1	USE OF ELECTRICAL STIMULATION IN BEHAVIORAL TREATMENT AT THE JUDGE ROTENBERG EDUCATIONAL CENTER (JRC) Matthew L. Israel, Ph.D. Judge Rotenberg Educational Center Canton, MA USA
2	Population 122 Individuals Ages 7- 41 73% school age; 27% adults 50% Autistic-Like; 50% Behavior/Emotional Disorders 61% on Positive Programming only; 39% on Positive Programming + Supplementary Aversives (Skin-shock)
3	Facilities School Building in Canton, MA (suburb of Boston) 21 Residences in Southeastern MA Canton Norton Attleboro Rehoboth Mansfield Stoughton
4	BASIC POLICIES Near-zero rejection/expulsion policy Average case rejected by 6 and ejected from 5 other placements Remove or minimize psychotropic medication Only 2 of 75 who have received skin-shock have also received psychotropic medication Maximize 24hr, consistent behavior modification procedure
5	Administration Building and Day School
6	Lobby
7	Mickey and Minnie
8	Main Hallway
9	Wall of Student Photographs
10	Wall of Music-and-Movement Clocks
11	Mannequin Sculptures in Hallways (Policemen and Pianist)
12	Mannequin Sculptures in the Hallways
13	Mannequin Sculptures (Cleaning Lady on the Right)
14	Mannequin Sculptures (Proctologist)
15	Coke Stairwell
16	Foyer, Lower Level
17	Lichtenstein Hallway
18	Warhol Hallway
19	Fawn Admires a Warhol
20	Haring Hallway
21	Multipurpose Room
22	21 Residences, such as this one in Norton, MA
23	Lorusso House, Attleboro, MA
24	Old Maple Residence in Stoughton, MA
25	Living Room, Old Maple Residence
26	Living Room, Old Maple Residence
27	Kitchen, Old Maple Residence
28	Dining Room, Old Maple Residence
29	Den, Old Maple Residence
30	Bathroom, Old Maple Residence
31	Bedroom, Old Maple Residence
32	Bedroom, Old Maple Residence
33	Classroom for Higher Functioning Students
34	Classroom for Lower Functioning Students
35	JRC Software to Teach Basic Skills
36	JRC Software to Teach Phonics and Spelling
37	JRC Software to Teach Math Facts
38	JRC Precision Teaching Curriculum on SAFMED Cards
39	Networked Computers for Students in the Classrooms
40	Paid Assembly Jobs in Work Activity Area
41	Paid In-School Jobs
42	Competitive Jobs in Local Community
43	Computerized Baby-Think-it- Over Program
44	JRC Graduation
45	Reward Systems & Facilities
46	Frequent intermittent, momentary rewards for not showing problem behaviors
47	Types of DRO Contracts
48	Reward Store in Each Lower Functioning Classroom
49	Reward Box in Classrooms for Lower Functioning Students
50	Contract Store
51	Big Reward Store
52	Big Reward Store
53	Barbecue/Reward Afternoon
54	Field Trip Rewards
55	JRC School Dances
56	TV, Stereo, CD Player, Computer and Sony Playstation in Each JRC Bedroom
57	Students Review JRC-Managed and Self-Managed Behaviors
58	Behavioral Counseling
59	Before-and-After Films of Students who have Benefited from Positive Programming + Supplementary Skin-Shock Before segment shows some of the student’s most problematic behaviors before the start of treatment. After segment shows the student during or after treatment.
