Ethics

Question 1

HISTORICAL IMPLICATIONS

Answer 1

• Cultural history and personal experiences with others
  abusing power, taught people to react negatively to behavior
  modification
• People with more reinforcers (resources) taking advantage of
  those with fewer
• This term evokes many negative feelings
• Brain washing, ECT, lobotomies

Question 2

TODAY

Answer 2

• Behavior modification
• ABA, BT, behavioral analysis, CBT
• Based on idea that
• 1. Behavior can be controlled
• 2. it’s desirable to do so for certain objectives
• Problem is that people misuse these tools

Question 3

BEHAVIORAL VIEW OF ETHICS

Answer 3

• Ethics – standards of behavior developed by culture to
  promote the survival of that culture
• Guidelines are an important source of behavioral control
  when immediate reinforcers influence individual to behave
  in a way that leads to aversive stimuli for others
• When members of the same culture learn to follow the
  same ethical guidelines, the guidelines exert rule-governed
  control over behavior

Question 4

ARGUMENTS AGAINST
CONTROLLING BEHAVIOR

Answer 4

• Because of history and experiences, some have argued
  that all attempts to control behavior are unethical
• Goal of any social help profession involve change in
  behavior and behavior control
• It is often necessary to change, manage, influence, or
  control behavior
• Planned Behavioral modification can be viewed as cold
• But more successful if done with warmth and empathy
• It is necessary to ensure that it is done ethically

Question 5

ETHICAL GUIDELINES

Answer 5

• Saying there’s a ‘need to be ethical” doesn’t mean people will
  behave ethically
• Countercontrol
• Person undergoing behavior mod has affect on the person in charge
• Stop seeing a therapist
• But not everyone has this power
• People engaging exerting modification techniques need to be held
  accountable

Question 6

ETHICAL GUIDELINES
2

Answer 6

• Organizations that have addressed ethical guidelines involved in
  behavior modification
• Often in charge of licensing or credentials
• Behavior Analyst Certification Board (BACB)
• International certification body for ABA
• Association for Behavioral and Cognitive Therapies (ABCT)
  (formerly, the Association for the Advancement of Behavior
  Therapy
• Association for Behavior Analysis International (ABAI)
  (formerly, ABA)
• American Psychological Association (APA)

Question 7

ETHICAL GUIDELINES
3

Answer 7

• Based on:
• 1977, Behavior Therapy, publication of set of ethical
  questions to ask
• 1978, Stolz & Associates, a comprehensive report on
  ethical issues involved in behavior modification
• 1988, Van Houten et al., The Behavior Analyst, published a
  statement of clients’ rights
• 2002, American Psychological Association’s Ethical
  Principles of Psychologists and Code of Conduct

Question 8

AABT ETHICAL QUESTIONS LIST

Answer 8

• Maximum involvement by person whose behavior is to be
  changed
• Fullest considerations of societal pressures on the person,
  the therapist, and therapist’s employer
• Settings may require some exceptions but not exceptions to ethical practice

Question 9

A. HAVE THE GOALS OF TREATMENT
BEEN ADEQUATELY CONSIDERED?

Answer 9

1. To ensure that the goals are explicit, are they written?
   * 2. Has the client’s understanding of the goals been assured by
   having the client restate them orally or in writing?
   * 3. Have the therapist and client agreed on the goals of therapy?
   * 4. Will serving the client’s interests be contrary to the interests of
   other persons?
   * 5. Will serving the client’s immediate interests be contrary to the
   client’s long-term interest?

Question 10

B. HAS THE CHOICE OF TREATMENT
METHODS BEEN ADEQUATELY
CONSIDERED?

Answer 10

• 1. Does the published literature show the procedure to be the best one
     available for that problem?
• 2. If no literature exists regarding the treatment method, is the method
     consistent with generally accepted practice?
• 3. Has the client been told of alternative procedures that might be preferred
     by the client on the basis of significant differences in discomfort, treatment
     time, cost, or degree of demonstrated effectiveness?
• 4. If a treatment procedure is publicly, legally, or professionally controversial,
     has formal professional consultation been obtained, has the reaction of the
     affected segment of the public been adequately considered, and have the
     alternative treatment methods been more closely re-examined and
     reconsidered?

