Experts on Self-Injurious Kids Challenge Dr. Israel's Methods

Though some behaviorists endorsed electric shocks for kids who injure themselves decades ago, practitioners long ago moved away from that approach—except for Dr. Matt Israel.

| Mon Aug. 20, 2007 3:00 AM EDT

Why would a child smash his head against his desk? Or chomp on his arm? Or smack himself in the face over and over again? A small number of children with developmental disabilities—10 to 17 percent—exhibit self-injurious behaviors. Caretakers used to have few options other than to place them in restraints or force-feed them psychotropic drugs. Then, in the 1960s, some people began using electric jolts and other pain-inducing methods—known as "aversive therapy"—in an attempt to stop these sorts of behaviors.

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But by the 1990s, even the pioneers of "aversive therapy" had moved on to other methods. Gina Green, a nationally known psychologist who has worked with autistic children for nearly 30 years, explains: "As our science has developed and research has been done, we've come up with better methods for treating severe problem behaviors." Matthew Israel, however, is still using electric shock. According to Israel, his Massachusetts facility, the Judge Rotenberg Center, is the only one in the U.S. that now uses shock.

Today, the most widely accepted approach to treating these children is known as "functional analysis." It involves analyzing the "function" of a certain behavior. For example, if a child bangs his head, this might bring him some reward—attention, food, games, toys—or a chance to get out of doing work. To stop the child from head banging, his caretakers alter his environment so that he no longer gets the reward.

Dr. Brian A. Iwata created the first comprehensive model of functional analysis procedures in 1982. His model involves isolating each potential benefit of a behavior and then presenting them all to the child one at a time in order to figure out which elements of the environment reinforce his problem behavior. "It's akin to conducting an allergy test by exposure to small bits of things that might cause allergies," Iwata says.

Functional analysis is now used to treat not only self-injury, but most problem behaviors exhibited by children with developmental disabilities. "It's considered best practices" in the field, says Iwata, a professor of psychology and psychiatry at the University of Florida. In California, Dr. Paul Touchette, a psychologist affiliated with the University of California-Irvine, does extensive direct observations of children and enlists the help of people from other disciplines. "It usually takes a team of a neurologist, psychiatrist, and psychologist," he says, along with other staff such as a speech therapist or a physical therapist.

Some causes of self-injury are easier to identify than others; a child's self-abuse could be caused by genetic factors, or it could be the result of a brain injury. A strategy for eliminating the problem behavior may involve both changing the environment and prescribing medication. The work is extremely time-consuming—and expensive. "There are very few very good comprehensive programs for people with autism and mental retardation—even fewer that can handle most severe problem behaviors," says Green.

The question of how the Judge Rotenberg Center uses functional analysis arose last year after the New York State Education Department sent in a team of investigators, then released a report noting that there was "limited evidence of comprehensive functional behavioral assessments in accordance with the Individuals with Disabilities Education Act (IDEA), being conducted." The report cited a statement on the center's own website: "We are very familiar with the field of functional analysis, but frankly we have little use for it."

In a lengthy rebuttal to the New York report, Dr. Israel insisted that his staff does conduct a functional analysis of each student, via observation and interviews with the family, and "designs all of its treatment systems"—which include electric shock—"so that the typical findings of a functional assessment...are already taken into account when the treatment program is applied...By doing this it does not matter what function...or combination of functions, a problem behavior has at any given time."

At the request of Mother Jones, Iwata reviewed Israel's description of his approach. "The procedures described do not amount to any type of functional analysis or functional assessment," Iwata concluded. Israel's "across-the-board rejection of the technology seems unusual for a program claiming to provide state-of-the-art services. In the case of [the Rotenberg Center], it seems that refinements in technology have been selective: The technology of punishment is unlike that used in any other program, whereas other technologies have been left behind."

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