Free Walden
Disability, Intersectionality. Autonomy, Human Rights,
and the Fight to Shut Down the Judge Rotenberg Center
Why the Graduated Electronic Decelerator Must be Banned Part 1:
It's Torture and it Doesn't Work!
May 2024 By KG
Methodological Concerns with Literature
Ethical Concerns with Research
The lack of Peer Reviews For CSS studies
bluured.jpg)
JRC staff member wearing a GED remote control.
Photo credit: Charles Krupa AP
In March 2024, the Food and Drug Administration (FDA) announced that it would be attempting to ban the Graduated Electronic Decelerator, the device that is used to shock disabled students at the Judge Rotenberg Center in Massachusetts, for a second time (1). The agency has gathered more evidence, considering clinical and scientific data, input from patients who have been subjected to Electrical Stimulation Devices (ESDs), parents of patients, disability rights groups, and experts in the field and state agencies, as well as comments from the previous ban proposal and input from FDA advisory panels (1). The FDA’s proposal to ban ESDs will be open for comment until May 28, 2024.
Adverse Effects
Numerous reports, studies, and investigations show that the Contingent Skin Shocks (CSS) administered via the GED, causes physical and psychological harm. The following list of adverse side effects was compiled using the following resources:
​
The Food and Drug Administration's March 25, 2024 press release on its proposed banning of ESDs (1).
The Food and Drug Administration's March 6, 2020 ruling on the ESD ban (2)
The Food and Drug Administration's April 22, 2016 press release on its proposed banning of ESDs (3)
International Association for the Scientific Study of Intellectual and Developmental Disabilities 2020 Review of 41 studies on the effects of contingent shock (Zarcone, Mullane, Langdon, & Brown,2020).
Israel, Blenkush, von Heyn, & Rivera, 2008 (ISRAELaggroshock/Israel2008)
van Oorsouw, Israel, Von Heyn, & Duker, 2008 ((ISRAEL2007/Oorsouw,Israel,VonHeyn,&Duker,2008)
2021 Contingent Skin Shocks Case Study on 173 JRC Students (Yadollahikhales G, Blenkush N, Cunningham, 2021)
ACLU’s written testimony for the April 24, 2014 hearing on averse conditioning devices (8)
ACLU's August 11, 2009 report “Impairing Education: Corporal Punishment of Students with Disabilities in US Public Schools” (9)
Accounts from GED-recipients (10, 11, 12, 13, 14, 15, 16)
The Effects of the Graduated Electronic Decelerator
​
-
Pain-(1, 3, 4, 7, 14, 16)
-
1st to 3rd-degree burns and other tissue damage (1, 3, 4, 8, 12, 13, 16)
-
Getting knocked off feet (10)
-
Errant shocks from a device malfunction (3, 16)
-
Muscle cramps (16)
-
Hair loss (8)
-
Tooth damage (8)
-
Impotence (8)
-
Loss of feeling in arms, hands, legs, and/or feet lasting up to a year (8, 16)
-
Crying out, whining, and other vocalizations when being shocked (4)
-
Shivering (4)
-
Tensing of muscles in between the time they engage in an unwanted target behavior and the time they get shocked.(1, 2)
-
Incontinence (4, 11)
-
Attempts to remove device (4, 5 )
-
Avoidance behaviors (2, 4, 7)
-
Escape responses (2)
-
Symptom substitution (4)
-
Suppression of all behavior (aka “freezing”) (4)
-
Increase in Emotionality (5, 6)
-
Hostility and retaliation (4)
-
Aggression (4)
-
Aggression fantasies (4)
-
Increase in self-injury (4)
-
Fear of Device (4)
-
Temporary anxiety (4, 7)
-
Humiliation (14)
-
PTSD (1, 3, 8, 16)
-
Panic, nervousness, extreme fear, or chronic anxiety (1, 2, 3, 4, 8, 12, 15, 16)
-
Marked startle response (2)
-
Decrease in happiness and Contentment/Depression ( 1, 2, 3, 4, 8, 14)
-
Thoughts of killing oneself (14)
-
Sleep disturbances (8, 14, 16)
-
Nightmares (2, 14, 16)
-
Intrusive thoughts (2)
-
Mistrust (2)
-
Flashbacks of panic or rage (2)
-
Memory loss (8)
-
Anger (2)
-
Hypervigilance (2)
-
Insensitivity to fatigue (2)
-
Catatonia (12)
-
Death (14)
What the Research Says
None of the contemporary textbooks in undergraduate and graduate ABA programs describe contingent skin shocks as being therapeutic for problem behavior (17), yet the JRC continues to justify shocking disabled students by pointing to the limited amount of problematic research regarding the effects of CSS.
1. Is the GED effective?
After reviewing 41 studies on CSS, Zarcone et al., 2020 determined that it does decrease the target challenging behavior by 80%, but the data is inconsistent and contradictory on immediate and long-term effectiveness, the number of treatments, and fading (4, 17).
