Tuesday, December 6, 2011

The Good, The Bad, & The Ugly: Punishment

Punishment and consequences......ahhhh.

So much can be said about these two concepts. Unfortunately much of what is said or written is incorrect, outdated, or just wrong.  In some circles (like school systems) punishment is viewed as a dirty word. Educators, families, and parents believe they understand consequences and punishment, but they really don't. I think anyone who has regular contact with children should have a basic understanding of reinforcement and punishment, but especially if you work with a child with Autism. This is helpful and vital knowledge to have, and can change the way you interact with these children. So lets jump in!

First, here's a definition:
Punishment- Punishment has occurred when a response is followed immediately by a stimulus change that decreases the future frequency of similar responses (Cooper & Heron, 2007, Applied Behavior Analysis).

Sound confusing?? Its really not.

Punishment is part of learning. Every behavior has a consequence to that behavior. Something good happens, something bad happens, or nothing happens. Punishment is a necessary learning tool so that we can learn to avoid things, or not do do things at all. If we didn't learn from consequences it would impact our lives in a negative way. For example, if every time you skipped work your boss got very angry and yelled at you but you continued skipping work, sooner or later you will likely be fired. However if after the first time you get yelled at you stop skipping work, then you just learned something important to your well being. Basically, punishment is something intended to make a behavior decrease. We use reinforcement for behaviors we want to see go UP, and we use punishment for behaviors we want to see go DOWN. Its that simple.
Something is labeled a punisher only if it made the behavior go down.  So if a teacher sends  a student to Time Out every day for acting up in class, and after a week the behavior has gone up then Time Out is not a punisher. Punishment has gotten a very bad connotation and most people think of it as a negative thing intended to cause harm or to hurt a child. That's just not true. There are many kinds of punishment, that can be divided into 2 groups: Positive or Negative. These groups are easy to distinguish if you think of math. Positive means you added something, and negative means you took something away.

Here is a helpful chart (I just love visuals)-
 
Positive Reinforcement-
Add something to increase a behavior
           +
Negative Reinforcement-
Take away something to increase a behavior
               -
Positive Punishment-
Add something to decrease a behavior
              +
Negative Punishment-
Take away something to decrease a behavior
               -




So based on what most people think about the word "punishment", which one sounds worse- positive punishment or negative punishment?
Negative punishment sounds worse. This is why its important to understand what these concepts actually mean, because doing something "bad" is what most people think of when they hear the word "punishment".  In actuality, positive punishment is the one you want to avoid, which includes things like spankings, electric shock, restraint, or aversives. Professionals in the field of ABA usually only use punishment after several other options have failed, and it will likely be a form of negative punishment (the child loses access to something). Punishment is somewhat controversial, due to a lot of misinformation out there about what punishment actually is.


Punishment is a learning tool, just as reinforcement is. When done correctly, punishment can bring about immediate change in behavior. Punishment is not "The Big Bad Wolf" as it gets portrayed in society. However, decades of research and empirical studies have clearly shown that it is always best to rely on reinforcement to bring about a change in behavior, rather than punishment (For anyone interested, I strongly recommend you research the history of ABA, to see how punishment was originally used on children with Autism. Life Magazine article, 1965  This article is not an easy or pleasant read, but it is important to see how far ABA as a field has come. If you have encountered anti-ABA people it is usually because they incorrectly believe that ABA has not evolved from this 1965 article ).

So lets discuss some types of punishment, now that we know what punishment is.
  1.  Reprimands: Yes, this is considered punishment! Remember the definition of a punisher is something that causes the target behavior to decrease. So if your client keeps touching the materials at the table and you say a stern "Hands Down", which causes them to stop touching materials, then "Hands Down" was a form of punishment. Other examples include "No", "Stop that", "Get down", etc.
  2. Response Blocking: This is when the child goes to do something, like push a sibling, and you block them from completing the action. I use blocking all the time, along with planned ignoring.  Blocking is a non intrusive way to stop a child from successfully engaging in inappropriate behavior.
  3. Over Correction: This is one of my favorite types of punishment. That might sound odd that I have a favorite kind of punishment, but its because whenever I have implemented an over correction technique it works super fast. Basically, over correction is when you OVER react to an inappropriate behavior. For example, if the child throws their cup of milk from the table during dinner, you would have the child go through the entire clean-up process several times in a row. What I really like about over correction is it is very easy to teach to parents, it can be done anywhere, and its very aversive to the child --which means they will stop the behavior quickly.
These are all effective forms of punishment that can be implemented easily by anyone, and can be a necessary component to a behavioral plan. Now I must mention, whenever you are implementing a punishment procedure it is imperative that you think of the behavior plan as a coin. On one side of the coin you have the punishment procedure. If you flip that coin, you must have a schedule of reinforcement so that child has a way to contact a reward. Otherwise you are setting the child up for a lose- lose situation, because they get nothing for good behavior and something for bad behavior. That "something" may prove more important than the "nothing" over time.  Continuing with the example above of the child who throws their cup of milk during dinner, if I was the therapist working with that child I would make sure that she got tons of attention and praise for being on task during dinner. On task could mean eating appropriately, interacting with siblings, passing bowls of food, using her napkin, etc. Then I would remove attention if she threw her milk, and go immediately into the over correction procedure.


