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Living with Autism


April 15, 2011

Anti-Psychotics and Other Medications for Autism and Chronic SIB

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           Let me say this about anti-psychotics in the treatment of autism and chronic self-injurious behavior (CSIB): They seldom work. 


Anti-psychotics attach to multiple “receptors” in the brain. Each “receptor”—as if God did this to show us who’s really in charge, has subtypes--- all with unique mechanisms of action. 

For additional ego-crushing lessons, neurotransmitter systems (histamine, adrenergic, dopaminergic, etc) that may cross talk and recruit each other. Hey, you, D1, yea it’s a2, activate, researchers closing in. Hurry. Tweak your mechanism of action and show low affinity for incoming agent.

For years, researchers have been obsessing over how to treat SIB. Well, Ok, I don’t know if they’ve been obsessing, but if they haven’t, they should be. Obsessive people get shit done.

Anyway, one the things that research shows is Dopamine (mainly D1 in corpus striatum—an area rich in receptors) dysfunction is implicated in chronic, refractory SIB. In case you’re wondering: 

There are no pure D1 antagonist drugs for clinical use in USA.

Consequently, psychiatrists prescribe multiple drugs to target SIB. 

Problem is, “Overblocking” or “underblocking” one receptor can throw brain into reverse, neutral, forward, or all three, within hours, depending on onset, peak and steady state of drug, and interactions with other drugs taken.

Don’t panic. It’s not hopeless. Finding synergistic (where all the receptors play nicely together) combination involves a LOT of cross-analysis, adjustments, trials and errors. It may take years. It may take weeks. Whatever it takes, don’t give up. SIB has to be STOPPED. At the very least, reduced. 

Atypical Anti-psychotics used to treat our Son’s Autism and Self-Injurious Behavior (SIB):

 DRUG                    What Happened After Drug Given              

1. Haldol:           Retrocollis, oculogyric crisis, laryngeal
                                        pharyngeal Dystonia. Increased seizures.
                        Not effective on SIB. Given @ hospital
2. Risperdal:         Slight reduction SIB, slight increase
                          Seizures; Tongue paralysis & tremor

3. Geodon:             Little effect on SIB, restless, crying,
                           Confused look on face, possible drug-
                           induced headache, dizziness, slight
                           increase seizures. Given @ hospital.

4. Seroquel:           Little effect on SIB outside sedation @
                           300 mg PRN. Slight seizure elevation

5. Zyprexa:            5mg zydis disintegrating tablet, slight
                           reduction SIB, tongue edema (swelled),
                           slight increase seizures.

What to do when bad reaction to anti-psychotic happens:

1.    Stop giving/taking them!

2.    Report side effects to health care provider

3.    If you’re having trouble breathing, call 911

Anti-dotes given to reverse adverse reactions to anti-psychotics:

1.   Cogentin  Intra-muscular (IM)
2.   Benadryl  PO (by mouth) or (IM)     

Thoughts on why these drugs didn’t work so well:

Haldol: Has high affinity for D2 in temporal and prefrontal areas, blocks dopamine in nigrostriatal pathways, which raises risk of extra pyramidal symptoms (EPS), slight affinity for D1 and D4, minimal affinity for serotonin and alpha-adrenergic receptors

Risperdal: High affinity for D2, slight affinity for D1 receptors. Targets various serotonin, histamine, alpha-adrenergic receptors

Geodon: High affinity for D2, D3 receptors, targets various serotonin, histamine, alpha-adrenergic receptors; doesn’t touch D1

Seroquel: Low affinity for D1, slightly higher for D2; high affinity for 5 HT2a and histamine receptors. Little, if any affinity for D4. Interestingly, a norepinephrine reuptake inhibitor, which should pump brain up, but is probably countered by the potent (H1)histamine effect

Zyprexa: High affinity for D1, D2, 5 HT 2a & c.

WARNING: Atypical Anti-psychotics: GEODON and SEROQUEL have high prolonged QTc interval risk. (Geodon wins 1st place, Seroquel 2nd). What does QTc risk mean? A high QTc score means high risk of elevating your heart rate, as in tachycardia. Rapid heart rate. Risperdal and Zyprexa come in 3rd & 4th place, in that order.

The utmost goal of physicians should be to rapidly achieve and manage neurotransmitter homeostasis in brain to promote and restore health to autistic persons suffering from chronic SIB. 