​
Immediate, Short, and Long-Term Results
​
Linscheid, Iwata, Ricketts, Williams, & Griffin, 1990 and Salvy et al., 2004 found that problem behavior is significantly reduced after just a few 10-minute sessions (4).
​
Blenkush, von Heyn, and Israel, 2013 found that the GED instantly reduced the targetted problem behavior to near-zero (4).
​
Blenkush, Williams & Oneil, 2020 found that problem behavior was reduced by 97% in the first month (21).
​
Israel, Blenkush, von Heyn, & Rivera, 2008 and Israel, Blenkush, von Heyn, & Sands, 2010 found that it takes many months of all-day CSS to be effective (4).
​
Mudford, Boundy, & Murray, 1995 and Williams, Kirkpatrick-Sanchez, & Iwata, 1993 found that the effectiveness of CSS lasted for many months (4).
Ricketts, Goza, & Matese, 1993 found that CSS lost its effectiveness over long periods (4).
Fading
​
Fading is the gradual decrease of a prompt (in this case, skin shocks) until it is no longer needed (26).
​
Williams et al., 1993 found that severe problem behaviors were reduced after fading (4).
​
Israel et al. 2008, Israel et al., 2010 , Barrera et al., 2007, and Linscheid et al., 1990 found that problem behavior immediately increased once CSS has been withdrawn (4, 7).
​
Israel et al. 2008 found that 38% of participants no longer “required” contingent skin shocks (4).
​
Blenkush et al., 2020 reported that after the GED was discontinued, problem behaviors returned for 18 participants after 3 months (21).
Yadollahikhales, Blenkush, and Cunningham, 2021 claimed that the discontinuation of the GED resulted in a return of problem behavior and that severe problem behavior was only effectively reduced for 27% of the subjects (7).
​
Mudford et al., 1995 failed to withdraw CSS altogether (4).
​
The majority of the research suggests most clients need to receive shocks for 3-20 years (5, 7, 17).
​
On Increasing the Pain
​
Research also shows that to remain effective the intensity of the shock must be increased. (4, 7,17).
2. Methodological Concerns with Literature
​
Low Number of Participants
​
In 2020, researchers from the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD) published a review of all available literature about the side effects and efficacy of CSS on disabled people. Zarcone, Mullane, Langdon, P.P., and Brown, 2020 looked at 41 studies that took place over a thirty-year period.
The first issue they found was with the number of participants. They state that single-case experimental designs (studies that test an intervention on only 1-3 people cannot accurately determine the functional relationship between CSS and behavior (27). They are typically not generalizable, meaning that different results can occur depending on the person, place, and context of CSS (28). Out of the 41 studies that were examined by Zarcone et al., 2020, there were only 101 participants (4).
​
Israel et al., 2008 and 2010 used 60 JRC students, but they did not replicate any of their findings, which is important to verify results, to ensure there are no errors or biases, and to identify inconsistencies or outliers (4, 5, 22).
​
Blenkush, Williams, and Oneil, 2020 and Yadollahikhales, Blenkush, and Cunningham, 2021 were published after the 2020 review from the IASSIDD. These two studies analyzed the data of 173 students who received CSS at the Judge Rotenberg Center between 2001 and 2019, but the students were on a combination of treatments. These studies also lacked inter-rater reliability and procedural integrity (7, 21).
​
A Combination of Treatments
Participants in most of the studies were receiving CSS in combination with other interventions and therapies, including medication, so it is impossible to know how effective the GED was (4).
​
Inter-rater Reliability and Procedural Integrity
​
The 41 studies Zarcone et al. 2020 looked at, Blenkush et al., 2020, and Yadollahikhales et al., 2021 failed to report on inter-rater reliability or procedural integrity (4, 7, 21).
​
Inter-rater Reliability is the degree to which two observers agree which ensures consistency (29).
Procedural Integrity is the extent to which an intervention (in this case, CSS) is implemented as described (30).
3. Ethical Concerns with Research (as found by Zarcone et al.)
​
Failure of Previous Treatments as Justification for CSS
​
The least intrusive and most contextually driven treatments for self-injurious or aggressive behavior should be chosen. Individuals should only receive contingent skin shocks when all other treatments have failed and when the benefits outweigh the risks (4).
​
All of the 41 studies Zarcone et al. looked at claimed that previous treatments had failed on 75% of the participants, but no data regarding these treatments was given for 42% (4).
(Israel et al., 2008, 2010) reported information on failed treatments in general terms (no technical info) and did not report baseline levels of problem behavior before the failed treatment. Neither prove that alternative treatments were sufficiently considered (4).
Unclear Functional Behavioral Assessments
​
A Functional Behavioral Assessment is a process where information about a person's behavior is gathered and analyzed to find the purpose of the behavior (31).
The quality of functional assessments in the 41 studies was unclear, so Zarcone et al. could not determine whether the use of CSS was justified (4). Researchers from the 41 studies claimed to have conducted a functional assessment on 66.3% of participants, but they only provided detailed information for 13%, and only provided actual data from the assessment for 1.5% of the participants (4).
