Open letter to Matthew Israel and the JRC

Matthew Israel was kind enough to drop by yesterday to comment on my post as part of Blogging Against Aversives Day, on the subject of the JRC, the only "special education school" in the United States that uses skin shocks as a form of "therapy" for children, teens, and adults with various disabilities and mental illnesses.

In response, I offer an open letter to Matthew Israel and the JRC, and invite a specific response to my concerns and the concerns of other bloggers who participated in Blogging Against Aversives Day. I could certainly discuss many outside sources- most of my favorites are linked in this post, as you've doubtless noticed- but for the time being, I will respond specifically to the PDF file Mr. Israel linked me to.

Dear Matthew Israel and JRC,

First, thank you for responding to my blog post. I have several concerns about the document provided in response to the many bloggers who oppose the use of aversives. I have selected portions of this document with which I take issue, and quoted them in italics, while detailing my concerns beneath each quote.

"This therapy is completely removed when students’ behaviors improve sufficiently."

If this is the case, why does Matthew Slaff, a resident of the JRC for over 19 years, continue to wear a Graduated Electronic Decelerator? The value of a therapy is measured first and foremost by its effectiveness. According to the Village Voice, Slaff banged his head to the point of severe self injury when admitted, and while that behavior has been eliminated, 19 years later, he continues to wear a GRE. Autism is a developmental disorder. This is not the same thing as developmental stasis, as Andrea recently explained in a post about another dubious and often harmful therapy given to Autistics. If after 19 years of GED "therapy," he still wears the device, can it truly be said that Matthew Slaff has improved because of the device? First, he still wears it. Second, he has had 19 years to mature and develop at his own, individual rate. Natural maturation could easily explain the improvement in Slaff's behavior despite, not as a result of, the GED device. How do you explain the use of a painful aversive therapy for 19 years, despite the discontinuation of the self injuring behaviors that qualified Slaff for the therapy?


"Skin-shock therapy is used for only 42% of the school-age students currently enrolled at JRC and is used only after a lengthy treatment of positive-only therapy if that has failed to modify self-destructive and other seriously harmful behaviors."

Skin shock therapy is used on 0% of school age students currently enrolled at any other center in the United States, and, strangely enough, nobody at those institutions is crying out, "Just let us shock our students! Nothing else works on 42% of them!"

If positive-only therapy is failing for 42% of students, have you re-evaluated your positive-only therapy program and improved it in order to offer more immediate rewards? JRC students wear cards on their belts, to which they can attach tokens with which to obtain rewards outside the classroom. For 42% of your students, is it truly that positive behavioral therapy is ineffective, or is it simply that these positive reinforcers are not reinforcing that student.

You are clearly aware that a consequence of behavior must be delivered promptly in order to be effective. This is the reasoning you have given for the use of skin shock therapy. However, the reward of a token for a card on a student's belt, no matter how prompt, is a conditioned reinforcer, not a primary reinforcer; and, in many cases, students with limited capacity may not find conditioned reinforcers rewarding. This is only one reason the token program is intrinsically flawed and causes 42% of students to end up wearing a GED. Another reason is that the reward program offers rewards available outside the classroom. In any type of teaching or training, with any species, it is a problem if the learner is happy to end the training session. Rewards that encourage the desire to hurry up and get out of class to receive these rewards are bad behavioralism.

TAG Teaching (Teaching with Acoustical Guidance) delivers a prompt, conditioned, positive reinforcer that has been shown to be effective on students in a variety of settings, from high-level gymnasts to students with disabilities. The TAG website offers the following tips on effective TAG Teaching:

1. TAG points must be phrased in the positive “The TAG point is…”

2. TAG points should be clear, concise, and have a yes or no answer as to its completion.

3. TAG only one movement element at a time—do not try to combine TAG points.
Ignore mistakes—resist the urge to give helpful suggestions about elements of a skill that are not the active TAG point. Keep track of these suggestions and note them for future TAG points.

