Affirming Neurodiversity within Applied Behavior Analysis

Criticisms of applied behavior analysis (ABA) from the autistic community continue to intensify and have an appreciable impact on research, practice, and conversation in stakeholder groups. ABA providers aspire to increase quality of life for autistic people; thus, it is imperative for providers to listen with humility and openness to the population we serve. Autistic individuals have unparalleled expertise in their own lives and their own communities. The concerns raised by the autistic community cannot, morally or ethically, be swept aside. There may be a misguided and harmful tendency to devalue concerns due to the speaker's identification as autistic or due to their difference in professional credentials. The concept of neurodiversity can help the ABA field respond to these concerns and collaborate with the largest stakeholders of our services, the autistic clients we serve. This article summarizes some of the key criticisms that autistic advocates raise concerning ABA, discusses the social model of disability and the neurodiversity paradigm, and proposes practical guidance to help the field of ABA integrate neurodiversity and thereby evolve our research and practice. By openly acknowledging the criticisms against ABA and recognizing how we can do better as a field, we believe we can take practical steps towards a profession and a society that more fully embraces inclusion.

Contingent Electric Skin Shock: An Empirical or Ideological Issue?

Intractable self-injury, aggressive, and other destructive behaviors are real human conditions. Contingent electric skin shock (CESS) is a technology, based on behavior-analytic principles, used to ameliorate such behaviors. However, CESS has always been extraordinarily controversial. The Association for Behavior Analysis (ABAI), commissioned an independent Task Force to examine the issue. After a comprehensive review, the Task Force suggested the treatment should be available for use in select cases through a largely accurate report. Yet, ABAI adopted a position indicating CESS is never appropriate. On the issue of CESS, we are extremely concerned behavior analysis departed from the fundamental epistemology of positivism and is misleading nascent behavior analysts and consumers of behavioral technology. Destructive behaviors are extremely difficult to treat. In our commentary, we outline clarifications regarding aspects of the Task Force Report, proliferation of falsehoods by leaders in our field, and limitations to the standard of care in behavior analysis. We recommend using science to answer important questions instead of propagating false information at the expense of current and future clients with treatment refractory behaviors.

Report of the ABAI Task Force on Contingent Electric Skin Shock

As a task force appointed by the Executive Council of the Association for Behavior Analysis International (ABAI), we investigated the clinical use of contingent electric skin shock (CESS) in behavior analytic treatments for severe problem behavior. We studied how CESS is used in contemporary behavior analysis, reinforcement-based alternatives to CESS, and current ethical and professional guidelines for applied behavior analysts. We recommended that ABAI uphold clients' right to receive CESS when it is restricted to extreme cases and used under rigorous professional and legal oversight. Our recommendation was rejected by a vote of the full members of ABAI, who instead endorsed an alternative recommendation, developed by members of the Executive Council, that opposed the use of CESS under any condition. Here we present for the record our report and initial recommendations, the formal statement that was rejected by the members of ABAI, and the statement that was endorsed.

Additional Comments on the Use of Contingent Electric Skin Shock

Prior to the ABAI member vote to decide between two alternative position statements on contingent electric skin shock (CESS), the current authors helped draft a consensus statement supporting the abolition of CESS. In this commentary, we provide additional, supporting information for that consensus statement by (1) showing that the extant literature does not support the supposition that CESS is more efficacious than less-intrusive interventions; (2) providing data showing that implementing interventions that are less intrusive than CESS does not lead to overreliance on the use of physical or mechanical restraint to control destructive behavior; and (3) discussing the ethical and public relations issues that arise when behavior analysts use painful skin shock to reduce destructive behavior in persons with autism or intellectual disability.

Response to ABAI Task Force on the Use of Contingent Electric Skin Shock

In this article, the authors provide their response to the Association for Behavior Analysis International (2022) position statement on the use of contingent electric skin shock (CESS). In this response, we address concerns raised by the task force regarding limitations of the Zarcone et al. (2020) review article in which both methodological and ethical concerns were raised about the quality of research in the use of CESS with people with disabilities in the treatment of challenging behavior. We note that with the exception of the Judge Rotenberg Center in Massachusetts, no state or country currently supports the use of CESS as it is not recognized as the standard of care in any other program, school, or facility.

When Science Cannot Guide us: A Call to Action for Applied Behavior Analysts

Evidence presented in the ABAI Task Force Report on Contingent Electric Skin Shock (CESS) revealed serious ethical, clinical, and practical problems with the contemporary use of CESS. As a member of the task force, I ultimately concluded that our recommended position statement ("Position A") was a misguided attempt to uphold the field's commitment to client choice. Furthermore, information gathered by the task force supports an urgent call to find solutions to two additional troubling issues: a severe shortage of treatment services for severe problem behavior and the near-absence of research on treatment-resistant behavior. In this commentary, I discuss reasons Position A was not a tenable stance and why we must do better to help our most vulnerable clients.