The treatment of dangerous behavior

Abstract

Individuals who display dangerous behavior towards others have historically been under-treated and under-researched. This paper discusses three published case studies wherein adult males were effectively treated for severe aggression towards others, the environment, and, in two cases, self-injury. All were diagnosed as having mental retardation and two also had a psychiatric diagnosis. All had experienced years of failed attempts to control their aggression through large pharmacological interventions and restricting their freedom of movement via restrictive environments. The use of comprehensive multifaceted behavioral programs involving punishment resulted in dramatic and long lasting reductions in aggression, the elimination or great reduction of drug use, and major lifestyle improvements. The conceptual, clinical, political, legal, philosophical, and ethical considerations that arose during the development and implementation of the programs are discussed as well as scientific issues related to achieving long term maintenance. An early published case study (Martin & Foxx, 1973) is discussed first because it illustrates how an informal functional analysis was used to design a very simple and effective non-punishment treatment program for a woman who displayed dangerous aggression.

The long term successful treatment of the aggressive/destructive behaviors of a preadolescent with autism

“…Yet as discussed previously (Foxx et al, 1989) using positive reinforcement alone at the beginning of treatment (see Foxx, 2005a and b) would not only be dangerous but also noncompetitive with the powerful negative reinforcement that is available. This is why the most honest, effective, and appropriate model was demonstrated in the present case in that Johnny's responsiveness to positive approaches greatly increased over time after his aggression was first brought to safe levels with appropriate reductive and positive procedures (Foxx, 2003).…”

Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: treatment or mistreatment?

“…2005). Foxx (2003) has suggested aversive punitive treatment in certain cases with similar behaviours, especially of the premeditated type.…”

Working With Clients Who Self-Injure: Providing Alternatives

“…It can be difficult to work with clients who selfinjure for multiple reasons. One of the main reasons, and predicaments, is that SIB can become worse before it ever improves (Foxx, 1982(Foxx, , 2003. SIB typically serves as a coping mechanism that is activated by an increase in emotional arousal (Favazza, 1987;van der Kolk, Perry, & Herman, 1991;Winchel & Stanley, 1991), and it assists the client in gaining a feeling of control or relieving tension (Gardner & Gardner, 1975).…”

“…Zila and Kiselica (2001) reported that limited information on SIBs in the literature frequently hinders proper treatment and can ultimately lead to a counselor's frustration, repulsion, or fear of the behavior. However, regardless of the treatment method, SIB can increase in frequency and severity when a client begins to work on underlying causes of the behavior (Foxx, 1982(Foxx, , 2003. Thus, it might be helpful for a client to have an alternative to SIB while working through some of the core, emotionally difficult, concerns.…”