|
Mother Jones
Experts on Self-Injurious Kids
Challenge Dr. Israel's Methods
News: Though some behaviorists endorsed electric shocks for kids who
injure themselves decades ago, practitioners long ago moved away
from that approach—except for Dr. Matt Israel.
August 20, 200
By Jennifer Gonnerman
Why would a child smash his head
against his desk? Or chomp on his arm? Or smack himself in the face
over and over again? A small number of children with developmental
disabilities—10 to 17 percent—exhibit self-injurious behaviors.
Caretakers used to have few options other than to place them in
restraints or force-feed them psychotropic drugs. Then, in the
1960s, some people began using electric jolts and other
pain-inducing methods—known as "aversive therapy"—in an attempt to
stop these sorts of behaviors.
But by the 1990s, even the pioneers
of "aversive therapy" had moved on to other methods. Gina Green, a
nationally known psychologist who has worked with autistic children
for nearly 30 years, explains: "As our science has developed and
research has been done, we've come up with better methods for
treating severe problem behaviors." Matthew Israel, however, is
still using electric shock. According to Israel, his Massachusetts
facility, the Judge Rotenberg Center, is the only one in the U.S.
that now uses shock.
Today, the most widely accepted
approach to treating these children is known as "functional
analysis." It involves analyzing the "function" of a certain
behavior. For example, if a child bangs his head, this might bring
him some reward—attention, food, games, toys—or a chance to get out
of doing work. To stop the child from head banging, his caretakers
alter his environment so that he no longer gets the reward.
Dr. Brian A. Iwata created the
first comprehensive model of functional analysis procedures in 1982.
His model involves isolating each potential benefit of a behavior
and then presenting them all to the child one at a time in order to
figure out which elements of the environment reinforce his problem
behavior. "It's akin to conducting an allergy test by exposure to
small bits of things that might cause allergies," Iwata says.
Functional analysis is now used to
treat not only self-injury, but most problem behaviors exhibited by
children with developmental disabilities. "It's considered best
practices" in the field, says Iwata, a professor of psychology and
psychiatry at the University of Florida. In California, Dr. Paul
Touchette, a psychologist affiliated with the University of
California-Irvine, does extensive direct observations of children
and enlists the help of people from other disciplines. "It usually
takes a team of a neurologist, psychiatrist, and psychologist," he
says, along with other staff such as a speech therapist or a
physical therapist.
Some causes of self-injury are
easier to identify than others; a child's self-abuse could be caused
by genetic factors, or it could be the result of a brain injury. A
strategy for eliminating the problem behavior may involve both
changing the environment and prescribing medication. The work is
extremely time-consuming—and expensive. "There are very few very
good comprehensive programs for people with autism and mental
retardation—even fewer that can handle most severe problem
behaviors," says Green.
The question of how the Judge
Rotenberg Center uses functional analysis arose last year after the
New York State Education Department sent in a team of investigators,
then released a report noting that there was "limited evidence of
comprehensive functional behavioral assessments in accordance with
the Individuals with Disabilities Education Act (IDEA), being
conducted." The report cited a statement on the center's own
website: "We are very familiar with the field of functional
analysis, but frankly we have little use for it."
In a lengthy rebuttal to the New
York report, Dr. Israel insisted that his staff does conduct a
functional analysis of each student, via observation and interviews
with the family, and "designs all of its treatment systems"—which
include electric shock—"so that the typical findings of a functional
assessment...are already taken into account when the treatment
program is applied...By doing this it does not matter what
function...or combination of functions, a problem behavior has at
any given time."
At the request of Mother Jones,
Iwata reviewed Israel's description of his approach. "The procedures
described do not amount to any type of functional analysis or
functional assessment," Iwata concluded. Israel's "across-the-board
rejection of the technology seems unusual for a program claiming to
provide state-of-the-art services. In the case of [the Rotenberg
Center], it seems that refinements in technology have been
selective: The technology of punishment is unlike that used in any
other program, whereas other technologies have been left behind."
|
