Overview
I do not believe aversive techniques should be used to treat self-injurious behavior (SIB) in children with autism spectrum disorder (ASD). Aversive interventions such as physical reprimands, loud noises, or other unpleasant stimuli can cause significant physical or psychological harm and may increase the frequency or intensity of SIB (Cooper et al., 2019). This is especially concerning for a 7-year-old boy whose head banging has already required medical attention. Aversives can sometimes quickly reduce SIBs when immediate safety is at risk (Cooper et al., 2019); however, their risks outweigh the benefits. They can cause physical or psychological harm, increase stress, and damage trust between the child and clinicians. Employing aversives would violate both ethical mandates because it exposes the child to unnecessary discomfort, rather than focusing on behaviors and safety skills.
The use of aversive procedures in behavior analysis must be approached carefully to avoid ethical violations. The Behavior Analyst Certification Board (BACB) Ethics Code (2022, Sections 2.06 and 2.15) requires behavior analysts to use the least restrictive and most effective interventions, focusing on positive reinforcement before considering any form of punishment. Using aversives without first trying less intrusive methods can conflict with these ethical standards. Likewise, the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct (2017, Principle A: Beneficence and Nonmaleficence) reminds professionals to maximize benefits and minimize harm. Behavior analysts are expected to prioritize clients’ dignity, safety, and well-being by using positive, humane interventions rather than aversive techniques.
Therefore, reinforcement-based intervention to reduce or eliminate SIB is strongly suggested. Reinforcement strategies, such as positive reinforcement, increasing communication, and making environmental modifications, are to be considered. Reinforcement-based interventions reduce self-injurious behavior safely and effectively while teaching adaptive skills (Hanley et al., 2003). Identifying the purpose of the SIB and addressing it directly allows for the behavioral analysis to reduce the behavior rather than induce fear or discomfort. Also, reinforcement-based interventions maintain the child’s dignity, safety, and overall well-being while still achieving behavior reduction.
Applying practical and parsimonious tactics can avoid the need for aversives when establishing a behavioral plan to reduce or eliminate SIBs. Behavior analysts should base all professional decisions and actions on ethical considerations, guided by three fundamental questions: What is the right course of action? What efforts are truly valuable? And what does it mean to practice with integrity as a behavior analyst (Reich, 1988; Smith, 1987, 1993, as cited in Cooper et al., 2019)?
Positive, reinforcement-based, and functionally informed strategies are consistent with ethical guidelines, evidence-based practice, and the best interests of the child, making them a responsible and effective approach to treatment. In contrast, aversive interventions are ethically questionable, potentially harmful, and unnecessary for addressing SIBs (BACB, 2022).
References
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/codeLinks to an external site.
Behavior Analyst Certification Board. (2022). Ethics code for behavior analysts. https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdfLinks to an external site.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied Behavior Analysis (3rd ed.). Pearson Education (US). https://mbsdirect.vitalsource.com/books/9780134798783Links to an external site.
Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional Analysis of Problem Behavior: A Review. Journal of Applied Behavior Analysis, 36(2), 147–185. https://doi.org/10.1901/jaba.2003.36-147