramme, K. W. & Dunlap, G. (1974). Increasing spontaneous play by suppressing self-stimulation in autistic children. Journal of Applied Behavior Analysis, 7, 521-528.

Lichstein, K. L. (1976). Employing Electric Shock With Autistic Children. Journal of Autism and Childhood Schizophrenia, 6(2), 163-173.

Lovaas, O. I. (1961). Effect of exposure to symbolic aggression on aggressive behavior. Child Development, 32, 37-44.

Lovaas, O. I., Schaeffer, B., and Simmons, J. Q. Experimental studies in childhood schizophrenia: building social behavior in autistic children by the use of electric shock. Journal of Experimental Research Personnel, 1965, 1, 99-109.

Lovaas, O.I., Ackerman, A., Alexander, D., Firestone, P., Perkins, M., Young, D.B.,
Carr, E.G., & Newsom, C. (1981). Teaching Developmentally Disabled Children: The
Me Book. Baltimore, MD: University Park Press.

Moore, B. L. & Bailey, Jon S. (1973). Social punishment in the modification of a pre school child's autistic-like behavior with a mother as therapist. Journal of Applied Behavior Analysis, 6, 497-507.

Nordyke, N.S., Baer, D.M., Etzel, B.C., & LeBlanc, J.M. (1977). Implications of the stereotyping and modification of sex role. Journal of Applied Behavior Analysis, 10, 553-7.

Powell, J., & Azrin, N. H. (1968). The effects of shock as a punisher for cigarette smoking. Journal of Applied Behavior Analysis, 1, 63-71.

Rekers, G.A., and Lovaas, O.I. (1974). Behavioral treatment of deviant sex-role behaviors in a male child. Journal of Applied Behavior Analysis, 7, 173-90.

Rekers, G.A., Lovaas, O.I., & Low, B. (1974). The behavioral treatment of a "transsexual" preadolescent boy. Journal of Abnormal Child Psychology, 2, 99-116.

Risley, T. R. (1968). The effects and side effects of punishing the autistic behaviors of a deviant child. Journal of Applied Behavior Analysis, 1, 21-34.

Shea, J., Shea, N. (1976). Reactions to "Employing Electric Shock With Autistic Children". Journal of Autism and Childhood Schizophrenia, Vol. 6(3), 289-294.

Skinner, B. F. (1953). Science and Human Behavior. New York: Macmillan, 1953.

Skinner, B. F. (1971). Beyond freedom and dignity. New York: Alfred A. Knopf.

Skinner, B. F. (1974). About Behaviorism. New York: Alfred A. Knopf. Skinner, B. F. (1948). Walden two. New York: Macmillan.

Skinner, B. F. (1985). Toward the cause of peace: What can psychology contribute? Applied Social Psychology Annual, 6, 121-25.

Solnick, J. V. Rincover, A. & Peterson, C. R. (1977). Some determiners of the reinforcing and punishing effects of timeout. Journal of Applied Behavior Analysis, 10, 415-424.

Tanner, B. A. & Zeiler, M. (1975). Punishment of self-injurious behavior using aromatic ammonia as the aversive stimulus.. Journal of Applied Behavior Analysis, 8, 53-57.

Tate, B. G. and Baroff, G. S. (1966). Aversive control of self-injurious behavior in a psychotic boy. Behavior Research and Therapy, 4(2), 281-287.

Ulrich, R. E., & Azrin, N. H. (1962). Reflexive fighting in response to aversive stimulation. Journal of the Experimental Analysis of Behavior, 5, 511-520.
Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11(2), 203-214.


8 Comments:

Blogger Jannalou said...

What kills me is that programs that "don't use aversives" will actually promote the use of overcorrection.

I know this because I've had to do it.

Hypocrisy, you see. I don't do such work anymore because of hypocrisy.

9:22 AM  
Blogger Interverbal said...

Hi Janna,

I know programs like that too.

I am glad that you got out of that mess. I hope one day, you can study a more ethical form of behavior analysis. I know I have always found such to be beautiful.

I think part of the problem is that we behavior analysts get sloppy when we try to translate from jargon to regular English. This can be done, this should be done.

I can't truly say that I am anti-aversive, but my defintion of the term is a lot different from most folks.