This may be, in my opinion, the most promising first-line-treatment in controlling devastating chronic SIB in autistic persons. The utmost goal of parents is to work with physicians to achieve this goal, which will most likely include using adjunct treatments, such as special diets, vitamins, herbs, massage, ABA therapy, exercise or whatever research supports as reasonable adjunct to target goal of achieving neurotransmitter homeostasis in brain.

What is showing promise for our son as of this month:
(This has changed now, of course)
1.    Topamax 100 mg Given 7a (50mg) & 7p(50mg) (Brand name also seems to be better at controlling atonic, but again, tachphylaxis occurs and you have to adjust meds as needed)
2.    Keppra 3000 mg  Given 7a (750mg) 1pm (750mg) 7p (1500mg) (keppra has always been a mainstay drug, seems to be very good for our's son's epilepsy, however, only the BRAND NAME, by UCB, as everytime we tried any generic, it caused increase in seizure activity)
3.    Clonazepam (1 mg) 1p (0.5mg) 7p (0.5mg) (had to be increased then decreased when increasing it caused more atonic seizures)
4.    Lamictal 300 mg  Given 7a (150 mg), 1p (150mg) (ended up increasing myoclonus)
5.    Seroquel  50 mg   Given 1p (ended up increasing seizures)
6.    Guanfacine 4mg   Given 7a (2mg)  1p (2mg)
7.    Mirtazapine 15mg  Given H.S. (night) 8p  (D/C: ended up causing RLS, aka restless leg syndrome)

Adjuncts: B-Vitamin/Iron complex
               Calcium/Vit D3 complex
               Multi-vitamin children’s chewable
               Himalaya Bacopa monnieri (herb)
               MRM Liver X with Bio-Sorb

Okay, so that’s what he’s on NOW, and I know it’s way too many meds, but our GOAL is to keep REDUCING meds, because goal is always LOWEST and LEAST drugs possible. This takes time. And careful thought. For example, NOW that we’ve reached final titration of the newest seizure med, Topamax, we will begin to scale DOWN on Keppra, seek to have clonazepam only as PRN (as needed for breakthrough seizure activity or agitation), and eventually, fade out Seroquel.

As for other new drug—Guanfacine--this drug has been a real surprise. I learned about this drug during one of my marathon research adventures. I then asked psychiatrist if we could try it, since I believe my son’s SIB could be fueled by episodic states of hyper-arousal: No doubt, hyperarousal being a ‘chaotic and frightening flood of affect that threatens and overwhelms brain’ could fuel SIB. Guanfacine is an alpha-2a receptor agonist, used to treat high blood pressure, thus decreasing body’s release of adrenaline and stress hormones. After all the anti-psychotic side effects, Guanfacine seemed like bite of a brown sugar and buttercream chocolate.

The great thing about Jamey, my son, by the way, is that no matter how horrible things get, he is an amazing autistic person. He blows everyone away with his ability to bounce back, as if the hammering he does to himself, and the panic and pain of it all, is somehow, for such a time as this, a useful tool in the hands of God.

For the things which are seen are temporal, but the things which are not seen are eternal.” 2 Corinthians

April 9, 2011

Behavioral Therapy Across Settings

1999. For months, the After School Program had issued dozens of reports to San Diego Regional center documenting Jamey’s need for a one to one aide, “Jamey continues to require 1:1 staff assistance due to self-injurious behavior.”

“During the Recreation Program Jamey needs constant supervision because of his controversial medically prescribed skin shock therapy.” It took forever for Regional to fund the one to one aide in the after school program. At a long meeting with Jamey’s Regional Center staff, I said: “I’m confused. You don’t support the skin shock therapy, but you haven’t provided one to one support for Jamey in order to protect him from hitting himself.”

“Approving the one to one aide takes time,” muttered a case manager, if indeed there was any management outside of a episodic phone update.

 "Look,” I said, breathing out and shaking my head as I felt angry tears rising.“It’s been over a year! Aren’t you’re the one who said one to one support is an alternative to skin shock therapy???!” None of these people made any sense.  And they liked it that way.
Not applying Jamey’s therapy across settings violated every behavioral principle the specialists opposing skin shock claimed to honor. This illuminated the worst kind of hypocrisy and narrow-minded thinking. The kind that leaves you pinching your nasal bridge and eyebrows, as you lay awake, skin tingling, plugging your ears and blinking— praying these people would just quit their jobs and find another place to abuse their authority and be ineffective.

