The ends don’t justify the means: using shock to punish aggression in high-functioning individuals

There were a lot of claims and counterclaims posted in response to an op-ed in the Boston Globe several months ago about the Judge Rotenberg Center (JRC). But one claim really caught my eye. One person wrote, in support of the center:

In regards to the teenagers at JRC that are not autistic. Their serious behaviors aren’t just beating up their parents, teachers, and care takers and threatening people with weapons; they are committing drug and gun crimes, attempting suicide, maiming themselves with cutting behaviors, raping their siblings and other sexual assaults, running away, and prostituting themselves. Not just incidental occurrences, daily occurrences! When these parents call JRC they are in fear that their child’s next night out will be their last.

it seems that the center has a significant sub-population who are not intellectually impaired but who are severely aggressive towards others. This second type of application of contingent skin shock is not new at JRC, although some of us may not have paid enough attention to it other than occasional news reports of brawls at the center that usually occur in the evenings and in the residences (such as this recent one).

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Massachusetts bills on aversive shocks stalled by GOP maneuvering

The Massachusetts legislature is again bogged down over proposals that would seriously limit the use of contingent and painful electric shock at the Judge Rotenberg Center. The bills are S. 45 and S. 46. The former proposal would add a lot of new restrictions to the use of aversive behavioral interventions but would still permit them. As such, the proposal does not address the recent finding of the U.N. Special Rapporteur on Torture who found that the use of any such skin shock is torture and therefore prohibited.

Kyle Cheney reports on the latest developments today for the State House News Service and quotes Rep. Sanchez, whose nephew attends the Judge Rotenberg Center and who has been a major stumbling block to those who would try to prohibit the intervention entirely:

Sanchez wondered why proponents of Joyce’s bill haven’t expressed “the same level of fervor and passion” about doctors who prescribe psychotropic drugs to kids.

“This is personal for me. It’s very difficult,” he said. “Aren’t parents the best advocates for their children?”

Well, no, Representative Sanchez, they are not always the best advocates for their children. We’ve all seen too many cases of child abuse to think that parents are always good advocates for their children. And when parents are desperate to help their children, that doesn’t mean that the treatment that they are advocating for is effective or safe in both the short-term and long-term.

I have repeatedly suggested that there needs to be more attention paid to long-term assessment by independent third parties. Selective long-term follow-up reports are neither consistent with solid scientific practice nor persuasive. Do we know how many children may have been traumatized or psychologically harmed by the use of this intervention? No, we do not know.

Rep. Sanchez told the News Service that sufficient safeguards already exist and that any further bureaucracy could be a “death sentence” for kids who have been helped by the treatment, including his nephew.

“Parents have to go through due process. This is not mandated upon parents. Parents request this because of how difficult their individual circumstances are. These are the most difficult children anyone will ever have to work with relative to their conditions,” he said.

Again, I must respectfully but firmly disagree with Rep. Sanchez. Due process as it is used here does not involve an independent panel of genuine experts who review the child’s full records and determine whether the intervention is necessary and reasonably calculated to be of benefit. JRC seems to take the position that anyone who argues that the intervention isn’t necessary is biased against aversives, yet their own data suggest that in at least some cases, other alternatives to aversives — including non-medication approaches — were never explored or given adequate trials prior to recommending the contingent shock.

UN Calls Shock Treatment at Judge Rotenberg Center ‘Torture’

Katie Hinman and Kimberly Brown report that the United Nations has responded to the MDRI report on the Judge Rotenberg Center. I had previously reported on the MDRI report here and have previously discussed the concerns about the Judge Rotenberg Center. Now ABC reports:

But after the release of a recent study by Mental Disability Rights International, Rotenberg has come under the scrutiny of no less than the United Nations, which is calling the school’s practices “torture.”

“To be frank, I was shocked when I was reading the report,” said Manfred Nowak, the UN’s Special Rapporteur on Torture. “What I did, on the 11th of May, was to send an urgent appeal to the U.S. government asking them to investigate.”

[...]

“This is torture,” said Nowak. “Of course here they might say, but this is for a good purpose because it is for medical treatment. But even for a good purpose — because the same is to get from a terrorist information about a future attack, is a good purpose. To get from a criminal a confession is a good purpose.

To Eric Rosenthal (of MDRI), there are two factors for the Obama administration to consider; the United States’ international treaty obligations on torture, and President Obama’s own reputation. “President Obama has staked his international reputation on ending torture and the world is now looking,” said Rosenthal. “Are we gonna live up to our obligations and is President Obama gonna live up to his promise to end torture by the United States government?”

The issue is clear, says Nowak: “You cannot balance this. The prohibition of torture is absolute.”

Read more on ABC News. Tonight’s edition of “Nightline” at 11:35 pm covers the story.

Controversy continues over Judge Rotenberg Center

The Washington Post contains a report by Associated Press reporter Bob Salsberg about the Department of Justice opening a "routine investigation" (.pdf) into the Judge Rotenberg Center in Canton, Massachusetts.   The stated purpose of the investigation is to determine whether the residential center’s methods violate the  Americans with Disabilities Act.  The complaint (.doc) was filed by 31 disability organizations. The Judge Rotenberg Center (JRC) has been controversial since its inception but all attempts to shut it down have failed, in part, because parents of children and adults placed there support the use of the aversive behavioral interventions and assert that the approach has been effective in reducing severely aggressive or self-injurious behaviors that did not respond to medication or less extreme treatment approaches. In 2006, when the New York  State Education Department (NYSED) attempted to prohibit  some of the interventions used by the school by enacting regulations that prohibit the use of aversive behavioral interventions, parents filed suit in federal court.    Just this week, the court has issued its opinion (pdf).  The court found for NYSED on some of the most important issues, but affected students will still be able to receive aversive behavioral interventions at JRC because the court refused to dissolve the temporary injunction prohibiting NYSED from implementing the regulations with respect to the students named in the lawsuit , and because the regulations provide that the students can receive aversive behavioral interventions if their Individualized Educational Plan (IEP) specified such interventions as an exception to the regulations prior to June 2009 and the student’s Committee on Special Education approved the plan. Read more