Question 11

C. IS THE CLIENT’S
PARTICIPATION VOLUNTARY?

Answer 11

• 1. Have possible sources of coercion on the client’s participation
     been considered?
• 2. If treatment is legally mandated, has the available range of
     treatments and therapists been offered?
• 3. Can the client withdraw from treatment without a penalty or
     financial loss that exceeds actual clinical costs?

Question 12

D. WHEN ANOTHER PERSON OR AN
AGENCY IS EMPOWERED TO ARRANGE
FOR THERAPY, HAVE THE INTERESTS OF
THE SUBORDINATED CLIENT BEEN
SUFFICIENTLY CONSIDERED?

Answer 12

• 1. Has the subordinated client been informed of the treatment objectives and
     participated in the choice of treatment procedures?
• 2. Where the subordinated client’s competence to decide is limited, have the
     client as well as the guardian participated in the treatment discussions to the
     extent that the client’s abilities permit?
• 3. If the interests of the subordinated person and the superordinate persons
     or agency conflict, have attempts been made to reduce the conflict by dealing
     with both interests?

Question 13

E. HAS THE ADEQUACY OF
TREATMENT BEEN EVALUATED?

Answer 13

• 1. Have quantitative measures of the problem and its progress
     been obtained?
• 2. Have the measures of the problem and its progress been
     made available to the client during treatment?

Question 14

F. HAS THE CONFIDENTIALITY OF
THE TREATMENT RELATIONSHIP
BEEN PROTECTED?

Answer 14

• 1. Has the client been told who has access to the records?
• 2. Are records available only to authorized persons?

Question 15

G. DOES THE THERAPIST REFER THE
CLIENTS TO OTHER THERAPISTS
WHEN NECESSARY?

Answer 15

• 1. If treatment is unsuccessful, is the client referred to other
     therapists?
• 2. Has the client been told that if dissatisfied with the treatment,
     referral will be made?

Question 16

H. IS THE THERAPIST QUALIFIED
TO PROVIDE TREATMENT?

Answer 16

• 1. Has the therapist had training or experience in treating problems like
     the client’s?
• 2. If deficits exist in the therapist’s qualifications, has the client been
     informed?
• 3. If the therapist is not adequately qualified, is the client referred to other
     therapists, or has supervision by a qualified therapist been provided? Is
     the client informed of the supervisory relation?
• 4. If the treatment is administered by mediators, have the mediators been
     adequately supervised by a qualified therapist?

Question 17

ETHICAL CONSIDERATIONS
AGAIN

Answer 17

• Qualifications of the Behavior Modifier
• Must receive appropriate training – academic and supervised practical
  training
• For complex problems or ones with risk, clients have a right to a
  doctoral-level analyst or therapist
• Procedures being used are the most up-to-date

Question 18

QUALIFICATIONS OF THE
BEHAVIOR MODIFIER

Answer 18

• Steps to ensure countercontrol and accountability:
• Supervision by members of ABAI, ABCT, or both
• Various certification bodies, such as the American Board of
  Professional Psychology Behavior Analysis Certification
  Board
• BACB identifies what a behavior analyst can do at each
  level of certification and what supervision is needed

Question 19

DEFINITION OF PROBLEM AND
SELECTION OF GOALS

Answer 19

• Target behaviors selected must be most important for client
  and society
• Emphasis on teaching functional, age-appropriate skills
• For those with handicaps, focus on teaching skills that
  promote independent functioning
• Goals should be consistent with the basic rights of the client
  to dignity, privacy, and humane care

Question 20

DEFINITION OF PROBLEM AND
SELECTION OF GOALS
2

Answer 20

• Steps to ensure countercontrol and accountability:
• Require behavior modifier to clearly specify his or her values
  relating to client’s problems
• Ideally consistent with client’s
• APA states therapists shouldn’t try to unnecessarily change
  client’s values
• Client as an active participant in the selection of goals and
  identification of target behaviors
• Or competent third parties

Question 21

SELECTION OF TREATMENT
METHOD

Answer 21

• Use the most effective, empirically validated methods with the least discomfort
  and fewest negative side effects
• Use least intrusive and restrictive interventions
• No agreement on a continuum of intrusiveness or restrictiveness
• Interventions based on positive reinforcement considered less intrusive than
  interventions based on aversive control
• Can use aversion but must be wary of harmful side effects, used as a last resort
• Intrusive and restrictive sometimes refer to
• The extent to which clients are given choices and allowed freedom of movement in a
  therapeutic environment
• The extent to which consequences are deliberately managed as opposed to naturally
  occurring