Salvy et al. 2004 administered CSS to a 3-year-old child who exhibited self-injurious behavior without conducting any functional assessment. The toddler had not had any previous treatment yet CSS was chosen (4).
​
Shocked for Non-aggressive or Self-Injurious Behavior
Some researchers used CSS on participants who did not exhibit an urgent need for it (4). With Israel et al. 2008, out of the 60 people who received CSS, 11 had not engaged in self-injury or aggression for the prior two weeks and 6 had not engaged in self-injury or aggression for one month prior (4, 5).
​
Since it is well-documented that Matthew Israel and the JRC shock disabled students for non-aggressive or self-injurious behavior all of the studies that took place at the facility should be questioned (8, 17, 32, 33).
4. The lack of Peer Reviews For CSS studies, including Matthew Israel’s Research
​
Peer review is the process of having one’s research and ideas scrutinized and critiqued by experts in the field to ensure that unwarranted, misleading, or false claims are not published. The peer review also verifies that the accepted standards of their discipline are met (34).
​
According to the ABAI's 2022 report, only one case study and six retrospective analyses of JRC data have been peer-reviewed in the past 20 years (17).
​
Zero studies on CSS have been published in the leading journal of peer-reviewed behavioral research, the Journal of Applied Behavior Analysis, in over 30 years (17, 35).
Matthew Israel has often been criticized for not submitting any of his research to be peer-reviewed. In a 2007 Mother Jones article, he claimed that he doesn’t have enough time between running a school and defending the JRC against people he calls “enemies” (36). The peer-review process can be complicated and time-consuming. (34), but what’s more likely is that Matthew Israel does not believe he would get a fair review considering his reputation for causing physical and psychological pain to disabled children and adults. Peer review is not some well-organized democratic process where a board of professional reviewers assesses every paper that has been submitted (37). There is no standard or official way to review research and, according to Smith 2006, the process is subjective, unreliable, inconsistent, and prone to bias (37).
The United Nations Calls the GED "Torture"
​
Torture as defined by the United Nations Office of the High Commissioner for Human Rights:
​
“Any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity" (Part 1. Article 1 38).
In April 2010, Disability Rights International sent an urgent appeal to the United Nations Special Rapporteur on Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment regarding the electric shock and restraints being used by the JRC (39). The group claimed that
​
-
The GED violates international human rights law.
-
The JRC and GED violate the UN Convention against Torture.
-
There is no evidence-based proof of the long-term efficacy or safety.
-
There is a risk of psychological trauma, marginalization, and alienation, and
-
There are non-dangerous treatments to manage disruptive, violent, and self-injurious behavior. (40)
​
“The intentional infliction of severe pain perpetrated against children and adults with disabilities by JRC violates the UN Convention against Torture. Aversive treatment is used to inflict pain as punishment to coercive and intimidate people with disabilities to change their behavior. The legal framework which allows such treatment is discriminatory – as it permits such practices to be perpetrated only against individuals with disabilities. The dehumanization and depersonalization of children at JRC by way of state-sanctioned punishment with electric shocks, 4-point restraint boards, mock assaults, food deprivation, shock chairs and shock holsters fosters an environment ripe for abuse and one that would not be tolerated – especially against children - in any other setting. These practices induce extreme and severe pain and suffering on an extremely vulnerable population of children and adults with disabilities and constitute ill treatment or torture against the UN Convention against Torture” (page 41 40).
The UN Special Rapporteur on Torture asked the US federal government to investigate the JRC’s use of electric shocks in May 2010 and June 2012 (41).
From October 3 to October 17, 2012, the UN Special Rapporteur on Torture, Juan E Mendez, who was tortured with an electric prod by the Buenos Aires police in 1975 (42, 43), investigated the JRC himself. On March 12, 2013, the report detailing his observations of torture throughout the world and the communications he’s had with the corresponding governments was published (44). Page 84 discusses the JRC’s use of skin shocks:
-
Despite the US government’s response, the Special Rapporteur continued to be seriously concerned about the physical and mental integrity of JRC students because of the GED and physical restraints.
-
Despite the Commonwealth of Massachusetts’ Department of Developmental Services (DDS) limiting the use of level III aversives (the skin shocks) on incoming students in 2011, JRC students with existing court-approved treatment plans predating September 1, 2011, could still receive shocks. Also, DDS’s regulations only affect the JRC in Massachusetts. It’s possible that the school could open in another state as it has done in the past.
-
There needs to be protections at the federal level to ensure that level III aversives are not used in the US.
-
A February 1, 2013, report presented at the UN Human Rights Council on the applicability of the torture and ill-treatment framework in healthcare settings states that a violation of the Convention against Torture may occur “where the purpose or intention of the State‟s action or inaction was not to degrade, humiliate or punish the victim, but where this nevertheless was the result.” This report challenges the idea that medical necessity justifies severe physical and emotional pain (paragraphs 31-35 45): “This is particularly the case when intrusive and irreversible, nonconsensual treatments are performed on patients from marginalized groups, such as persons with disabilities, notwithstanding claims of good intentions or medical necessity” (para. 32 45).