4. Let students TAG the teacher or each other.

5. You can pump up the motivational power of the TAG by allowing the students to receive an additional reward for the TAG or “collect” their TAGs and redeem them later for stickers, stamps, candy, free playtime, or whatever is motivational to the individual.

6. Stop before fatigue or boredom sets in—if you go past this point—switch to an easy TAG point. Let the athlete have success and then end the session.

Can you present evidence that these six steps key to a positive-only method that has been shown in in-dept scientific trials to be effective are incorporated in the positive therapy used as a first resort with JRC students?

As a followup to my concerns about the poor application of positive behavioral therapy in the JRC, I must wonder why other therapies outside the behavioral paradigm are not employed. Any behaviorist is well aware that what works for one learner will not necessarily work for another. One learner may find praise reinforcing; a second learner may find the attention embarrassing and in fact try NOT to perform behaviors that are "reinforced" with praise. For many learners, the positive reinforcement in the form of tokens may not be reinforcing, and may actually be subjectively punishing, particularly for students with disabilities like Autism that relate to social interaction. For these students, why are the following therapies, and dozens of others, never employed before using aversive skin shocks?

-Talk therapy, perhaps the most common form of psychiatric treatment, studied and employed successfully for decades.
-Drug Therapy, which is successful for many patients, but is banned at the JRC.
-Art Therapy, which enhances recovery and wellness while providing an outlet for creative expresson.
-Photo Therapy, akin to art therapy, with similar benefits.
-Animal-Assisted Therapy, shown to be associated with moderate effect sizes in improving outcomes in the areas of Autism-spectrum symptoms, medical difficulties, behavioral problems, and emotional well-being.
-Occupational Therapy, which uses meaningful occupation to assist all people in participating in society to their fullest individual potential.
-Play Therapy, which uses play to allow children to better communicate and obtain improved mental health.

The false dichotomy which poses positive behavioral therapy and aversive behavioral therapy as the only two alternatives is harming students.

"If not treated successfully, these behaviors will interfere with their development and consign them to a lifetime of institutionalization, debilitating drugs and physical restraint."

Why, exactly, is it that this sentence is written in reference to the suggestion that the JRC is ineffective, rather than in reference to the JRC itself? A successful treatment, by this description, would result in de-institutionalization and the removal of physical restraint. The GED device is a physical restraint device, and is often applied while children are strapped face down to a board that immobilizes them and prevents them from seeing the staff member administering shocks. If not to a lifetime of institutionalization, to what outcome does this lead? Again, Why is Michael Slaff wearing a GED after 19 years, if this is so effective? Can you tell us the average length of a student's stay at the JRC, and how many students continue to wear a GED after reaching adulthood? How many residents are adults and wearing a GRE?

"As a first step, with the guidance and supervision of its psychiatrist, JRC removes students from psychotropic medication which in most cases has been ineffective with these students and which often has negative and sometimes irreversible side effects. Parents (and the students themselves) are often grateful for this step alone and have expressed their relief that they have their child back now fully alert rather than sleeping 18 hours a day."

A fully alert child who does not need drug therapy is capable of learning without skin shocks. A child being shocked painfully and embarrassed by the wearing of a GED, even in the shower, is not better off than a child on psychotropic drugs. The blanket policy of removing all drug therapy from the treatment of JRC residents harms students suffering from conditions which can be mediated by drug therapy, and further indicates the pathological adherence to a behavioral-only therapy method, which has proven so ineffective that 42% of students receive aversive skin shocks, and which has never been overhauled to include alternative therapies for the students for whom behavioral therapy is ineffective.


"The judge then decides what the student would have chosen if the student had been competent to make his/her own treatment decision."

