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Review article
First published online May 30, 2020

A Systematic Review of the Ethics of Punishment-Based Procedures for Young Children With Disabilities

Abstract

Punishment-based procedures are used to reduce challenging behavior in both special education and applied behavior analytic practices. Although commonly effective, these interventions are associated with an increased level of risk, making their use controversial. However, no research has specifically analyzed the extent to which researchers comply with the ethical standards of the professional organizations for special educators and behavior analysts (i.e., Council for Exceptional Children [CEC] and the Behavior Analyst Certification Board [BACB], respectively) when implementing punishment-based procedures. This might be especially important for young children with disabilities, who are a highly vulnerable population. We systematically analyzed the use of punishment-based procedures with this population to determine (a) characteristics of included children and treatments and (b) the degree to which researchers adhered to ethical standards during implementation. Results indicated a variety of punishment-based procedures have been used with this population and have generally resulted in decreased challenging behavior; these results were demonstrated across age, diagnosis, target behavior, and treatment type. However, researchers demonstrated minimal adherence to ethical standards, with no improvements over time. This indicates a need for improved ethical rigor of researchers implementing punishment-based interventions. Recommendations include (a) the creation and validation of an ethics code to assess the degree to which researchers demonstrate ethical practices, and (b) the development of tools to help practitioners recognize the ethical implications of punishment-based interventions and choose/implement appropriate interventions for behavioral interventions.