Question 22

SELECTION OF TREATMENT
METHOD
2

Answer 22

• Most effective treatment is based on functional assessment of
  causes of problem
• If aversive methods may work, need to have countercontrol
• Steps to ensure countercontrol and accountability
• Informed consent
• Explain alternatives, pros/cons, choice
• Behavioral contract
• Ethical review committees

Question 23

RECORD KEEPING AND
ONGOING EVALUATION

Answer 23

• Maintenance of accurate data throughout the
  program
• Behavioral assessment before the program
• Ongoing monitoring of target behavior
• Possible side-effects
• Appropriate follow-up evaluation after treatment
• Confidentiality to be respected at all times

Question 24

RECORD KEEPING AND
ONGOING EVALUATION
2

Answer 24

• Steps to ensure countercontrol and
  accountability:
• Client access to records
• Frequent discussions with client about progress in
  the program
• Periodic peer evaluation of data

Question 25

ABA & AUTISM

Answer 25

• Wolf et al. 1964
• Effectiveness of operant conditioning procedures to decrease
  interfering behaviors like tantrums and increase pro-social
  behaviors (wearing glasses, bedtime behavior, communication
  skills) with a boy who was at risk of vision loss and
  institutional placement
• Took place while institutionalized at first

Question 26

WOLF ET AL., 1964

Answer 26

• Procedure
• Tantrums – mild punishment and extinction
• Placed in his closed room when tantrums began
• Took away social contacts
• Allowed for DRO (diffeerential reinforcement of other behavior) – door opened with non-tantrum
  behavior
• Bedtime – similar
• Put on schedule: bath, cuddling, put to bed, door open
• Closed door if he had to be told to go back to bed
• Glasses wearing
• Shaping procedure: fake glasses to real glasses
• First few sessions used conditioned reinforcer pairing
  clicker with candy or fruit. Click because SD for going to
  bowl of food
• Also, shaper not well-trained, imprecise
• Candy was a weak reinforcer
• Tried it at breakfast (for deprivation), lunch, ice cream was
  the winner
• Verbal behavior
• Used breakfast as reinforcer to get mimicking, answering
  questions
• Maintained with approval after established
• Eating behaviors – no silverware, stealing from
  other’s plates, throwing food
• Told no, put in his room
• Intervention worked
• 6 month follow up: continued to wear glasses, no
  tantrums, sleeping problems, more verbal

Question 27

ABA & AUTISM 2

Answer 27

• Many studies and programs used with
  autistics/individuals with autism
• Considered evidence-based practice (National Autism
  Center, 2015)
• Effective interventions
• Autism rights & neurodiversity activists expressed
  concern
• “anti-ABA”, “all ABA is abuse” “Autistic Conversion
  Therapy”
• Why?
• Historical events
• Lovaas

Question 28

• In the 1960s and 1970s, Ivar Lovaas developed behavioral treatments for children
  with ASDs. Using an approach he called early intensive behavioral intervention (EIBI),
  Lovaas (1966, 1977) focused on strategies to teach social and play behaviors,
  eliminate self-stimulatory behaviors, and develop language skills. When EIBI was
  applied to children with ASDs younger than 30 months old and continued until they
  reached school age, 50% of those children were able to enter a regular classroom at
  the normal school age (Lovaas, 1987). Moreover, the behavioral treatment produced
  long-lasting gains (McEachin, Smith, & Lovaas, 1993).
• Although some reviewers have criticized the experimental design of the
  Lovaas study (e.g., Gresham & MacMillan, 1997; Tews, 2007), subsequent
  research has established EIBI as the treatment of choice in terms of both
  cost and effectiveness for children with ASDs (Ahearn & Tiger, 2013;
  Kodak & Grow, 2011; Matson & Smith, 2008; Matson & Sturmey, 2011).
• There are an increasing number of government- funded EIBI programs for children
  with ASDs. In Canada, for example, EIBI programs are currently available in all
  provinces and territories. For examples of behavior modification with children with
  ASDs, see Cox, Virues-Ortega, Julio, & Martin, 2017; Dixon, Peach, & Daar, 2017;
  Gerencser, Higbee, Akers, & Contreras, 2017; Johnson, Vladescu, Kodak, & Sidener,
  2017; Leaf et al., 2017).