-
Paragraph 7a of Resolution 8/8 of the Human Rights Council (HRCresolution8/8) states that corporal punishment, including that of children, can amount to cruel, inhuman, or degrading punishment or even torture.
-
The Special Rapporteur’s report to the 60th session of the General Assembly stated that corporal punishment violates the prohibition of torture and other cruel, inhuman, or degrading treatment or punishment. States cannot change their laws to justify or legalize torture.
-
Paragraph 5 of General Comment No. 20, the Human Rights Committee stated that the ban on torture and ill-treatment must include corporal punishment and include excessive punishment for a crime or “as an educative or disciplinary measure”.
-
“Therefore and in the absence of evidence to the contrary, the Special Rapporteur determines that the rights of the students of the JRC subjected to Level III Aversive Interventions by means of electric shock and physical means of restraints have been violated under the UN Convention against Torture and other international standards. The Special Rapporteur calls on the Government to ensure a prompt and impartial investigation into these continued practices. He calls on the Government to provide information on the Department of Justice‟ 's (DOJ) investigation into possible violations of civil rights laws and to take measures to prohibit the use of Level III Aversive Interventions for all students on a national level, including those students who had an existing court-approved treatment plan as of 1 September 2011 in Massachusetts” (page 84 45).
Coercion
​
The ABAI’s 2022 report asserts that the assent and wishes of students of the JRC are not considered at all (17). The students at the Judge Rotenberg Center are unable to consent or object to being shocked, institutionalized, restrained, and secluded, so written informed consent is given by parents and legal guardians (page 1 46). ​
Students can assent, though. Assent refers to a child's agreement to participate in treatment or research because children benefit from having a say, being listened to, and being informed. Attaining a child’s assent demonstrates respect for the child and promotes their growth, development of autonomy, and decision-making skills (47). According to the Behavior Analyst Certification Board’s Code of Ethics, behavior analysts must obtain assent from clients when appropriate (page 11 48).
Since students at the JRC typically have a history of serious behavioral problems, their assent is not required or considered. For them, dissenting only results in more punishment. This is coercion.​ Coercion is the act of controlling behavior through punishment, the threat of punishment, or negative reinforcement (49).
​
Behavioral scientist, Murray Sidman, states that just because coercion must be used to halt violence occasionally doesn’t mean it should be the gold standard for therapy (49).
According to Guy Stephens from the Alliance Against Seclusion and Restraint and the authors of a 2019 paper “Reducing Coercion in Mental Healthcare,” coercion is a pervasive practice in psychiatry and psychology (50).
​
Coercion contains a wide array of tactics including
-
Implicit or explicit pressure to take certain drugs
-
Implicit or explicit pressure to accept certain treatments
-
Involuntary admission to a psychiatric unit
-
Restraint
-
Seclusion, and
-
The fear/threat that noncompliance will lead to further forced or coerced treatment (50, 51)
​
When children are coerced at school, they develop aversions to learning, their teachers, and the learning environment. They are also less likely to participate in continued education or vocational training. Children who come from families where excessive coercion and punishment develop aversions to their families (50).
​
Board-certified behavior analyst, Jo Ram, asserts that enforcing obedience and blanket compliance to authority grooms autistics and the developmentally disabled to be more likely to be taken advantage of, bullied, and abused (52).
Research shows that coercion
Restraints
​
Any device or action that limits another person’s movement is a restraint (53). There are several types of restraints:
​
-
Chemical restraints-drugs/medications that are given to inhibit someone’s ability to move and/or think (53).
-
Mechanical restraints- Any device used to limit someone’s movement. This includes handcuffs, straps, ropes, tape, mitts, straight jackets, chains, etc (53, 54).
-
Electronic restraints- Any device that gives an electrical shock to people (55)
-
Physical restraints-when a person uses their body to physically immobilize someone (53).
-
Prone restraint-when a person is forced to lie on the floor face down, held either by a physical or mechanical restraint (53).
-
Supine restraint-like a prone restraint except the person is face up (53), and
-
Seclusion-a form of restraint where someone is involuntarily confined to a room, alone, without being able to leave. (54, 56).
​
​
The Judge Rotenberg Center uses all of these restraints except for chemical restraints (57). The school does not use psychotropic medication because, according to its website, the medications have not been FDA-approved for children, the side effects are dangerous, and there is a risk of long-term irreversible side effects (58). When disabled people arrive at the JRC they are usually weaned off (58, 59).
Dangers of Restraint
The physical risks of restraint include skin trauma, pressure sores, loss of muscle tone, contractures, incontinence, broken or fractured bones, skull fracture, internal bleeding, nerve damage, asphyxiation, and death. The psychological risks include aggression, anger, agitation, frustration, fear, apathy, anxiety, depression, PTSD, cognitive decline, delirium, and social withdrawal (50, 60, 61, 62, 63, 64). For those who have previously experienced physical abuse, it is even more traumatizing (62).