I glanced around the house. Where were the experts now? Why hadn’t they called to inquire of Jamey? Amazingly, the fact Jamey regularly beat himself and non-aversive or conventional therapies didn’t stop him—didn’t matter to ideologists. To persons opposing aversive therapy, Jamey wasn’t a person—he was a threat—a tangle in their tightly woven ideology.

There was a desperate air of unreality the days when Mark worked and respite hours expired. “The request for the one time only respite of 12 hours, for the rest of month was denied,” said a letter I received the previous week. Yes, Regional Center had denied the extra respite I requested months before I would have my tonsils taken out. Hence, Melanie, who by this time had absorbed responsibilities beyond her years, helped the best she could. More than once, she slipped a movie into the VCR, rolled out a sleeping bag, got Mike a drink of water or found Matt’s kaleidoscope while I tended Jamey. Just like she had all the other times Regional denied extra respite hours. Funny thing is, I discovered families with mildly disabled children who had more respite than we had. So, clearly the denials were personal. Retaliation, you might say. Retaliation didn’t stop me from pushing Regional Center to provide more respite and the one to one aide for Jamey in his Regional funded Recreation program I had requested. A request repeatedly diverted and forgotten. 
Around this time, a school OT wrote: “Jamey communicates his wants and needs by walking toward or taking a desired item…Jamey will smile, laugh, and may demonstrate a skip in his gait when he is in a happy mood, and will communicate displeasure through crying, resistance to task, and will occasionally display self-injurious behavior when angry. Jamey’s self-abuse includes hits to head, mainly to ears and sides of face. Self-injurious behavior has decreased significantly during his Occupational Therapy sessions, primarily due to Jamey using his medically prescribed SIBIS protocol at home and during his day school program. Jamey likes to swing on platform swing, bounce on large trampoline and enjoys deep pressure massage. He understands difference between rough and smooth, hot and cold by moving his hands either away or toward the stimulus. He visually tracks horizontally and diagonally with maximal head rotation and vertically with minimal head rotation. Eye convergence is normal. Can relocate item when it’s in his direct line of vision otherwise won’t seek out the item.

Another scheduled IEP meeting. Another report: “The SIBIS has been used successfully with James at school.” With the success came plans of fading the device. “I don’t understand,” I asked. “Why fade it if it’s working?” “The Hughes Bill is still in effect,” said Ms. Bowen. She wrote: “The IEP team agrees the behavior plan to address James self-injurious behavior is as follows: The skin shock will be administered after one hit to the head. The SIBIS will be worn for 30 minutes after each head hit.” I accepted the new plan, half-hoping Jamey would respond to alternative methods of controlling the self-injury without wearing the device.

