The Justice Department plans to “examine vigorously” the use of so-called aversive therapy, according to a senior department official.
Aversive therapy, a controversial treatment that uses physical punishments to modify behavior, particularly with children and young adults, gained national attention in 1985 after a 22-year-old died following such treatment in a Massachusetts group home for the severely handicapped. The home was one of at least seven in Massachusetts and more elsewhere run by the Behavior Research Institute, a Providence, R.I., organization that makes extensive use of what it calls “averse counter-conditioning.”
“Such ‘treatment’ raises serious questions about our vision of civilized society, as well as posing constitutional issues of a fundamental nature,” said William Bradford Reynolds, who is counselor to the attorney general and an assistant attorney general in the department.
He made his comments in a Sept. 22 speech before Community Services For Autistic Adults and Children, a community organization in Rockville, Md.
Mr. Reynolds said the “startling array” of treatments that fall under the “aversive” rubric also include: the use of noxious odors and force-fed materials, such as ammonia, Tabasco sauce, vinegar, and lemon juice; loud noises or “white noise;" squirting water in the face; covering the patient’s face with a cloth or bag; and certain kinds of physical restraints.
Widening the Scope
The assistant attorney general’s comments do not signal the start of a full-scale Justice Department probe into such practices, said Joseph Krovisky, a department spokesman. But Justice officials plan, he explained, to begin including examinations of the use of aversive therapy as part of the regular reviews of mental-health and mental-retardation facilities conducted by the department under the Civil Rights for Institutionalized Persons Act.
In the past, Mr. Krovisky said, the scope of those reviews had been limited to the adequacy of the food, the quality of the living conditions, the availability of medical treatment, and other non-therapeutic practices in such institutions.
Opposition to aversive therapy also has widened beyond the Justice Department. In a letter to the editor published this month in The Washington Post, Madeleine C. Will, an assistant education secretary, joined with Mr. Reynolds in condemning the use of electroshock-therapy in treating the disabled. Ms. Will heads the Education Department’s office of special education and rehabilitative services.
“We ask, as a number of behavioral psychologists have asked us, whether society can sanction for use with disabled citizens forms of punishment, such as electroshock, that would never be tolerated for use with nonhandicapped children and adults,” they wrote. The letter was written in response to an article in the newspaper on the use of such devices in treating people with autism or mental retardation.
‘Far Enough’?
“Certainly, this position is in line with what we want to see happen,” said Liz Moore, a spokesman for the Association for Retarded Citizens, a national organization based in Arlington, Texas. “The only thing I’m not sure of is whether it would go far enough.”
The association is one of a number of national groups that have called for a ban on the use of aversive practices in treating young people in institutionalized settings. In his speech, Mr. Reynolds said that the Association for Persons with Severe Handicaps also urged a similar ban8in 1981 and that two other groups had called for “severe restrictions” on the use of aversive therapy.
“There’s no question that there’ve been abuses of aversives,” said Steven Forness, who is president of the Council for Children with Behavior Disorders, a division of the Council for Exceptional Children. “But there are also people who use aversives in a systematic and cautious way.”
He said members of his organization are currently “in a quandary” over how to address the topic in an upcoming position paper. He noted that one recent and widely read study of autistic children in California described an intensive 40-hour-a-week treatment program that successfully uses mild aversives along with positive reinforcement.
In that University of California at Los Angeles study, the researcher gave the children a quick, sharp slap on the thigh when they began to exhibit behavior considered “self-stimulating or self-injurious,” Mr. Forness said. In contrast to the control group that did not participate in the aversive program, many of the children in that study were eventually able to attend school in classrooms with nonhandicapped children.
“That’s one study that’s keeping a lot of people on the edge of the question of whether aversives should be banned altogether,” he said.
Legal Precedents
In his talk, Mr. Reynolds noted that courts have been deferential to professional opinion on such issues.
Though institutionalized children and adults are protected under the 14th Amendment, he said, the Supreme Court has also said that “a considerable degree of deference should be accorded the judgment exercised by qualified professionals.” Thus, the assistant attorney general explained, such professional judgment is regarded by the Court as “presumptively valid.”
He added: “It is high time, I think, that the challenge be made in the public arena to those who profess that the use of aversives--at least those calculated to control behavior through the regular infliction of painful stimuli--actually have presumptive validity under this standard.”