The Association for Behavior Analysis International (ABAI) is opposed to the “inappropriate and unnecessary use of seclusion, restraint, or other intrusive interventions” (65).
The US Department of Education guidelines on restraint and seclusion dictate that they can only be used if a child is engaging in behavior that is causing or will cause serious physical harm to themselves or others (66), but schools and private institutions use restraint and seclusion for various non-dangerous reasons, and it often goes under-reported (50, 66).
There is no scientific basis for using restraint for non-life-threatening reasons (60, 62, 67). Students cannot learn new skills when being restrained and problem behaviors can inadvertently be reinforced if a person desires connection or attention (62).
​
The use of restraint and seclusion has resulted in unlawful discrimination against disabled students according to federal civil rights laws (54). Physical restraints are disproportionately used on marginalized people and communities. Only 12% of students enrolled in school are disabled, yet 71% of students who are restrained and 66% of students who are put into seclusion are disabled (66)
​According to the “Professional Crisis Management” website between 50 and 150 disabled students die every year as a result of being restrained. The improper use of restraint, lack of training, and lack of supervision (62).
​
The Alliance Against Seclusion and Restraint and the United Nations say that coerced treatment denies people their human right to autonomy (44, 50).
Human and Civil Rights
​
The Judge Rotenberg Center’s reliance on coercion, restraint, and electric shocks proves that the human and civil rights of disabled students are systematically ignored (39, 44).
​
Disabled students experience corporal punishment at higher rates than their non-disabled peers (9) and racial minorities experience corporal punishment at higher rates than their white peers (68). Mental health professionals routinely overestimate the risk of violence in Black patients (69) which results in Black adolescents receiving more diagnoses for conduct disorders, while white adolescents are diagnosed with ADHD (68). Simply put, Black disabled children are most likely to be sent to a facility like the JRC, which is why a disproportionate number of students at the JRC are Black and Hispanic: 45.3% Black, 28.1% Hispanic, and only 21% are white (in 2022 70).
​
Disabled people are entitled to a proper education in an environment where they can thrive without aversives) (9), but students at the JRC are denied this along with other related services, which violates the Americans with Disabilities Act. (page 20) (32, 71)​
In addition to all the research that shows contingent skin shocks, aversives, and coercion are harmful attention should also be focused on the Judge Rotenberg Center itself; the numerous reports of abuse, neglect, and death; and the experiences of the actual students.
​
Why the GED Must Be Banned Part 2: Abusive and Negligent Staff at the Judge Rotenberg Center
​What is the Graduated Electronic Decelerator?
​
References
1. FDA Press Release. March 25, 2024. FDA Proposes New Ban of Electrical Stimulation Devices for Self-Injurious or Aggressive Behavior. https://www.fda.gov/medical-devices/medical-devices-news-and-events/fda-proposes-new-ban-electrical-stimulation-devices-self-injurious-or-aggressive-behavior?utm_medium=email&utm_source=govdelivery
​
2. A Rule by the Food and Drug Administration on March 6, 2020: Banned Devices; Electrical Stimulation Devices for Self-Injurious or Aggressive Behavior. Federal Register.gov https://www.federalregister.gov/d/2020-04328/p-122)
​
3. FDA Press Release “FDA proposes ban on electrical stimulation devices intended to treat self-injurious or aggressive behavior” April 22, 2016. FDA.gov https://www.fda.gov/news-events/press-announcements/fda-proposes-ban-electrical-stimulation-devices-intended-treat-self-injurious-or-aggressive-behavior
​
4. Zarcone, J. R., Mullane, M. P., Langdon, P. E., & Brown, I. (2020). Contingent Electric Shock as a Treatment for Challenging Behavior for People With Intellectual and Developmental Disabilities: Support for the IASSIDD Policy Statement Opposing Its Use. Journal of Policy and Practice in Intellectual Disabilities, 17(4), 291-296. https://onlinelibrary.wiley.com/doi/10.1111/jppi.12342
​
5. Israel, M. L., Blenkush, N. A., von Heyn, R. E., & Rivera, P. M. (2008). Treatment of aggression with behavioral programming that includes supplementary contingent skin-shock.The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 1(4), 119–166. https://doi.org/10.1037/h0100460
​
6. W.M.W.J. van Oorsouw a, *, M.L. Israel b , R.E. von Heyn b , P.C. Duker “Side Effects Of Contingent Shock Treatment” 2007. Research in Developmental Disabilities.http://www.effectivetreatment.org/SideEffectsContingent.pdf
​
7. Yadollahikhales G, Blenkush N, Cunningham, 2021. patterns for individuals receiving contingent skin shock aversion intervention to treat violent self-injurious and assaultive behavioursBMJ Case Reports CP 2021;14:e241204.https://casereports.bmj.com/content/14/5/e241204
8. Written Statement of the American Civil Liberties Union For a Hearing on “The Safety and Effectiveness of Averse Conditioning Devices” Neurological Devices Panel of the Medical Devices Advisory Committee of the U.S. Food and Drug Administration (FDA). April 24, 2014.