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References

Asterisk indicates reference was included in the review.
*Agosta J. M., Close D. W., Hops H., Rusch F. R. (1980). Treatment of self-injurious behavior through overcorrection procedures. Journal of the Association for the Severely Handicapped, 5, 5–12.
*Altman K., Haavik S., Cook J. W. (1978). Punishment of self-injurious behavior in natural settings using contingent aromatic ammonia. Behaviourresearch and Therapy, 16, 85–96.
*Barnard J. D., Christophersen E. R., Wolf M. M. (1976). Parent-mediated treatment of children’s self-injurious behavior using overcorrection. Journal of Pediatric Psychology, 1, 56–61.
Barton E. E., Lloyd B. P., Spriggs A. D., Gast D. L. (2018). Visual analysis of graphic data. In Ledford J. R., Gast D. L. (Eds.), Single case research methodology (3rd ed., pp. 179–214). Routledge.
Behavior Analyst Certification Board. (2012). Coursework requirements for BACB credentials: Fourth edition task list. https://www.bacb.com/wp-content/uploads/2017/09/BACB_CourseContentAllocation.pdf
Behavior Analyst Certification Board. (2015). U.S. behavior analyst workforce: Understanding the national demand for behavior analysts. https://www.bacb.com/wp-content/uploads/2017/09/151009-burning-glass-report.pdf
Behavior Analyst Certification Board. (2017). Professional and ethical compliance code for behavior analysts. https://www.bacb.com/wp-content/uploads/BACB-Compliance-Code-english_190318.pdf
*Briggson S. (2014). Decreasing stereotypy through response interruption and redirection (RIRD) and stimulus control [Master’s thesis]. Available from ProQuest Dissertations & Theses Global database (UMI No. 1583024).
Brodhead M. T., Higbee T. S. (2012). Teaching and maintaining ethical behavior in a professional organization. Behavior Analysis in Practice, 5, 82–88.
*Cassella M. D., Sidener T. M., Sidener D. W., Progar P. R. (2011). Response interruption and redirection for vocal stereotypy in children with autism: A systematic replication. Journal of Applied Behavior Analysis, 44, 169–173.
Catania A. C. (2013). Learning (5th ed.). Prentice Hall.
Conroy M. A., Dunlap G., Clarke S., Alter P. J. (2005). A descriptive analysis of positive behavioral intervention research with young children with challenging behavior. Topics in Early Childhood Special Education, 25, 157–166.
Cooper J. O., Heron T. E., Heward W. L. (2007). Applied behavior analysis (2nd ed.). Pearson.
Council for Exceptional Children. (2009). Policy on physical restraint and seclusion procedures in school settings. https://www.cec.sped.org/~/media/Files/Policy/CEC%20Professional%20Policies%20and%20Positions/restraint%20and%20seclusion.pdf
Council for Exceptional Children. (2015). What every special educator must know: Professional ethics and standards. https://www.cec.sped.org/~/media/Files/Standards/Professional%20Ethics%20and%20Practice%20Standards/Code%20of%20Ethics.pdf
*Donaldson J. M., Vollmer T. R., Yakich T. M., Van Camp C. (2013). Effects of a reduced time-out interval on compliance with the time-out instruction. Journal of Applied Behavior Analysis, 46, 369–378.
*Doughty S. S., Poe S. G., Anderson C. M. (2005). Effects of punishment and response-independent attention on severe problem behavior and appropriate toy play. Journal of Early and Intensive Behavior Intervention, 2, 91–98.
Duker P. C., Sigafoos J. (1998). The Motivation Assessment Scale: Reliability and construct validity across three topographies of behavior. Research in Developmental Disabilities, 19, 131–141.
Dunlap G., Strain P. S., Fox L., Carta J. J., Conroy M., Smith B. J., Kern L., Hemmeter M. L., Timm M. A., McCart A., Sailor W., Markey U., Markey D. J., Lardieri S., Sowell C. (2006). Prevention and intervention with young children’s CB: Perspectives regarding current knowledge. Behavioral Disorders, 32, 29–45.
*Durand M. V., Carr E. G. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis, 25, 777–794.
Durand V. M., Crimmins D. B. (1988). The Motivation Assessment Scale. In Hersen M., Bellack A. (Eds.), Dictionary of behavioral assessment techniques (pp. 309–310). Pergamon.
Fiedler C. R., Van Haren B. (2009). A comparison of special education administrators’ and teachers’ knowledge and application of ethics and professional standards. The Journal of Special Education, 43, 160–173.
Fixsen D. L., Naoom S. F., Blase K. A., Friedman R. M. (2005). Implementation research: A synthesis of the literature. http://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/resources/NIRN-MonographFull-01-2005.pdf
Gaylord-Ross R. (1980). A decision model for the treatment of aberrant behavior in applied settings. In Sailor W., Wilcox B., Brown L. (Eds.), Methods of instruction for severely handicapped students (pp. 135–158). Paul H. Brookes.
Gershoff E. T. (2002). Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychological Bulletin, 128, 539–579.
Graber A., Graber J. E. (2019). The unique challenge of articulating the behavior analysts’ ethical obligations and the case of punishment. Behavior Analysis in Practice, 12, 688–695.
Graziano A. M., Hamblen J. L., Plante W. A. (1996). Subabusive violence in child rearing in middle-class American families. Pediatrics, 98, 845–849.
Hales B. M., Pronovost P. J. (2006). The checklist: A tool for error management and performance improvement. Journal of Critical Care, 21, 231–235.
Iwata B. A., DeLeon I. G., Roscoe E. M. (2013). Reliability and validity of the functional analysis screening tool. Journal of Applied Behavior Analysis, 46, 271–284.
Jacobson J. W. (1992). Who is treated using restrictive behavioral procedures? Journal of Developmental and Physical Disabilities, 4, 99–113.
Johnston J. M. (2006). “Replacing” problem behavior: An analysis of tactical alternatives. The Behavior Analyst, 29, 1–11.
Johnston J. M., Sherman R. A. (1993). Applying the least restrictive alternative principle to treatment decisions: A legal and behavioral analysis. The Behavior Analyst, 16, 103–115.
