A Systematic Review of the Ethics of Punishment-Based Procedures for Young Children With Disabilities

Abstract

Punishment-based procedures are used to reduce challenging behavior in both special education and applied behavior analytic practices. Although commonly effective, these interventions are associated with an increased level of risk, making their use controversial. However, no research has specifically analyzed the extent to which researchers comply with the ethical standards of the professional organizations for special educators and behavior analysts (i.e., Council for Exceptional Children [CEC] and the Behavior Analyst Certification Board [BACB], respectively) when implementing punishment-based procedures. This might be especially important for young children with disabilities, who are a highly vulnerable population. We systematically analyzed the use of punishment-based procedures with this population to determine (a) characteristics of included children and treatments and (b) the degree to which researchers adhered to ethical standards during implementation. Results indicated a variety of punishment-based procedures have been used with this population and have generally resulted in decreased challenging behavior; these results were demonstrated across age, diagnosis, target behavior, and treatment type. However, researchers demonstrated minimal adherence to ethical standards, with no improvements over time. This indicates a need for improved ethical rigor of researchers implementing punishment-based interventions. Recommendations include (a) the creation and validation of an ethics code to assess the degree to which researchers demonstrate ethical practices, and (b) the development of tools to help practitioners recognize the ethical implications of punishment-based interventions and choose/implement appropriate interventions for behavioral interventions.

Examining stereotypy in naturalistic contexts: Differential reinforcement and context‐specific redirection

“…According to Pokorski and Barton (2020), behavior-analytic research must be conducted in accordance with ethical standards by evaluating reinforcement-based procedures prior to implementing punishment-based procedures (BACB, 2020). Col on et al ( 2012) did this by directly targeting appropriate vocalizations with verbal operant training before redirecting stereotypy with RIRD.…”

“…C-RD paired with a DRA might be effective in cases that RIRD is ineffective, but further evaluations are necessary to systematically compare RIRD and C-RD to quantify the procedure corresponding to higher levels of contextually appropriate behavior and less time redirecting stereotypy. Given the recommendations of Pokorski and Barton (2020), RIRD and C-RD should be compared while reinforcement is simultaneously available for appropriate behavior. Additionally, future investigations involving C-RD should recruit parent or teacher feedback on the acceptability of procedures and the degree to which the results are socially meaningful.…”

“…Lanovaz et al (2013) concluded that reducing stereotypy often results in increases in untargeted behavior, suggesting that practitioners should explicitly program the reinforcement of appropriate responses. Pokorski and Barton (2020) suggest that punishment-based procedures, such as RIRD, must be evaluated with other sources of reinforcement available to meet behavior analytic ethical standards (Behavior Analyst Certification Board [BACB ® ], 2020).…”

Development and validation of an instrument to measure pediatric nurses' adherence to ethical codes

“…Ethical principles such as authority, human dignity, privacy, and confidentiality can easily be compromised in pediatric settings [ 16 – 18 ]. The systematic review of the literature conducted by Pokorski and Barton in 2020 revealed that although the code of ethics is established to guide nurses in research and practice, they are not adhered to by researchers in the field of pediatric nursing [ 19 ]. In the study of Beykmirza and colleagues (2019), it was reported that Nurses reported significantly higher levels of ethics than mothers of children with cancer [ 20 ].…”

A retrospective analysis of stereotypy: Applicability of the behavioral subtyping model

“…Further, because interventions based on reinforcement alone are not universally effective, behavior analysts may forgo these interventions and implement punishment‐based strategies immediately, either alone or in combination with reinforcement. In a recent review of the ethical use of punishment‐based interventions for preschool children, seven studies implemented punishment (either response interruption and redirection [RIRD] or overcorrection) contingent on stereotypy; only three of these seven studies documented that reinforcement‐based strategies were attempted and were ineffective prior to the use of punishment (Code Variable 13; Pokorski & Barton, 2020). Although it is unknown whether this is due to a lack of reporting or other factors, it is essential that punishment‐based procedures are not implemented when they are unwarranted.…”