I try to provide accurate information to chidlren and adults. That can be very aversive and it can precede agressive behavior (think the EoHarm crew).
Bu that is not say that it should not occur or uis unethical.

10:22 AM  
Blogger Jannalou said...

I am glad that you got out of that mess. I hope one day, you can study a more ethical form of behavior analysis. I know I have always found such to be beautiful.

I haven't found it yet. I thought VB was it, but it wasn't. I'm incredibly disillusioned at this point. Any recommendations for reading material would be very welcome.

I can't truly say that I am anti-aversive, but my defintion of the term is a lot different from most folks.

I'm not anti-aversive, either. I just like the aversives to be the kind of thing that's going to make sense in relation to whatever is being dealt with at the time. Taking privileges away in return for abusing said privileges makes sense. Making a 2yo child spin in circles when he doesn't "Do this" immediately after you do... really doesn't. (That was in a Lovaas-type program.)

I had different problems with the VB program. On AutAdvo, they've identified way more than four reasons for behaviour, so the behaviour management techniques used in VB are severely limited in scope. That means abuse, in the end.

It's still all about power, and lack of power. The teacher has all the power and won't give any to the student. The teacher gets to decide when things will happen. The teacher gets to decide what the student gets to choose between ("choice & control" isn't really anything of the kind when none of the choices offered is something the person actually wants). The teacher gets to decide whether or not a student is actually able to complete a task at any given moment (and that baffles me, as I've experienced being completely unable to do something that I really "should" be able to do).

And there is more, but I'll stop there for now.

As I said, suggestions for reading material: good thing.

12:38 PM  
Blogger Interverbal said...

I think you might enjoy incidental teaching. It has some promising looking data. It is just as old as DTT, but it never caught on in the same way.

You also might enjoy Postive Behavior Support which is behavior analysis (barring the opinion of Mulick). It is picking up speed in the special ed world.

Pubmed the term, and check out some articles.

There many, many, more than just four types of reasons for behavior. Heck, there are 16 types of operants. Speaking of which read Malott's book "Principles of Behavior" you are going to gag on it, but he does pull apart the idea of just four contingencies, better than anyone. He also makes the connection to cognition reasonably well.

Check out Relational Frame Theory, which picks up were VB leaves off. There is a yahoo group that discusses it. It is controversial and kind of exciting.

I think you should try to power through Skinner's "Science and Human Behavior". Take small chunks of it at a time if you can't get into the flow of the book (some folks just can't).

Also, number one on you list should be Murray Sidman's "Coercion and its fallout".

I would be interested in reading your opinion and critiques on these things. Maybe you could blog about them?

1:51 PM  
Blogger Jannalou said...

Thanks.

You're the first person who actually gave me a list - and I've asked around.

I've heard of PBS, but when there were workshops offered on it I had no money. (That is my life.) Now I don't really have the time. But I'm a quick study. :)

I'll see what I can find, and as I read them I'll comment over on my new blog.

Thanks again.

3:11 PM  
Blogger Jannalou said...

I've finally gotten together a list of things to ask my brother to locate for me (he's a librarian at the local University). I have a bunch of stuff to read for a letter I'm working on, plus the books and articles you suggested. I actually found two articles for free on PubMed, which is awesome and I'm printing the second one as I type this comment. Next I'll look for the stuff from Michelle Dawson (for my letter) and see if any of THAT is available for free online, because that would make my brother's life a lot easier. ;)

Not sure how long it'll take for me to read and comment on everything, but I'll get through it all eventually.

I was wondering about PubMed, though; why is that the place to go? I remember at one point it was PsychINFO - of course, that costs money to search, and PubMed is free... does PubMed index everything PsychINFO does? Because one of the things I want to get done eventually will require a lot of searching for articles and stuff.

12:50 AM  
Blogger Interverbal said...

Hi Janna,

No, PsychINFO and Pubmed don't match up perfectly, but JABA is progressively getting more and more articles online now, so you should be able to get any JABA articles by Googling them and going to the JABA homepage.

Good hunting!

11:19 AM  
Blogger Ettina said...

Google Scholar is useful too.

9:03 PM  

Post a Comment

Links to this post:

Create a Link

<< Home