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Hywel Morgan

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Textbook Readings Article Provided on Blackboard Balancing Freedom From Harm and Right To Treatment for Persons with Developmental Disabilities Maurice A. Feldman Introduction - Ethical and practical dilemma’s practitioners in the field of developmental disabilities: o Defending the individual’s right to effective treatment and education o Protecting him/her from unnecessary intrusion, discomfort, or pain - Effective techniques for teaching persons with developmental disabilities o Behavioural procedures, such as contingencies of reinforcement, shaping and stimulus control - Behavioural procedures have been used to eliminate maladaptive behaviour and to replace it with alternative, functional behaviour o Use both positive reinforcement and punishment Issues The “Freedom from Harm” Position - Claims: o Advocates claim that use of punishment with persons who have developmental disabilities is unethical and unnecessary o Non punitive methods, such as reinforcing alternative behaviour, produce better generalization and maintenance of therapeutic and educational gains o Reinforcement based reductive procedure - How valid are these claims? o Published reviews consistently reveal that combinations of positive reinforcement and punishment strategies are most effective than reinforcement alone in treating severe behaviour problems o Claims of those that advocate the exclusive use of nonpunitive procedures may be premature, given the current technology and research - Impact: Positive side: o Led to a rejuvenation of interest and research in nonpunitive procedure (best interests of clients) o Systematic and thorough behavioural assessment helps identify the controlling and maintaining variables for the maladaptive behaviour - Impact: Negative side: o Banning of punitive procedure:  Expected prolonged suffering, not just of individual, but also of the family, friends and care providers  Alifetime of physical and/or chemical restraint  Placement in a more restrictive environment  Rejection  Lost opportunities to engage in meaningful social, educational, vocation, and recreational activities o Denying access to treatment  Some individuals, due to current behaviour disorders, will be considered “unteachable” therefore denied access to training programs that would teach them alternative functional behaviour due to unwillingness on the part of administrators or program staff to use certain procedures Textbook Readings Article Provided on Blackboard o Formal punishment programs are discrouaged  May be an increased risk of nonprogrammatic and unrecognized use of intrusive procedures  To avoid charges of promoting intrusive programs, some practitioners re-label contingent restraint as “crisis intervention” as opposed to time out room o Increased likelihood of abuse to clients is possible due to staff’s lack of recognition, documentation, understanding, and raining in the procedures being employed  Safeguards to protect the clients from unnecessary harm need to be put in place regardless of whether restrictive, intrusive, and aversive procedures are considered behavioural programs or not - Reluctance to acknowledge the use of punitive procedures are found in treatment literature: o Astudy reported that injury decreased in four persons with mental retardation when stimulation (vibration) was provided, to affected body areas. The treatment of this effectiveness is questionable as there were flaws in methodology (design 3 of 4 subjects, non-naïve observers, no reliability data, and trainer intervened by holding the subjects hand until a decrease in resistance… occurred). The very next study in the same issue of the journal providing evidence that a treatment package including brief hand restraint decreased stereotypic behaviour. In his discussion, he acknowledged the multicomponent aspect of the treatment package consisting of both reinforcement and punishment. o Asecond example claims o show a decrease in the disruptive behaviour of four children with autism “through reinforcement of appropriate play behaivour” but fails to acknowledge the possible punishing effects of an accompanying verbal reprimand procedure. - Summary o Recent efforts to promote positive procedures and decry punitive methods has had both positive effects:  Example: Development and promotion of research on new nonpunitive approaches, re-emphasis on functional analysis o And negative effects:  Example: denial of right to treatment, exclusion from less restrictive settings, failure to document active treatment variables The “Right to Effective Treatment” Position - Claims: o There are three practiti
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