9. “Impairing Education: Corporal Punishment of Students with Disabilities in US Public Schools” August 11, 2009. ACLU
10. Evelyn Nicholson’s complaint against Freeport Union Free School District and the Judge Rotenberg Educational Center. July 19, 2006. https://autistichoya.files.wordpress.com/2016/04/2006_a.twone_nicholson_lawsuit-1.pdf
11. Cynthia McFadden, Kevin Monahan and Adiel Kaplan. “A Decades-Long Fight Over an Electric Shock Treatment Led to an FDA Ban. But The Fight iIs Far From Over” April 28, 2021. NBC News.https://www.nbcnews.com/health/health-care/decades-long-fight-over-electric-shock-treatment-led-fda-ban-n1265546
12. “Video Evidence of Torture at JRC Released to Public” April 11, 2012. Disability Rights International. https://www.driadvocacy.org/video-evidence-of-torture-at-jrc-released-to-public/
13. Jen Quraishi. “School Of Shock” Founder Forced To Resign” May 27, 2011. Mother Jones. https://www.motherjones.com/politics/2011/05/judge-rotenberg-forced-resign-school-shocks/
14. Paul Kix. June 17, 2008. “The Shocking Truth” Boston Magazine. https://www.bostonmagazine.com/2008/06/17/the-shocking-truth/
15. Ian Cook: Transcript of testimony given before FDA public hearing (24 April 2014). Autistic Hoya. The Judge Rotenberg Center https://autistichoya.net/2016/07/22/transcript-of-ian-cook-april-2014-testimony/
16. LYDIA X. Z. BROWN “Jennifer Msumba April 2014 Video Testimony” Bearing Witness, Demanding Freedom: Judge Rotenberg Center Living Archive. https://autistichoya.net/2016/04/22/jennifer-msumba-april-2014-video-testimony/
17. Perone M, Lerman DC, Peterson SM, Williams DC. Report of the ABAI Task Force on Contingent Electric Skin Shock. Perspect Behav Sci. 2023;46(2):261-304. Published 2023 Jun 15. doi:10.1007/s40614-023-00379-w https://autisticadvocacy.org/wp-content/uploads/2022/11/CESS-Task-Force-Report-09-28-22.pdf
18. Linscheid1990 Linscheid TR, Iwata BA, Ricketts RW, Williams DE, Griffin JC. Clinical evaluation of the self-injurious behavior inhibiting system (SIBIS). J Appl Behav Anal. 1990;23(1):53-78. doi:10.1901/jaba.1990.23-53 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1286211/
19. Salvy, 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(2), 59-
72. https://doi.org/10.1002/bin.157
20. Nathan A. Blenkush, Robert E. von Heyn, and Matthew L. Israel The Effect of of Contingent Skin Shock on Treated and Untreated Problem Behaviors. 2013. The Judge Rotenberg Center. http://www.effectivetreatment.org/effectsofshock.pdf
21. Blenkush NA, O’Neill J (2020) Contingent Skin-Shock Treatment in 173 Cases of Severe Problem Behavior. Int J Psychol Behav Anal 6: 167. doi: https://doi.org/10.15344/2455-3867/2020/167
22. Israel, Matthew & Blenkush, Nathan & von Heyn, Robert & Sands, Christine. (2010). Seven Case Studies of Individuals Expelled from Positive-Only Programs. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention. 2. 10.1037/h0100470. https://www.researchgate.net/publication/228650987_Seven_Case_Studies_of_Individuals_Expelled_from_Positive-Only_Programs PDF: http://www.effectivetreatment.org/SevenCaseStudies.pdf
23. Murray,1995 Mudford, O. C., Boundy, K., & Murray, A. D. (1995). Therapeutic shock device (TSD): Clinical evaluation with self-injurious behaviors. Research in Developmental Disabilities, 16(4), 253–267. https://doi.org/10.1016/0891-4222(95)00011-B https://psycnet.apa.org/record/1996-92677-001
24. Williams, D. E., Kirkpatrick-Sanchez, S., & Iwata, B. A. (1993). A comparison of shock intensity in the treatment of longstanding and severe self-injurious behavior. Research in Developmental Disabilities, 14(3), 207–219. https://doi.org/10.1016/0891-4222(93)90031-E
25. Ricketts RW, Goza AB, Matese M. A 4-year follow-up of treatment of self-injury. J Behav Ther Exp Psychiatry. 1993;24(1):57-62. doi:10.1016/0005-7916(93)90009-l https://pubmed.ncbi.nlm.nih.gov/8370798/
26. “Fading” University of Nebraska-Lincoln.