Kennedy C. H. (2002). Toward a socially valid understanding of problem behavior. Education and Treatment of Children, 25, 142–153.
Laraway S., Snycerski S., Pradhan S., Huitema B. E. (2019). An overview of scientific reproducibility: Consideration of relevant issues for behavior science/analysis. Perspectives on Behavior Science, 42, 33–57.
Lecavalier L., Leone S., Wiltz J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183.
Lee G. T., William D. E., Simmons J., Johnson-Patagoc K. (2018). The right to effective treatment for people with developmental disabilities and severe problem behaviors. Behavior Analysis: Research and Practice, 18, 436–447.
Lerman D. C., Vorndran C. M. (2002). On the status of knowledge for using punishment: Implications for treating behavior disorders. Journal of Applied Behavior Analysis, 35, 431–464.
Lovaas O. I., Favell J. E. (1987). Protection for clients undergoing aversive/restrictive interventions. Education and Treatment of Children, 10, 311–325.
*Luiselli J. K., Ricciardi J. N., Zubow M., Laster K. (2004). Practice of an alternative behavior as intervention for object stereotypy: Comparison of contingent and non contingent implementation across evoking stimuli. The Behavior Analyst Today, 5, 304–312.
Lydon S., Healy O., Moran L., Foody C. (2015). A quantitative examination of punishment research. Research in Developmental Disabilities, 36, 470–484.
Matson J. L., Taras M. E. (1989). A 20-year review of punishment and alternative methods to treat problem behaviors in developmentally delayed persons. Research in Developmental Disabilities, 10, 85–104.
*Miguel C. F., Clark K., Tereshko L., Ahearn W. H. (2009). The effects of response interruption and redirection and sertraline on vocal stereotypy. Journal of Applied Behavior Analysis, 42, 883–888.
Moher D., Liberati A., Tetzlaff J., Altman D. G. & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Medicine, 6, Article e1000097.
Mulick J. A. (1990). The ideology and science of punishment in mental retardation. American Journal of Mental Retardation, 95, 142–156.
Paul J., French P., Cranston-Gingras A. (2001). Ethics and special education. Focus on Exceptional Children, 34, 1–16.
*Perry T. L. (2013). The effects of response interruption and redirection on language skills in children with vocal stereotypy [Doctoral dissertation]. http://commons.emich.edu/cgi/viewcontent.cgi?article=1805&context=theses
*Rapoff M. A., Altman K., Christophersen E. R. (1980). Suppression of self-injurious behaviour: Determining the least restrictive alternative. Journal of Mental Deficiency Research, 24, 37–46.
Regalado M., Sareen H., Inkelas M., Wissow L. S., Halfon N. (2004). Parents’ discipline of young children: Results from the National Survey of Early Childhood Health. Pediatrics, 113, 1952–1958.
*Salvy S.-J., Mulick J. A., Butter E., Bartlett R. K., Linscheid T. R. (2004). Contingent electric shock (SIBIS) and a conditioned punisher eliminate severe head banging in a preschool child. Behavioral Interventions, 19, 59–72.
Scotti J. R., Ujcich K. J., Weigle K. L., Holland C. M., Kirk K. S. (1996). Interventions with CB of persons with developmental disabilities: A review of current research practices. Journal of the Association for Persons with Severe Handicaps, 21, 123–134.
Sexton J. B., Thomas E. J., Helmreich R. L. (2000). Error, stress, and teamwork in medicine and aviation: Cross sectional surveys. British Medical Journal, 320, 745–749.
Sidman M. (1989). Coercion and its fallout. Authors Cooperative.
Sileo N. M., Sileo T. W., Pierce T. B. (2008). Ethical issues in general and special education teacher preparation: An interface with rural education. Rural Special Education Quarterly, 27, 43–54.
Sullivan P. M., Knutson J. F. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse & Neglect, 24, 1257–1273.
*Swenson C. R., Simpson R. L. (1978). The effects and side-effects of overcorrection procedures for self-stimulatory behavior applied by parents of severely emotionally disturbed children in natural home settings [Doctoral dissertation]. https://files.eric.ed.gov/fulltext/ED180151.pdf
Tincani M., Travers J. (2019). Replication research: Publication bias, and applied behavior analysis. Perspectives on Behavior Science, 42, 59–75.
U.S. Department of Education. (2010). Twenty-ninth annual report to Congress on the implementation of the Individuals with Disabilities Education Act.
U.S. Department of Education. (2012). Restraint and seclusion: Resource document.
Van Houten R., Axelrod S., Bailey J. S., Favell J. E., Foxx R. M., Iwata B. A., Lovaas O. I. (1988). The right to effective behavioral treatment. The Behavior Analyst, 11, 111–114.
Vittrup B., Holden G. W., Buck J. (2006). Attitudes predict the use of physical punishment: A prospective study of the emergence of disciplinary practices. Pediatrics, 117, 2055–2064.
Vollmer T. R., Hagopian L. P., Bailey J. S., Dorsey M. F., Hanley G. P., Lennox D., Spreat S. (2011). The Association for Behavior Analysis International position statement on restraint and seclusion. The Behavior Analyst, 34, 103–110.
Westling D. L., Trader B. R., Smith C. A., Marshall D. S. (2010). Use of restraints, seclusion, and aversive procedures on students with disabilities. Research and Practice for Persons with Severe Disabilities, 35, 116–127.
Wolf M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203–214.
*Wunderlich K. L., Vollmer T. R. (2015). Data analysis of response interruption and redirection as a treatment for vocal stereotypy. Journal of Applied Behavior Analysis, 48, 749–764.
*Wunderlich K. L., Vollmer T. R., Zabala K. A. (2017). Assessment and treatment of automatically reinforced self-induced emesis. Journal of Applied Behavior Analysis, 50, 418–423.
Zolotor A. J., Theodore A. D., Runyan D. K., Chang J. J., Laskey A. L. (2011). Corporal punishment and physical abuse: Population-based trends for three-to-11-year-old children in the United States. Child Abuse Review, 20, 57–66.

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