Miles Cunningham
McLean Hospital, USA
Title: Elimination of violent and intractable self-injurious and assaultive behaviors with humane aversive conditioning
Biography
Biography: Miles Cunningham
Abstract
Background: Individuals with developmental disorders, such as intellectual disability (ID) and autism spectrum disorder (ASD), can engage in violent behaviors that place themselves and others at dire risk. Many of these patients are refractory to pharmacological and behavioral interventions and are expelled from conventional treatment programs with no recourse. Graduated electronic deceleration (GED) is an aversive conditioning approach that has been shown to be effective in eliminating dangerous behaviors without physical or psychological side effects. However, no mechanism has been offered for its efficacy.
Objective: Here we present evidence for the efficacy of GED using case histories, and we propose a hypothesis for the neuroanatomical basis for the success of GED.
Methods: Students enrolled at the Judge Rotenberg Center (JRC) with severe behaviors who had not responded to multiple behavioral and pharmacological interventions were evaluated before and after introduction of GED. All subjects continued to undergo positive behavioral analysis throughout the evaluation period. Self-injurious and assaultive behaviors were quantified daily and depicted graphically. We also conducted a literature review of imaging data for patients with ID and ASD and formulated a potential neuroanatomical explanation for failure of positive-only behavioral treatments and success of GED.
Conclusions: GED has repeatedly proven effective in eliminating high-risk, dangerous behaviors for individuals with developmental disorders who are otherwise treatment refractory. The neuroanatomical abnormalities seen in these patients are consistent with the failure of conventional behavioral interventions and the success of GED.