1999 Another behavioral specialist hired by Regional evaluated Jamey’s case wrote: “The general family situation is extremely stressful. Since 1992, 13 attempts have been made at professional behavioral assessment and intervention for Jamey. Antecedents associated with the behavior include periods of inactivity, environmental over stimulation, task avoidance, frustration related to inability to communicate needs or desires, and when physically ill. A number of self-injurious behaviors have occurred without obvious antecedents. Over the years, numerous consequences have been attempted to intervene upon Jamey’s self-injurious behaviors. These include: sensory stimulation, redirection, and differential reinforcement of other behaviors, pharmaceutical interventions, extinction, close supervision, arm restraints, protective head equipment, physical restraint, and use of SIBIS…When the SIBIS was first permitted in the home setting, school personnel were legally prohibited from utilizing it. When I became involved in case (1997), frequency and intensity of the self-injury was significantly higher in the school than at home. Between 1995 and 1998, non-aversive techniques were utilized at school with minimal success…The etiology of Jamey’s self-injurious behavior is rooted in the autistic syndrome. In 1995, the hospital bio-ethics committee approved the use of skin shock. In [1997 and 1998], the state board of education granted a special waiver for Jamey’s skin shock device. Jamey appears to be one of the rare individuals who are driven to engage in self-injury because of a compulsive drive…while the use of skin shock has greatly reduced the frequency and intensity of behavior, it has not been eliminated; a condition commonly found if aversive procedures are not used in conjunction with a consistent plan, across settings, to teach more adaptive behaviors…Because Jamey has demonstrated a good ability to come under stimulus control of environments where SIBIS is used, it is possible to fade the skin shock in a short time. However, due to the spontaneous recovery phenomenon, it will be to retain the option to use the SIBIS or rare occasions…In Jamey’s case, skin shock appears to be the most critical part of treatment to prevent severe physical damage.”
Years later, skin shock therapy still radically reducing his SIB where SIBIS device was allowed, Jamey was still attending the After School Program. No skin shock allowed. This must have been confusing for Jamey. Nevertheless, a March, 2000 report written by the After School Director and submitted to Regional, said: “Jamey is an eleven year old boy…During leisure time Jamey requires 1:1 supervision. Kim states someone must know where he is at all times. At home, Jamey walks up and down the halls looking at pictures. He loves baths and bouncing on his bed. Specific skills that Kim would like to see Jamey work on in the Recreation Program include: exercise and exposure to different people, places, sounds, tastes and smells…Though Jamey is in his own world, he grabs food and drinks off the table. This is a big change from his pre-SIBIS days when all he wanted was to isolate himself and hit himself in the head…Jamey is a very enjoyable and challenging young boy, but responds to staff that learn to anticipate his needs. Jamey is unable to use neighborhood care providers for several reasons. The threat of self-injurious behavior is the biggest concern. Jamey is safest where people know him and have extensive experience with self-injurious behavior…Jamey doesn’t use signs or talk, but makes vocal sounds and communicates through non verbal behavior, such as seeking items with his eyes or grabbing object…Because Jamey communicates visually, all items of interest should be in his field of vision…Jamey doesn’t like crowds unless he’s wearing his earphones. Noise may upset him. Occasionally, Jamey will bite staff if they try and stop him from hitting himself. The SIBIS therapy is used at school and home. The SIBIS device is not used in the Recreation Program.”

When All Else Fails

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Years ago, we considered skin shock therapy for our autistic son. A doctor prescribed it.

At some point, I mentally ran through the reasons parents like me would result to skin shock therapy.

From what I learned, parents were desperate and wanted to save their children from a complex savage behavior that has stumped and baffled experts for over 40 years.

I have never understood the vicious attacks on Judge Rotenburg Center (JRC). What the public doesn't hear is that BEFORE arriving to JRC, many students are near death, the result of being subjected to tortuous years of ineffective behavioral and drug therapies by professionals who later gave up and left them to die.  

Look, I have seen several before and after skin shock videos, which, I might add, rivaled a West Craven horror flick. JRC seemed to be taking the autistic client that other had THROWN AWAY and GIVEN UP on. I'm not agreeing with everything that went on there, but holy moly, at least they were trying. Matthew Israel was a behavior psychologist, for pete's sakes, he was doing the best he could with a population other professionals had tossed off. And that governmental agencies had ignored, downplayed and wanted doped up on antipyschotics. Let's be REAL here folks. That's the TRUTH.  Instead of judging Judge Rottenburg Center, people should've done the friggin jobs to begin with so no parent had to consider skin shock.

In one home video, a young girl with autism screamed and bashed her skull into a hardwood floor, blood sprinkling her face, almost splattering the camera. Another video documented an autistic boy whose daily habit of shoving hands down his throat until he vomited—resulted in severe dehydration and malnutrition, until a finally judge ordered skin shock therapy to save his life..

For many of the JRC students, the suppression of self-injury led to the first time in years they could get dental or medical care exams. Or have a day in their lives where they were held hostage to constant self-harm. 

During this 1995 visit to JRC, I recall Security cameras scanned the classrooms and hallways at JRC, ensuring student safety. Several students wore the GED device. “He receives a shock contingent upon hitting his head,” said the psychologist, pointing to a student who, according to Dr. Israel, had bitten half the nose off a teacher, punched out staff members and repeatedly driven his skull into walls. Wearing the GED now, this same student, was calmly placing beads on a piece of rope and smiling.

“Does skin shock hurt?” I asked. “No,” said Dr. Israel. “You’ll feel a mild sting, like a rubber band snap—and that’s about it.” I confess, I was a bit nervous. “Go ahead, put it on,” I said, feeling my heart race. A staff member attached the device. “Are you ready?” she asked. “Ready,” I said. She pushed the button on the remote. A deep vibration tickled my skin for about 1 second. “Is that it?” I asked. The sting was brief, like a skin pinch, but didn’t linger, and isolated to the point of skin contact. 

