Punishment on Trial (Cipani 2004).

Using certain punishing aversive consequences is not something that should be lightly considered, particularly if one is only concerned about a minor problem. However, if I ever get shot, I would certainly waive my right to be free from intrusive surgery if it meant living. In the example below, someone did not take into account the dangerousness of the situation facing the individual.

Doing Nothing is a Risky Venture?

One of the greatest miscarriages of doing nothing was a case of an adolescent male in a state hospital for the developmentally disabled. I was called in to consult with the staff at the hospital for a serious behavioral problem. If you are squeamish, I apologize for the following description of his life-threateningproblem. On two prior occasions and more recent to my consultation, this individual took a staple and scratched the underside of his penis, the length of the shaft. Blood was everywhere, and he was rushed to emergency at the hospital and fortunately survived this incident.

I attempted to make sense of his behavior. What purpose or function might such a behavior serve? I drew up a number of treatment procedures, based on several hypotheses about the possible function of the behavior. Does he do this to get attention? Maybe he does this to protest something that happened to him. One of my theories was that this incident was a mishap of a behavior that was probably occurring more frequently. He had scaly skin, on his leg, which was probably itchy. My hypothesis was that he would use some instrument, or whatever he could get his hands on, to scratch the dead skin off. One thing to keep in mind, he is not terribly communicative due to his developmental disability, thus hampering his ability to tell staff what the problem is (e.g., “Hey I have itchy skin here. Can I have something to scratch/ relieve the itch?”).

To address this hypothesis, I designed a plan that would teach him to use a shower brush for scratching the leg. In this manner, if his skin needed scratching, this would do the trick. Further, the disastrous result that occurred with the staple, even with a slip of the shower brush would be improbable. However, you must realize I was shooting in the dark, so to speak. The evidence pointing to any of the hypotheses was weak. This one made the most sense to me, upon examining all the evidence. But what if I missed the boat? What if I was wrongabout this behavior’s function? Then giving him a shower brush would obviously not take care of the problem. We would still have him scratching himself with the staple, with potential disastrous consequences.

I wanted to cover all possibilities, in light of the seriousness of the situation. I remember telling the hospital psychologist that my plan also called for a punisher if he was even caught with a single staple, since we most certainly knew he did not intend to staple papers together. My statement

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at that time was, “If my hypothesis about this behavior is wrong, I will at least feel that the use of a punisher will make the behavior less likely. In other words I did not want to put all my eggs in one basket, this person’s life may have depended on my being correct.

The plan for the use of punishment was the following: If he was caught before the act or during the act, I wanted him to receive a consequence involving some extremely aversive smell, taste or sensation. While I know some of you may be inquiring, “why do that,” there is research data to support the use of contingent aversive tastes/ smells to decrease target behavior, particularly with individuals in institutional settings. Again, my approach was to cover all bases, including the reinforcement of appropriate behavior and the teaching of new adaptive behaviors.

I submitted the lengthy written plan, which called for the enactment of all parts. I left the consultation and the hospital administrator thanked me for my input. That was the end of my involvement. I called up the psychologist several weeks later, not beingon the consultation anymore but obviously concerned about the case, and inquired about the client’s progress. To my dismay and horror, nothing had changed. Someone on the human rights committee was concerned about the individual’s right to be free from aversive tastes or smells as part of the punishment plan. What about his right to not have to be checked into an emergency room in a life- threatening situation.

What was missing here is perspective. Taking risks is relative. When you are pretty comfortable, you need not take risks. But if your situation changes drastically, risks of treatment have to be weighed against the ramifications of the continued maintenance of the problem. I would venture to say that most people would not like to have to receive injections on a daily basis. But people with diabetes subject themselves to this intrusion every day. Risk is relative.

# Why would the plan (i.e., to give him a brush for his scaly skin) not workifmyhypothesis(regardingthe behavior’sfunction)wasinaccurate?

# What are other circumstances in everyday life where risk is relative to benefit?

The risk of not interveningeffectively with child problem behaviors is far greater than some of the purported risks of using punishment. The next time someone says to you, “Aren’t you worried that using time-out will pose problems,” you should make the following reply. “Not as worried as having my 7-year-old son fail to learn how to behave in a nonaggressive manner on the playground.” That risk is too great, and using time-out will be far outweighed by the benefits of having him learn to play appropriately with other kids on the playground.