Lecture – Stigma vs. Benefit of Controlled Aversive Conditioning for Extreme Self-Injurious and Assaultive Behaviors

Presented by Miles Cunningham, MD, PhD, McLean Hospital McLean Forum lecture

Severe behaviors, such as headbanging, self-injury, hitting, pinching, and scratching, may be problematic in patients with autism spectrum disorder (ASD) and intellectual disability (ID).

Many of these individuals do not show significant improvement after medication trials, behavioral interventions, hospital admissions, and placements in school and treatment programs. In many cases, families and patients become desperate for effective treatment.

According to Cunningham, controlled adverse conditioning, including contingent skin shock, can be helpful to these individuals. With this treatment, a practitioner uses a device to deliver a small electric shock to the patient. The shock, which is described as like a bee sting, is given to stave off undesired behaviors or known indicators of those behaviors.

Watch now to learn more about:

• The small proportion of patients for whom dangerous behaviors are hard to manage with standard behavioral and medication interventions
• The many patients who experience a rapid and dramatic decrease in dangerous behaviors using contingent skin shock
• Primitive structures in the brain that may be responsible for the efficacy of aversive interventions

During this talk, Cunningham explains how a small proportion of patients with developmental disabilities engage in violent self-injurious and assaultive behaviors that place themselves and those around them at an elevated level of risk.

Further, he describes how these behaviors are chronic, frequent, and resistant to state-of-the-art behavioral interventions (including positive behavioral supports), as well as multiple trials of psychotropics.

Court-approved contingent skin shock, Cunningham reports, has resulted in dramatic and rapid reduction of violent behaviors in select individuals. This has allowed these individuals to develop socially, academically, and vocationally without the need for sedating medications or frequent restraint with isolation.

Yet, many health professionals and others oppose the application of electrical stimulation as an aversive stimulus. During the lecture, Cunningham explores the ethical debate about controlled adverse conditioning. He presents evidence from more than 200 cases of intractable self-injurious and assaultive behaviors.

Based on the evidence, Cunningham advocates for the use of adverse conditioning for intractable illnesses. He asserts that the treatment is effective and without side effects. Also, he states that opposing this approach denies a patient’s right to treatment and allows continuous self-injury.