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USING THE GRADUATED ELECTRONIC DECELERATOR TO TARGET ANTECEDENT BEHAVIOR IN MR/AUTISTIC STUDENTS

Patricia M. Rivera, Ph.D., Matthew L. Israel, Ph.D., Candy McGarry, Heather Sutherland 

Judge Rotenberg Educational Center

Canton, MA

The Judge Rotenberg Educational Center operates day and residential programs for children and adults with behavior problems, including conduct disorders, emotional problems, brain injury or psychosis, autism and developmental disabilities. The basic approach taken in all of JRC's programs is the use of behavioral psychology and its various technological applications, such as behavioral education, programmed instruction, precision teaching, behavior modification, behavior therapy and behavioral counseling.  From JRC's inception, its basic philosophy has always included the following principles: a willingness to accept students with the most difficult behavioral problems and a refusal to reject or expel any student because of the difficulty of his or her presenting behaviors; the use of a highly structured, consistent application of behavioral psychology to both the education and treatment of its students; a minimization of the use of psychotropic medication; and the use of the most effective behavioral education and treatment procedures available.

Introduction

This study examines the use of the Graduated Electronic Decelerator (GED) to target antecedent behaviors in individuals with mental retardation and/or autism.  The GED is a contingent skin shock device used as a consequence to decelerate inappropriate behavior.  The GED has been shown to be effective in decelerating behaviors such as aggression destruction, and health dangerous behaviors (please see our website www.judgerc.org for more details).  Data from two students at the Judge Rotenberg Center (JRC) will be presented.  Both students participated in court authorized aversive treatment program with the goal of decelerating their inappropriate behaviors.  Results will show an initial deceleration of aggressive behaviors treated with the GED and a subsequent continued deceleration after initiating GED treatment of antecedent behaviors.  Discussion of these results and the implications for further study will also be presented.

Participants

Participants for this study were 1 current and 1 past student from the Judge Rotenberg Center (JRC).  The students participated in all aspects of  JRC’s residential and educational programming.  All students were referred to JRC because they exhibited a high frequency of inappropriate behaviors and were not able to be maintained within a regular school setting or other residential schools.  They exhibited maladaptive behaviors such as aggression, destruction and self-abuse that interfered with their educational growth and put themselves and others at high risk for physical harm.  Both of the students have also received multiple psychiatric diagnoses.  They were involved in special education at an early age and due to their behaviors were placed in various psychiatric hospitals and residential placements.  These students had been rejected from numerous facilities due to the severity of their behavior.  Alternative treatments for the students’ behavior problems prior to JRC included positive only behavior modification and medication management, all of which proved to be ineffective in treating their maladaptive behaviors. 

Method

Positive only programming was implemented with both of the students upon their admission to JRC.  This treatment included positive reinforcement such as tokens, and tangible rewards for performing appropriate behaviors and refraining from inappropriate ones.  Social reprimands as consequences for inappropriate behavior, and ignoring of certain problematic behaviors were also incorporated into the students’ behavior modification programs.  DRO contracts of varied lengths (range1 minute to 1 month) were also implemented.  Due to the intensity an frequency of the students inappropriate behavior a court approved aversive program was implemented which included the use of water spray, spatula spanks, muscle squeezes, and SIBIS which is a contingent skin shock device.  These aversive methods were found to be ineffective in treating the students and their inappropriate behaviors continued to accelerate.  Both students were subsequently switched to the Graduated Electronic Decelerator (GED) for their major inappropriate behaviors including aggression.  The GED is an FDA approved skin shock device used to decelerate inappropriate behaviors.  Frequency data were recorded 24 hours a day and tally charts were converted to standard behavior charts in order to track behavior changes and adjust the length and time of contracts.

Participant #1:  L.L.

D.O.B. 1/10/70

Diagnoses include:

·        Mental Retardation (Mild)

·        Psychosis

·        Organic Dementia

·        Mood Disorder NOS

Past medications include:

·        Haldol

·        Cogentin

·        Inderal

·        Ativan 

·        Benedryl

Problematic behaviors exhibited prior to JRC placement:

·        Aggression towards others (bite, kick, punch etc.)

·        Health Dangerous Behaviors (biting self, hitting self, etc)

·        Numerous psychiatric hospitalization for disorganized and assaultive behavior

Participant #2: J.C.

32 year-old male

Diagnoses include:

·        Mental Retardation (Severe)

·        Autism

Past medications include:

·        Mellaril

·        Ritalin 

Problematic behaviors exhibited prior to JRC placement:

·        Pulled hair until almost bald

·        Health Dangerous behaviors (bite self, bang head, etc.)

·        Aggression towards others (hit, head butt, bite, etc.)

·        Multiple day and residential placements due to aggressive and self-abusive behavior

 Results

Results of this study indicate a significant deceleration in both students’ aggressive behavior as a result of their antecedent behavior being treated with the GED.  For participant #1, L.L., his aggressive behavior was increasing before the implementation of GED (see Figure 1).  These behaviors were multiplying at a rate of 9.28 every 6 months.  There was an initial deceleration of his aggressive behaviors following GED treatment but this progress appeared to level off and he continued to be aggressive at an approximate rate of 20 occurrences per month.  It was noted that most of L.L.’s aggressive episodes started with him bolting out of his seat and then attacking staff/other students.  In June of 1993 we began to treat the antecedent behavior of “out of seat without permission” with the GED.  Using negative reinforcement, a chair was created that would close a switch, activating the GED any time L.L got out of his seat without permission.  The GED applications continued every 2 seconds until he returned to his seat.  If he raised his hand to get out of his seat, staff were able to deactivate the seat board switch.  Figure 1 shows L.L’s aggressive behaviors decelerated significantly following the treatment of his antecedent behavior with the GED.  For participant #2, J.C., her aggressive behavior was also accelerating at a rate of 1.27 every six months before the implementation of GED (see Figure 2).  There was an initial deceleration in her aggressive behavior once they were treated with the GED but this behavior appeared to level off at a median of 5 occurrences per month.  Again, the antecedent of “out of seat with out permission” was identified and began being treated with GED in May of 2002 (negative reinforcement was not used in this case).  Figure 2 shows that J.C.’s aggressive behaviors decelerated at a rate of 2.17 every 6 months following the treatment of her antecedent behavior with the GED.

Discussion

This study supports the effectiveness of treating antecedent behaviors of aggression with the GED to further decelerate the occurrence of aggressive behaviors in students with mental retardation.  Quite often the inappropriate behavior being treated is not the first link in the chain of events.  Using frequency data, a clinician can clearly distinguish behavior that precipitates an aggressive act.  Identifying and treating such antecedent behaviors with aversive interventions such as the GED can be considered an effective treatment option for further decelerating aggressive behavior.  Future studies could examine the effectiveness of starting to treat the antecedent behavior at the same time as the aggressive behavior instead of waiting for the aggressive behavior to level off.  Also, one could look at other behavioral topographies such as health dangerous behaviors and identify and treat their antecedent behaviors.  Finally, when examining the effectiveness of treating antecedent behaviors of aggression with the GED it would also be beneficial to look at the effect this treatment has on decelerating other defined behaviors such as destruction, major disruptive behaviors and non-compliance.