It is absolutely crystal clear that, if this is indeed the judge's intention, those judges have failed horrifically and repeatedly. In the Mother Jones article, School of Shock, a former JRC resident discusses contemplating suicide as a result of painful skin shocks. This student would not have chosen a therapy that would cause pain and suicidal thoughts, had he been given the choice, as he makes quite clear in the article. The few students who would choose to receive skin shocks are likely acting out the same self harm behaviors and need for physical pain they act out by cutting, punching themselves, head banging, and other behaviors cited as reasons for the use of skin shock. How does the JRC reconcile the fact that it is delivering physical pain to students who want physical pain, and who display their need for physical pain through self-harm behaviors? The cycle of self harm is perpetuated in a perverse twist on the "Suicide by Cop" story, where a suicidal person provokes an authority figure into carrying out his or her desire to die- only, here, a troubled child is provoking authority figures into carrying out the desire to inflict pain on him or herself.


"The shock feels like a hard pinch. It has no side effects other than a very occasional reddening or discoloration of the skin that clears up in a few minutes or at most a few days."


If this is the case, why exactly was a student taken to the hospital for first degree burns after a recent incident in which students were shocked as a result of a prank call? Why did a CNN representative describe the shock as very painful? Why does Mother Jones describe it as like being stung repeatedly by wasps?


"Such vestigial behaviors, as well as antecedent behaviors, might seem to be not significant enough to deserve treatment if they are considered in isolation, outside the full treatment
context; however, they are important to treat for reasons similar to those that cause a doctor to recommend treating cancer at its earliest possible stage to recommend that a patient continue taking antibiotics even after the outward signs of an infection are no longer evident."


Let's ignore for the moment that cancer is not an infection, and address this quote tself.

It certainly makes sense that antecedent behaviors can be identified which lead to a behavior that is targeted for aversive skin shocks. Similarly, advocates of Clicker Training, which I discussed in my last post, have shown that rewarding even minute behaviors that could eventually lead to the desired behavior is effective in shaping a behavior. Does the philosophy of punishing antecedent behaviors extend to positive reinforcement? Are students immediately, promptly, and in a way reinforcing to the individual, rewarded for minute steps toward the desired behavior? Is the tiniest glance at a teacher in a student who has difficulty paying attention rewarded immediately, just as the movement of hands upward in a student who pulls his hair out would be punished? Or is this enthusiasm for prompt response reserved for the use of skin shocks?


"Every surgical, dental or medical treatment involves discomfort, risks or costs on the one hand, and expected benefits on the other."

Can you offer testimony from a self sufficient adult graduate of the JRC, who is able to participate in society, that skin shock therapy was worth the over $200,000 yearly charged in tuition by the JRC? Can you connect me by telephone or email with a single autistic adult who would go back and do it all over again- skin shocks and all- because that therapy was so valuable?

The only JRC survivors I see speaking out for themselves are the ones who discuss physical, emotional, and sexual abuse in the institution- not how rewarding and beneficial the JRC's skin shock therapy was.

"With aversives however, many are able to obtain an education for the first time in
their lives, reunite successfully with their families, and have hope and optimism for their future where none had previously existed."

Prove it. Prove that the improvement in students over years of therapy is due to that therapy, not in spite of it. Show us the hordes of thankful graduates who should be swarming the blogosphere with congratulations to you, Mr. Israel, if your 100% success rate is truly due to skin shock therapy's intrinsic benefits, not to the fact that aversives subdue aggression by force, not through learning. I can show you an adult autistic who was abused and never benefited. I can show you dozens more like her. Can you show me an adult autistic who will tell me how much the abuse helped her?

I can show you an expert who developed functional analysis who doesn't feel that the JRC is conducting any functional analysis or assessment. Can you show me an expert of similar stature who will go to bat for skin shock therapy? Can you direct him here, or to the blog of any other participant in Blogging Against Aversives Day, to retort?

Show us where your salary- over $300,000 of it- is going. Show us the people. Show us the results. Show us someone who is willing to personally contradict all the horror stories told by JRC survivors. Then show us that these are the vast majority, and that the people who see their time at the JRC as a waking nightmare are the exception.

Can you?

-Sandy