Actually, ABA was accurate in saying that they are the expert in this subject matter. š Negative punishment is not the same as negative reinforcement. The distinction is that punishment, whether positive or negative is designed to decrease behavior; whereas, reinforcement, whether negative or positive, is designed to increase a behavior. Since I taught Psych 101 for a few years, I like to be pedantic on this stuff. āŗļø
When I was working in MR/DD we were also seeing a lot of apparent 't.a.r.d.i.v.e. akathisia'--which was more a 'theoretical'/hypothesized entity at that point which, I think, has since made its way into the DSM-5.
Not even in jest!
I'm pretty sure they were attempting a joke. If not, PsyDr is dead to me.
One of the "side effects" of punishment is that it can be hugely negatively reinforcing to the person who delivers the punisher. As a result, it often gets informally applied to other behaviors with following the appropriate steps (both clinically and regulatory wise). I don't want to publicaly get into my direct history with JRC here (IM me if you are interested and I'll provide more details if I think you are a reasonable person asking for purely information seeking purposes). I would ask you all, though, is it appropriate or effective to place a bowl of food on the table in front of a child with Prader-Willi and deliver shock contingent upon food-approach behavior? What about contingent shock for delusional statements made by an individual clearly in a psychotic episode? How about contingent shock for OCD related behaviors? What about for cursing? Maybe you could make an argument for retina detaching SIB, but how about this other stuff?
You make very good points--concerning which I believe we would all be in agreement. I would think that punishment (of any sort) should only be seriously considered in situations where: (a) all other more humane alternatives have been exhausted; (b) the behaviour is resulting in serious/permanent tissue damage; and (c) the approval/implementation of the plan enjoys rigorous oversight by a qualified, multidisciplinary team of professionals including, at minimum, at least one licensed doctoral level psychologist who is also board certified in behavior analysis (these days).
The use of contingent skin shock actually also requires a hearing with a judge, with the decision to approve based on the standard of "substituted judgement"- i.e., "would a competent person in the same situation consent to this procedure." This is similar to the process for getting approval to administer anti-psychotic medication to a legally non-competent adult. Sounds like a good safeguard, but the examples I cited above were approved by the court. I recently (within the last year) had a long interaction with the JRC clinical director and asked him if there was ever a case that was denied by the court, and he indicated that he did not know of any from his experience at the program.
Wait...these days a hearing with a judge is required prior to an intellectually disabled person being prescribed an antipsychotic medication? I'm really surprised that client's rights have advanced so much in this area. Does this only apply in certain jurisdictions? Just geniunely curious.
if not competent and in Massachusetts, pretty much yes: Learn about Rogers guardianships
Yep. It's a whole thing, what with people having rights and all.
I just wasn't aware that this was a requirement. At least as of about 10 years ago (and in at least some jurisdictions) all that was required was approval by a 'behavior intervention committee' and a 'human rights committee' of a facility. Approval had to be renewed annually and upon any addition of new 'restricted' elements. So, is the approval to use antipsychotics in a patient's care a 'one-time' deal or do they have to go before a judge again annually and present their case?
This is an excellent pointābehavioral contingencies apply to all parties, not just the clients/patients, and if we forget that, weāre not looking at the whole picture and making informed analyses.
Agreed - great point.
I am merely the results of my training and experience. It's easy to sound smart about things you do all the time! plus there is some selection bias, in in that I try to avoid posting on topics that I'm not very good with
Exactly- in practice (at least with EIBI with young children diagnosed with ASD), most of our behavioral intervention are being directly implemented, at best, by undergrad educated clinicians with decent training in the application of ABA techniques. Often we rely on caregivers and others not specificallyh trained in ABA to do the dirty work.
And all of those people operate under their own contingencies. For example, giving a screaming toddler a toy to get them to be quiet may be positively reinforcing the toddlerās tantrum but itās also providing a lot of negative reinforcement to the caregiver. If we donāt address those contingencies as well, our interventions arenāt going to be as effective.
I'm alive on the outside....
Clearly, I dropped out of a div6 program for a reason.
Yes! And it's not just "addressing" those contingencies, but all respecting the necesity of them without be judgmental. It's one thing to point out that giving the screaming toddler the toy may reinforce the screaming and be counterproductive to our functional communication training, DRA, DRO, etc. It's much more complicated to create a more nuanced intervention that accounts for the fact that, sometimes, mom just needs to do whatever it takes to get that todddler to stop crying (or not even cry to begin with), and this all has to be addressed first and foremost at the MO level. All too often, clinicians do the first part- the pointing out the inadvertent reinforcment- without being caring or kind enough (and, let's face it, skilled enough) to recognize the need of the mom to not only be the contingency manager for the toddler in question, but also the head chef, waiter, and dishwasher for the rest of the family, doing so between shifts as CNA, all while studying to get their nursing degree. IMHO, only a real jerk says "yeah, but if you don't stop giving them the toy when they scream then they won't stop screaming" and leaves it at that. That only leads to a plan that CAN'T be followed (not "won't" be followed, as if the mom had a choice in the matter) and blaming the mother for "lack of follow-through" or some such nonsense.
The court appoints the "Roger's Monitor" (in my experience, often an attorney or some type of professional advocate) who signs off on the anti-psychotic treatment plan(s). The need for a monitor is supposed to be reviewed by the court at least annually.
Honestly I think a lot of people in the fieldāespecially in ABAānot understanding this is why ABA has a horrid reputation in the autistic community, because so often our treatment goals have looked like āthey need to be less noticeably autistic/disabled, because autistic/disabled people make me uncomfortable/are different/are lesserārather than looking at āwhat can be changed to help this person be happier and healthier,ā even though our science says that that should always be our focus. We get intersecting ableism and ABA, and it makes ABA look awful (kind of like the intersecting ableism and homophobia with Lovaas and his gender conformity work) and also limits our meaningful positive outcomes.
Exactly. ABA folks can be a bit myopic in their approach. There is also a weird deference given to some of the seminal works (e.g. Lovaas and his whole "indistinguishable from typical peers" emphasis. I am certainly guilty of some of this in the past (and probably the present). I have, however, learned over the years (in part from my interactions with and exposure to you and your research- big thanks! ) to challenge my own assumptions and just plain assume that I'm likely to- if unchecked- engage in one of the "isms." To counteract this, I've learned that is crucial to seek out multiple views and perspectives, and that incorporating this into my clinical decision making does mot go against my adherence to empiricism. One big effect is that I now clearly articulate that my goals in working with young children with ASD is not to make them "indistinguishable" from "typicals," but to arm them with the tools to do so in the future if they so choose, as well as to communicate to others as best they can why they may choose not do so.
Our BIC had the opposite reputation, lol. Every plan had to be rooted in the behavioral literature complete with explicitly cited references. And data collection, graphing, and interpretation of graphs over time and plan revision were mandatory. It had a reputation of being a 'pain' to present / pass cases but, in reality, if the team were presenting a logically coherent plan rooted in the literature, were collecting data to track progress and were making modifications and testing clinical hypotheses over time, they were passed.
Guess I should have listened to my own advice upthread.
I made a Reddit comment with some very valid criticism of EMDR and got accused of spreading misinformation
Reddit is pretty terrible - I got accused of being a pedo because I criticized recovered memories. WIth citations.
And "everyone I don't like must have a raging personality disorder"
"If you like multiple things you have ADHD and autism."
"If you have ever felt at all like an outsider or awkward, you have autism"
"If you shiver during a pee, you have tourettes."
TRAUMA
wait what