https://www.unl.edu/asdnetwork/virtual-strategies/fading
27. Krasny-Pacini, A., & Evans, J. (2018). Single-case experimental designs to assess intervention effectiveness in rehabilitation: A practical guide. Annals of Physical and Rehabilitation Medicine, 61(3), 164-179. https://doi.org/10.1016/j.rehab.2017.12.002
​
28. Kassiani Nikolopoulou. What Is Generalizability? | Definition & Examples. October 8, 2022. SCRIBBR. https://www.scribbr.com/research-bias/generalizability/
29. Lange, R.T. (2011). Inter-rater Reliability. In: Kreutzer, J.S., DeLuca, J., Caplan, B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79948-3_1203
30. Han, J. B., Bergmann, S., Brand, D., Wallace, M. D., St. Peter, C. C., Feng, J., & Long, B. P. (2023). Trends in Reporting Procedural Integrity: A Comparison. Behavior Analysis in Practice, 16(2), 388-398. https://doi.org/10.1007/s40617-022-00741-5
31. How To ABA “How to Do a Functional Behavior Assessment in ABA: A Comprehensive Guide” November 2, 2023. How to ABA. https://howtoaba.com/how-to-do-a-functional-behaviour-assessment/
32. New York State Education Department Review of Judge Rotenberg Center. 2006 https://www.documentcloud.org/documents/1379107-2006-nysed-review-of-judge-rotenberg-center.html
33. Jennifer Gonnerman “Matthew Israel Interviewed by Jennifer Gonnerman” August 20, 2007. Mother Jones.
https://www.motherjones.com/politics/2007/08/matthew-israel-interviewed-jennifer-gonnerman/
34. Kelly J, Sadeghieh T, Adeli K. Peer Review in Scientific Publications: Benefits, Critiques, & A Survival Guide. EJIFCC. 2014;25(3):227-243. Published 2014 Oct 24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975196/#:~:text=WHAT%20IS%20PEER%20REVIEW%20AND,to%20serve%20two%20primary%20purposes.
35. Journal of Applied Behavior Analysis. (2024, May 15). In Wikipedia. https://en.wikipedia.org/wiki/Journal_of_Applied_Behavior_Analysis
36. Jennifer Gonnerman. August 20, 2007. “School of Shock” Mother Jones. https://www.motherjones.com/politics/2007/08/school-shock/
37. Smith, R. (2006). Peer review: A flawed process at the heart of science and journals. Journal of the Royal Society of Medicine, 99(4), 178-182. https://doi.org/10.1258/jrsm.99.4.178
38. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Office of the High Commissioner for Human Rights. United Nations. https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-against-torture-and-other-cruel-inhuman-or-degrading
39. Disability Rights International. July 12, 2010 .https://www.driadvocacy.org/torture-against-disabled-in-us/#:~:text=Washington%2C%20DC%20%E2%80%94%20April%2029%2C,Torture%20to%20demand%20the%20United
40. Disability Rights International Report: Torture not Treatment: Electric Shock and Long-Term Restraint in the United States on Children and Adults with Disabilities at the Judge Rotenberg Center (JRC). 2010. https://www.driadvocacy.org/sites/default/files/2023-10/USReportandUrgentAppeal.pdf
41. “The United Nations calls again for investigation of JRC’s shock treatments” Disability Rights International. June 5, 2012. Disability Rights International.https://www.driadvocacy.org/the-united-nations-calls-again-for-investigation-of-jrcs-shock-treatments/
42. Ed Pilkington. “UN calls for investigation of US school's shock treatments of autistic children” June 2, 2012. The Guardian. https://www.theguardian.com/society/2012/jun/02/un-investigation-shock-treatments-autism?newsfeed=true
43. Juan Mendez, former Special rapporteur (2010-2016). United Nationshttps://www.ohchr.org/en/special-procedures/sr-torture/juan-mendez-former-special-rapporteur-2010-2016
44. March 12, 2013 United Nations Human Rights Council Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez. https://www.ohchr.org/sites/default/files/Documents/HRBodies/HRCouncil/RegularSession/Session22/A-HRC-22-53-Add4_EFS.pdf
45. (A/HRC/22/53, 1 February 2013) “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez” United Nations. General Assembly. Human Rights Council Twenty-second session.
46. Judge Rotenberg Center Policy – Safeguards for the Use of Aversives with Students at JRC. Uploaded 2023. Judge Rotenberg Center Website. https://judgerc.org/wp-content/uploads/2023/05/jrc_policy_safeguards_for_the_use_of_aversives.pdf
47. Spriggs M. Children and bioethics: clarifying consent and assent in medical and research settings. Br Med Bull. 2023;145(1):110-119. doi:10.1093/bmb/ldac038
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10075240/
48. Behavior Analyst Certification Board’s Code of Ethics. 2022. https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240201-a.pdf
49. Murray Sidman. “Reflections on Behavior Analysis and Coercion” Behavior and Social Issues, Double Issue 1993, Volume 3, No.1 and 2. New England Center for Autism