Answer 28

• In the 1960s and 1970s, Ivar Lovaas developed behavioral treatments for children
  with ASDs. Using an approach he called early intensive behavioral intervention (EIBI),
  Lovaas (1966, 1977) focused on strategies to teach social and play behaviors,
  eliminate self-stimulatory behaviors, and develop language skills. When EIBI was
  applied to children with ASDs younger than 30 months old and continued until they
  reached school age, 50% of those children were able to enter a regular classroom at
  the normal school age (Lovaas, 1987). Moreover, the behavioral treatment produced
  long-lasting gains (McEachin, Smith, & Lovaas, 1993).
• Although some reviewers have criticized the experimental design of the
  Lovaas study (e.g., Gresham & MacMillan, 1997; Tews, 2007), subsequent
  research has established EIBI as the treatment of choice in terms of both
  cost and effectiveness for children with ASDs (Ahearn & Tiger, 2013;
  Kodak & Grow, 2011; Matson & Smith, 2008; Matson & Sturmey, 2011).
• There are an increasing number of government- funded EIBI programs for children
  with ASDs. In Canada, for example, EIBI programs are currently available in all
  provinces and territories. For examples of behavior modification with children with
  ASDs, see Cox, Virues-Ortega, Julio, & Martin, 2017; Dixon, Peach, & Daar, 2017;
  Gerencser, Higbee, Akers, & Contreras, 2017; Johnson, Vladescu, Kodak, & Sidener,
  2017; Leaf et al., 2017).* In the 1960s and 1970s, Ivar Lovaas developed behavioral treatments for children
  with ASDs. Using an approach he called early intensive behavioral intervention (EIBI),
  Lovaas (1966, 1977) focused on strategies to teach social and play behaviors,
  eliminate self-stimulatory behaviors, and develop language skills. When EIBI was
  applied to children with ASDs younger than 30 months old and continued until they
  reached school age, 50% of those children were able to enter a regular classroom at
  the normal school age (Lovaas, 1987). Moreover, the behavioral treatment produced
  long-lasting gains (McEachin, Smith, & Lovaas, 1993).
• Although some reviewers have criticized the experimental design of the
  Lovaas study (e.g., Gresham & MacMillan, 1997; Tews, 2007), subsequent
  research has established EIBI as the treatment of choice in terms of both
  cost and effectiveness for children with ASDs (Ahearn & Tiger, 2013;
  Kodak & Grow, 2011; Matson & Smith, 2008; Matson & Sturmey, 2011).
• There are an increasing number of government- funded EIBI programs for children
  with ASDs. In Canada, for example, EIBI programs are currently available in all
  provinces and territories. For examples of behavior modification with children with
  ASDs, see Cox, Virues-Ortega, Julio, & Martin, 2017; Dixon, Peach, & Daar, 2017;
  Gerencser, Higbee, Akers, & Contreras, 2017; Johnson, Vladescu, Kodak, & Sidener,
  2017; Leaf et al., 2017).

Question 29

LOVAAS & YOUNG AUTISM
PROJECT

Answer 29

• Before this program, assumption that people with ASD were “lost
  causes”
• Positive reinforcers for desired/”normal” behaviors
• Food, saying “good boy,” and /or giving the child a hug or pat
• Attending to lessons or using spoken language, looking at, the
  experimenter upon request.
• Also used “aversives”
• Slaps, electric shocks and reprimands
• Self-injurious behaviors, self-stimulating behaviors

Question 30

LOVAAS

Answer 30

• “One way to look at the job of helping autistic kids is
  you have to construct a person. You have the raw
  materials but you have to build the person.”
• Worked with grad student Rekers to help with grant
  funding for
• Feminine Boy project

Question 31

AUTISM & ABA

Answer 31

• Current procedures & goals
• Use of aversives like electric shock not used in behavior
  modification therapy
• But punishment & extinction are
• May lead to side effects
• Doesn’t allow for non-compliance, teaching kids to be
  neurotypical, masking
• Research hasn’t shown lasting trauma, but these individuals
  do report feeling that way