A comment on punishment
A comment on punishment
The early methods of behaviour modification tended to focus on how self-injurious behaviour could be decreased as quickly as possible. Inevitably, this meant that there was a good deal of research conducted into the use of punishment as a treatment for self-injurious and other behaviour problems. The term punishment used in this context refers to the decrease of behaviour when an aversive stimulus is presented following an instance of the behaviour. Following heated debates in the late 1980s and early 1990s the description of punishment techniques in the research literature has decreased and has been replaced by the approach which we have adopted in this book.
Whilst this is the approach that is now advocated by many researchers and clinicians in the field, there is still the possibility that punishment can be proposed as a method of control of the self-injurious behaviour of people with intellectual disabilities. In this section we are want to draw attention to the three main issues that are important to consider.
- First, punishment tends to give a short term success. There is some evidence in the research literature that the behaviours decrease more quickly when punishment methods are used than when alternative approaches are adopted, although there is some debate about whether this is the case. One factor that may be related to the short term success is that the punitive stimulus delivered, needs to be quite severe or unpleasant in order to suppress the behaviour. Inevitably this may lead to the use of punishers in a way that may be considered inhumane. For example, squirting lemon juice into the mouth, enforcing physical activity and inducing pain. Whilst there is evidence that these procedures may lead to short-term success there is also evidence that when children and adults who have been involved in these treatments are followed up at a later date the self-injury has returned and persists 23.
- Second, whilst punishment may decrease selfinjurious behaviour, it does so simply by teaching somebody what not to do. However, if we accept the model that is described in Chapter 5 that the behaviour is functional then if we use punishment alone, clearly we do not teach the person what to do instead of self-injuring. This means that the person will have the same needs but no way of satisfying those needs. If the model is correct then this means the self-injury will occur again at a later stage and the evidence on punishment shows that this is exactly what happens.
- The model that we have presented in Chapter 5 shows how self-injurious behaviour can be learned. Punishment as an effective treatment also depends on learning i.e. the person learns not to self-injure because the punishment will follow. If this is the case then there is agreement that the self-injurious behaviour is learned. The question then is how best to affect the unlearning of self-injurious behaviour. Our argument is that if there is agreement that self-injurious behaviour is a learned behaviour then either approach may work but we would argue that using positive methods is preferable to punishment simply because of the short term success issue, the inhumane nature of many punishment methods and the importance of replacing the behaviour with a different behaviour.
This discussion of punishment presents a brief summary of our views and we accept that there are different opinions on the use of punishment as an intervention for self-injurious behaviour. Clearly, it is a personal decision as to whether punishment techniques are used and not all punishment techniques will necessarily be inhumane. If you are considering using punishment techniques to decrease self-injurious behaviour we would strongly advise you to seek advice from a clinical psychologist or behaviour analyst and to keep all of the effects of punishment under close review.