https://link.springer.com/content/pdf/10.5210/bsi.v3i1.199.pdf?pdf=inline%20link
50. Guy Stephens. “About seclusion and restraint” September 1, 2019. Alliance Against Seclusion and Restraint.
https://endseclusion.org/2019/09/01/about-seclusion-and-restraint/#more
51. S. P. Sashidharan, Roberto Mezzina, and Dainius Puras. “Reducing Coercion in Mental Healthcare” December 28, 2019. Epidemiol Psychiatr Sci.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032511/
52. Jo Ram “I am a disillusioned BCBA: Autistics are right about ABA” June 2, 2020. Neuroclastic.com https://neuroclastic.com/i-am-a-disillusioned-bcba-autistics-are-right-about-aba/
53. Lori McIlwain “Restraint & Seclusion | A Guide for Autism Parents” Jan 21, 2015. National Autism Association. https://nationalautismassociation.org/restraint-seclusion-a-guide-for-autism-parents/
​
54. “Students with Disabilities and the Use of Restraint and Seclusion in K-12 Public Schools” US Department of Education. Retrieved February 16, 2023.
55. Electronic Restraint Devices. https://reference.jrank.org/security/Electronic_Restraint_Devices.html
56. 1“Use of restraints” Medline Plus Medical Encyclopedia. Retrieved November 2022. https://medlineplus.gov/ency/patientinstructions/000450.htm
57. The Judge Rotenberg Center: Information About The Use Of Contingent Skin Shock For Severe Problem Behavior. https://judgerc.org/css/
58. Key Features of JRC’s Program. Retrieved January 2023. Judge Rotenberg Center Blog.https://keyfeatures.judgercblog.org/#medication
59. Heather Vogell and Annie Waldman. “New York City Sends $30 Million a Year to School With History of Giving Kids Electric Shocks” December 23, 2014. Propublica.
60. Gunawardena R, Smithard DG. The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards-A Brief Literature Review. Geriatrics (Basel). 2019 Sep 4;4(3):50. doi: 10.3390/geriatrics4030050. PMID: 31487923; PMCID: PMC6787583.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787583/
61. Sailas E, Fenton M. Seclusion and restraint for people with serious mental illnesses. Cochrane Database Syst Rev. 2000;2000(2):CD001163. doi:10.1002/14651858.CD001163 https://pubmed.ncbi.nlm.nih.gov/10796606/
62. Lorien Quirk “Use of Restraint: Thoughts from a Behavior Analyst” February 20, 2012. Positively Autism Blog. http://positively-autism.blogspot.com/2012/02/use-of-restraint-thoughts-from-behavior.html
63. Brian Ross, Angela M. Hill and Matthew Mosk. “Death at School: Parents Protest Dangerous Discipline for Autistic, Disabled Kids” November 29, 2012. ABC News.
64. Corey Mitchell “The U.N. says it’s torture. Judges ruled this school can use shock therapy anyway.” July 30, 2021. Center For Public Integrity Watchdog Newsletter. https://publicintegrity.org/inside-publici/newsletters/watchdog-newsletter/when-a-school-turns-to-shock-therapy/
65. Vollmer TR, Hagopian LP, Bailey JS, Dorsey MF, Hanley GP, Lennox D, Riordan MM, Spreat S. The association for behavior analysis international position statement on restraint and seclusion. Behav Anal. 2011 Spring;34(1):103-10. doi: 10.1007/BF03392238. PMID: 22532734; PMCID: PMC3089400 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089400/
66. Jenny Abamu and Rob Manning “Desperation And Broken Trust When Schools Restrain Students Or Lock Them In Rooms” June 5, 2019. Oregon Public Radion. NPR. https://www.npr.org/2019/06/05/726519409/desperation-and-broken-trust-when-schools-restrain-students-or-lock-them-in-room
67. Beth Tolley “Questioning the evidence behind evidence-based approaches” October 10, 2020. Alliance Against Seclusion and Restraint. https://endseclusion.org/2020/10/10/questioning-the-evidence-behind-evidence-based-approaches/
68. Vera Pertsovskaya, Divya Shan, Andrew C. Meltzer “The Role of Race on Restraint Use: Racial Bias in Healthcare, Psychiatric Diseases, and Utilization of Restraints (Part 2 in a 3-Part Series)” June 25, 2021. GW School of Medicine.
69. Sonya M. Shadravan, Matthew L. Edwards, and Sarah Y. Vinson “Dying at the Intersections: Police-Involved Killings of Black People With Mental Illness” June 10, 2021. Psychiatric Services. Volume 72. Issue 6. https://doi.org/10.1176/appi.ps.202000942
70. The Judge Rotenberg Center in Canton, Massachusetts. USA School Info. 2022. http://www.usaschoolinfo.com/school/the-judge-rotenberg-center-canton-massachusetts.127441/enrollment
71. Nancy Weiss “Call for Action to End the Judge Rotenberg Center and Aversives” October 12, 2009. Autistic Self Advocacy Network. https://autisticadvocacy.org/2009/10/call-for-action-to-end-the-judge-rotenberg-center-and-aversives/