So finally, lets address "The Ugly". If done incorrectly, or without adequate supervision by a qualified professional punishment can have negative side effects. Issues usually arise from the application of punishment, which is a clinical way of saying HOW the punishment is delivered to the child. Just like with reinforcement, if punishment is delivered too quickly, or too intensely you are likely to cause harm. Here are a few side effects of punishment that everyone should know:

  1. Aggression/Anger/Retaliation- This is the one I see the most. In response to a punishment procedure, the child starts to hit, bite, scratch, or pinch, in order to stop the therapist from completing the punishment technique. The child resists being restrained, they fall to the floor and scream when told to go to time out, or they attempt to bite me when I implement an over correction technique. Be prepared that this may happen, and have a crisis plan in place in case the child become aggressive.
  2. Escape/Damaged Relationship/Harm to Rapport Building Process- A large risk to punishment techniques is that they directly destroy the purpose of rapport building: to establish a nurturing, caring relationship with the child. The child may start to avoid you, to fear you, or to become upset/agitated when in your presence. This may take the form of escape, where the child runs from you or attempts to leave the therapy room. This could also look like avoidance, where the child just avoids being near you or around you. Obviously, having a situation where the child is afraid of you is counter productive. The first time you spank your child, you may not see an avoidance or escape response. Just be aware it could happen, and decide upfront if that's a risk you want to take.
  3. Behavioral Contrast- This is an ABA term, that basically means creating a situation where X doesn't occur here , but X occurs over there and may even occur more frequently. Here is a real life example: A therapist gets a child to stop stimming at the table by immediately removing reinforcement, combined with holding the child's hands down in their lap for 5 seconds each time they stim. Very quickly, the stimming goes down to 0 when the therapist is around. However, when the therapist is not around, the child stims near constantly and the parents don't know how to handle it. What the therapist has actually taught this child is "Don't stim around me". 
Please remember: punishment on its own does not teach anything. Yes, you may reduce or eliminate a behavior but you need to also teach the child what to do instead of the inappropriate behavior. Otherwise they will just replace the behavior you didn't like with another behavior that you really wont like. An example of this that I see all the time in schools, is a child will begin to run down the hall and a teacher will say "Stop running!". Very quickly the child will stop running. BUT, they may begin to skip, hop, or be inappropriate in some other way. A better way to handle this is to say "Walk please", which tells the child what you want them to do instead of allowing them to decide what their replacement behavior should be.

10 comments:

  1. This is a good perspective for me to read, since the first people I heard about ABA from are ones who received abusive, aversives-based "therapy" in years past.

    One question on this post... I think I have a good idea a possible answer of yours... but a lot of people with negative views expressed on ABA seem to have had all types of stimming, no matter how small, prohibited which caused a great deal of anxiety. Some stimming is a behavior which needs to be reserved for a certain place or time, others could safely be left alone probably? What is your general philosophy on stim behaviors?

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    1. Hi there, thanks for your comment.
      I have heard some of those horror stories as well, and it angers me just like anyone else when people who call themselves "ABA professionals" cause harm to individuals, and completely misrepresent this field.

      Not every professional has the same stance on "stimming", and I have heard differing viewpoints from my colleagues over the years. I see stims as a type of the hair twirling, nail biting, foot tapping, repetitive behaviors that many people engage in (take a look around the next time you are standing in a long line, its quite fascinating!).

      When working with a client, my treatment goals are going to reflect the concerns of whoever initiated therapy...usually the parents. Some parents want to target stimming, and some dont. For those who do, we typically redirect stimming to more appropriate times when it wont interfere with/prevent learning.

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  2. I looked up behavior contrast on google and this appeared. It was super helpful in helping me understanding the meaning for real world application. Sometimes textbooks can be hard for me to understand. Thanks for sharing this information. My name is Cory Nichols. I'm a first year master's student in SPED(and ABA) at Vanderbilt. Nice to meet you.

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    1. Hi Cory,

      You are welcome, I'm glad the information was helpful for you!

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  3. Hello! I am interested about behavioral contrast to Child with autism.Could you help me with articles or research for Behavioral contrast of People with autism ? Because I found only for typical People or animals. Thank you very much!

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    1. Hi there,

      You may want to expand your search a bit. Even if the participants used in the research study are not individuals with Autism, behavior is behavior. That does not mean the conclusion wouldn't apply to an individual on the Spectrum.
      Here is a link to a study that is particular to individuals with Autism: http://www.sciencedirect.com/science/article/pii/002209658090048X

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  4. I love your blog, and i have learned so much by reading your posts. Thanks from a mother with a child with autism and future ABA Therapist,

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    1. I appreciate your comment and thanks for visiting my blog!

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  5. Thank you very much Tameika. Your article has helped me with my assignment the dangers of punishment and how punishment can be effectively administered. Continue with the good work.

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    1. Glad to hear it, and thank you for visiting the blog! :-)

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