I observed another student. “We obtained a court order for this student’s device,” said Dr. Israel. “He had mutilated his genitals and pulled his colon out.” “How does someone do that to themselves?  I asked, queasy from the image. “He shoved his hand down his pants and throat…just tore things out...,” said a staff member.  “Nothing stopped him, until skin shock therapy." Dear God, why? WHY? WHY, do we have to be faced with such horrors? And gut-wrenching decisions to help stop a behavior that most people don't even know exists? Can I scream now, God, because I'm terrified. Terrified for my son, terrified for all who suffer with this devastating behavior.

Because JRC used skin shock they made enemies. Cruel and combative enemies. Consider the October 11, 1995 report by David Armstrong of the Boston Globe: “A Judge in Massachusetts, accusing state officials of exhibiting ‘pervasive public corruption’ has ordered [Mary Cerreto and Philip Campbell) to pay more than one million dollars to an area center (JRC) which treats self-injurious students.

Judge Elizabeth O’Neil LaStaiti charged that Campbell, Commissioner of the Massachusetts Department of Mental Retardation, and top aide, Cerreto, used unethical measures in an attempt to shut down the Judge Rotenberg Center. I wonder how much energy that went into attacking Dr. Israel went into finding cures and offering in-home assistance went into helping these vulnerable autistic people and their families. Or how much energy was spent advocating for more staffing, better medications or autism programs.

According to LaStaiti, Campbell and Cerreto had a ‘personal bias’ against the center because it sometimes uses aversive therapy to handle dangerous behaviors. ‘The findings of this court,’ LaStaiti ruled, ‘include findings that high ranking government officials have been deliberately untruthful on the witness stand,; expended public funds to pursue baseless allegations (gee, and we wonder where our tax dollars go)  have authorized unfounded ethical attacks and launched investigations on court personnel, constituting pervasive public corruption.” Way to go Campbell and Cerreto. Way to look out for the RARE cases of people who require lifesaving skin shock therapy. God help  these two if they need chemotherapy to save their lives.  After all, it's "aversive." It's "painful."
The controversy over skin shock therapy has a long history, making its way onto  20/20 ("When All Else Fails, 1986); Oprah (1993) and CNN (with Brian Jenkins, 1995). Upon reviewing news tapes, Oprah’s segment stuck with me: Audience was mostly parents whose autistic, self-injurious children hadn’t responded to therapies and required court-ordered skin shock therapy. Guests included, Anne Donnellan and Connie Lapin, a fierce, hostile, pair who openly opposed skin shock therapy, though neither had children with severe, chronic, health damaging self-injurious behavior. Interestingly, Donnellan, who appeared high on herself, never directly answered questions from audience--while Lapin sat pinched faced, as if she’d been constipated for months.

When a mother of a self-abusive child using skin shock asked Lapin what she thought parents should do when treatments for self-injury fail, Lapin rolled her eyes and said in a singsong voice, “You have to treat them like human beings.” How insulting! As if the parent hadn’t.  This, of course, caused an immediate audience uproar. To wit, Donnellan, hollered over outraged audience: “Skin shock is like a cattle prod!” “What’s next? Shocking BLACK children?”  A hush blew over the set. Then a riot nearly broke out. An African American mother (whose kid used skin shock) from the audience shouted:. “Why is she referring to black children?” Yes, why was she? We know why. That’s what people who have no good argument do. They fire rounds of incendiary words as diversionary tactics.