60	Use of Aversives at JRC (May, 2001) Currently JRC serves 122 total students 61% (75 students) receive positive programming only 39% (47) students receive positive programming plus occasional supplementary aversives
61	1971-1989: Non-shock Aversives Water squirt (plant spray bottle) Vapor spray (compressed air + water) Pinch, spank, or muscle squeeze White noise/visual screen helmet Mechanical restraint Combinations of the above
62	Results with Non-Shock Aversives Improvement (but nowhere near as much as with skin-shock) Many students still in partial restraint Continuous struggles with many students Injuries to staff, students and property
63	Safeguards in use of Skin Shock Approval by parents/guardians Individual authorization by family court Human Rights Committee Peer Review Committee Medical and psychiatric contraindications sign-off Daily review by nursing staff
64	Safeguards (Cont.) Close management of direct care staff Video monitoring during school Video monitoring at residences Review of videotapes of each evening and overnight at residences Extensive recording and charting of behaviors
65	24-Hour Video Monitoring of School and Residences
66	Daily Recording Sheet
67	Sample Daily Chart
68	Sample Standard Weekly Chart
69	Sample Monthly Chart
70	JRC’S USE OF SKIN SHOCK Wide variety of behaviors treated Health Dangerous (includes self-abuse) Aggressive Property Destruction Noncompliance Inappropriate urination/defecation Major Disruptive Simultaneous treatment of all behaviors Treatment of antecedents, attempts, and incipient stages
71	JRC’S USE OF SKIN-SHOCK (Cont.) Treatment of shaped down versions Occasional: preventive treatment through behavioral rehearsal lessons Holidays to assist recovery from adaptation Occasional: use in negative reinforcement paradigm Occasional: punishment of wrong answers as refusal behavior
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74	Feature Comparison:SIBIS, GED and GED4
75	Transmitter
76	Stimulator
77	Battery
78	Battery Pack Holder
79	Electrode Separated from Stimulator Chassis by a Wire
80	Concentric
81	Electrode Placement Sites
82	Spread
83	Spread Electrode: Finger to Palm
84	Spread Electrode: Finger to Finger
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87	Median Frequency of GED Applications to 47 Current Users = 1.4/wk (May, 2001) This is 1 application every 5 days 47 of 122 current students (39%) have GED in their program. For 37% of these 47 students the median frequency is 0/wk
88	Gabe’s Chart
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90	Holiday to Counteract Adaptation
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100	GED & GED-4 JUMP DOWNS (Monthly SCC Chart)
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102	GED & GED-4 CELERATIONS (Monthly SCC Chart)
103	New: Increased Use of GED with Higher Functioning Students Emotionally Disturbed Psychotic Post-traumatic Stress Disorder PDD ADHD Oppositional/Defiant Disorder Obsessive/Compulsive Disorder Conduct Disordered Behavior problems such as truancy, aggression, depression, suicidal actions, fire setting, etc.
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107	GED & GED-4 JUMP DOWNS (Monthly SCC Chart)
108	GED with Higher versus Lower Functioning Students Higher jump-downs Jump-downs usually go to zero Frequencies stay at zero Fading of GED more feasible. Non-treated behaviors also go to zero
109	Discoveries/Conjectures (1) Effective over long period (up to 10 years) Desirability of treating earliest possible phase of the behavior Treatment of wide variety of behaviors feasible (health dangerous, aggression, destruction, noncompliance, major disruptive, inapp. urination/ defecation,etc.) Simultaneous treatment of all behaviors feasible
110	Discoveries/Conjectures(2) Potential for preventive use (behavioral rehearsal lessons) Usefulness of negative reinforcement Start with most intense stimulus available (avoid working up the intensity ladder) Occasional effectiveness through verbal mediation Especially effective with higher functioning students
111	Discoveries/Conjectures (3) Desirable features of device: Adequately high intensity level Wire-attached electrodes Spread electrodes Multiple electrodes Holidays from treatment may promote recovery from adaptation Absence of side effects A treatment of first choice for significant problem behaviors
112	3 Handouts Abstract of Presentation/Program Description (1 sheet, both sides) JRC Newsletter Powerpoint printout of key slides
113	WEB SITES FOR FURTHER INFORMATION Site on skin-shock, with abstracts and texts of this symposium: www.geocities.com/effectivetreatment Judge Rotenberg Center’s web site: www.judgerc.org
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