Abstract

We conducted analyses of contingent skin-shock (i.e., positive punishment) in the treatment of severe problem behaviors in 173 individual cases between 2001 and 2019. Overall, a 97% reduction in the frequency of severe aggressive and health dangerous (e.g., self-injurious) behaviors was observed in the first full month of treatment across participants with diagnoses including intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, among other disorders. Findings provide support for the supplemental use of contingent skin-shock in conjunction with differential reinforcement and other behavioral procedures for severe treatment refractory behaviors. We present novel findings from (a) the largest clinical sample in the skin-shock literature (describing approximately 350 treatment years), (b) planned versus unplanned fading of treatment, (c) reversal of treatment effects, and (d) follow-up data spanning 15 years. The evidence provides support for the assertion that contingent skin-shock is the least intrusive, most effective and efficient treatment available for the severe problem behaviors of some individuals.