As Oprah pacified the insulted parents of children and teens using therapeutic skin shock therapy, tempers softened and parents began telling heartbreaking stories of failed behavioral and educational treatments for their self-abusive children. As they spoke, Lapin’s face soured, as if the reality of other people’s pain left a bad taste. Meantime, Donnellan interrupted grieving parents with the empathy of a saber-toothed tiger, and shamelessly extolled her book on positive behavior interventions. Clearly, it didn’t matter if a myriad of inept therapies had failed or that research showed skin shock therapy was, in rare instances, the best adjunctive therapy. Donnellan and Lapin remained hopelessly irrational.
Ironically, in 1989, the famous Harvard psychologist, American behaviorist, B.F. Skinner,
writing to the Massachusetts Senate to oppose anti-aversive legislation, wrote: “Although I have done everything I can do minimize use of aversives in schools and elsewhere…there are legitimate uses of aversive behavioral therapy that have considerable value, and that the Bill would make it impossible to give many people the help they need.” In, A Statement on Punishment, Skinner wrote, “The use of punishment is widely debated, especially in connection with education and therapy. Punishment is usually used to the advantage of the punisher, but there are exceptions, and they can sometimes be justified. Some autistic children, for example, will seriously injure themselves or engage in other excessive behavior unless drugged or restrained, and other treatment is virtually impossible. If brief and harmless aversive stimuli, made precisely contingent on self-destructive behavior, suppresses the behavior and leaves the children free to develop in other ways, I believe it can be justified. [However], to remain satisfied with punishment without exploring non punitive alternatives is the real mistake.”  This is a man who had a logical mind. He is saying skin shock therapy, in rare cases, is warranted, so LONG as you don't use it in the absence of other therapies. I agree. Skin shock should be used as a last resort, RESCUE medical intervention, when intracable self-injury poses a repeated threat to health and safety of a person who, by internal dysregulations, can't control urge to stop savagely self-abusing--no matter how many drugs or positive interventions tried.
In 1989, a federal panel of experts, convened by the National Institute of Health, issued a statement in favor of skin shock therapy— when other methods failed. The panel had suggested exploring skin shock therapy and said self-injurious persons were overmedicated and caregivers for disabled were untrained, underpaid and unqualified.
In Dr. Siegel’s book, The World of the Autistic Child, she wrote: “It is worth discussing physical aversives and learning more about what they can and can’t do to change behavior.” Psychiatrists Harold Kaplan and Benjamin Sadock, writing in their book, “Synopsis of Psychiatry,” describe aversion therapy as “therapy used for …behaviors with impulsive or compulsive qualities.” On page 205 of “Let Me Hear Your Voice,” Catherine Maurice writes: “We have heard of devastating cases where a child’s self-injurious behavior was so severe as to threaten sight, hearing or even his life...all three of us believe in the necessity of some aversives, in some circumstances, with some children.” One of the greatest authorities on autism, Dr. Rimland, in 1993, wrote,  “In recent years our society has been directed—often to the detriment of the handicapped—by ideas based on good wishes and fantasies than factual information and rational thought…I have coined the word advozealot to characterize people who purport to be advocates for the handicapped but are zealous advocates of their own Alice in Wonderland ideology…A major weapon of the advoealots is politically correct (PC) language. They insist words like “autistic”, “retarded” and “handicapped” not be used. They insist the silly euphemism “challenging” be used to describe severely self-injurious or assaultive behavior… Pretending the handicapped are not handicapped robs them of the respect they deserve and the tremendous effort they must exert to achieve small accomplishments that come easily to the rest of us… You can’t solve problems by hiding from them, or smothering them in a fog of murky words…How do we combat these seductive but pernicious ideas, which are implemented so uncritically? Do not meekly accept the advozealots arrogant assumption of the moral high ground…The advozealots, some with a hidden agenda and others with the best of intentions, have done much harm...The idea of using electric shock on a handicapped person is…outrageous to the anti-aversive people…and is repugnant to me also [but] it is not nearly as repugnant as some the things severely self-injurious people do to themselves, such as causing blindness, fracturing skulls or chewing off both thumbs. I have tried SIBIS device on myself. It produces discomfort, not pain. Its nine-volt transistor battery provides a…rather unpleasant, stinging sensation…there is no residual discomfort or skin irritation.” THINK TEN's UNIT: "The TENS unit is turned on, generating a small electrical shock which stimulates the nerves in the area." Now think skin shock therapy. BOTH generate a small electrical shock which stimulates nerves to reduce pain or INTERRUPT an out of control self-abusive fit. Have you ever seen one? It's insane. Nothing stops it, not even mega-drugs and restraints. Unless you've WITNESSED this TYPE of rare self-abusive behavior in autism, I suggest you start learning more about it before you shoot your mouth off about the evils of aversive therapy. I have ZERO tolerance for people who don't educate themselves on the reality of other people's pain and suffering, but have the temerity to judge others and tell them how to live their lives.
In a letter to me on July 15, 1995, Behavioral Psychologist Dr. Laura Schriebman wrote: “Behavioral approaches, such as SIBIS, have been successful in treatment of self-injurious behavior.” Rather than joining the revolution against aversive therapy, the above professionals cited supported reformation with a call to consider the old ways, in unique situations— whereas anti-aversive revolutionists deemed everything old as outdated and evil. Surely, such fanaticism was and is counterproductive to treating persons with disabilities