The successful treatment of a dually-diagnosed deaf man's aggression with a program that included contingent electric shock

A behavioral program that included contingent electric shock was developed to treat the severely aggressive behaviors of an institutionalized, dually-diagnosed deaf male. All previous interventions including high dosages of psychotropic medications, custodial restraint, seclusion, and various behavioral procedures had been ineffective. The program included: (a) a high density of positive reinforcement for appropriate behavior; (b) a short period of intensive compliance training in a special setting using remote controlled or direct electric shock consequences contingent on aggression or property destruction; and (c) the gradual transfer of programmatic control to supervisory personnel and then direct-care staff with the inclusion of additional procedures (e.g., nonexclusionary time-out) that were intended to help ensure their safety. All forms of aggressive behavior were reduced to zero or near zero levels within one month and these effects have been maintained by direct-care staff for more than a year. The client now works all day at the institutional vocational workshop and has made several home visits without displaying aggression. The ethical, clinical, and practical considerations that arose during the development and implementation of the program are discussed in detail.