Medicine:Self-Injurious Behavior Inhibiting System

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The Self-Injurious Behavior Inhibiting System (SIBIS) is an apparatus designed to reduce self-injurious behavior (SIB) directed at the head, such as banging the head against walls and other objects or hitting oneself in the head. Invented by Dr. Robert E. Fischell, Glen H. Fountain, and Charles M. Blackburn in 1984, the device is able to detect instances of head-directed SIB, and delivers an aversive electric shock contingent on its occurrence.[1]

It use is controversial and some areas in the United States have banned its use.[2] In 2016 the FDA proposed banning the device.[3]

Effectiveness

The amount of evidence that looks at the usefulness of SIBIS is small.[4] One study was undertaken in 1990 of five individuals with developmental disabilities exhibiting severe self-injurious behavior that was resistant to multiple other treatments, who showed rapid and large decreases in self-injury when a SIBIS device was used.[5] Another study in 2004 reported positive effects of SIBIS on a single pre-school child.[6] Its usefulness, however, varies between people.[4]

Side effects

The FDA states that psychological and physical harm may result from the devices use.[3] This may include depression, anxiety, and worsened behavior.[3] Physical issues may include burns and pain.[3]

Components

There are two models of SIBIS. The simpler model consists of an electrode and a radio transmitter wrapped around the arm or leg using Velcro.[7] When a child administers a blow to the head, the SIBIS device is used to recognize the self-injurious behavior. This is possible because the SIBIS device is composed of two wirelessly connected parts: the "sensor module" and the "stimulus module".[1] The impact monitor serves to both detect an impact to the head and to protect the head from the damage that the impact could potentially incur. The sensor module is placed on either the body part receiving the impact (such as the head) or on the body part delivering the impact (such as the arm or knee). Wherever it is placed, the sensor module senses the impact of the blow and sends out an electrical signal. This electrical signal triggers the stimulus module, allowing for the aversive stimulation, the shock, to be delivered.

Specifications

SIBIS is designed to reduce SIB by immediately delivering positive punishment when head-directed SIB occurs. Only 5 cm × 3 cm × 1 cm in size,[8] the stimulus module delivers an 85 V electrical shock at 3.5 mA of current to the subject each time the patient strikes his or her head sufficiently hard enough to register on the velocity impact detector.[6] The delivered shock is designed not to be very painful, but rather an uncomfortable response to the SIB. The impact detector of the apparatus can be adjusted, allowing for the reduction of punishment over time and the eventual dismissal of the apparatus from the child's punishment schedule.[8]

Ethical debate

The utilization of SIBIS is controversial, thus making it the center of ethical debates. Dr. Brian A. Iwata refers to SIBIS as a “default technology."[9] More specifically, Dr. Iwata states that default technology is a last resort to behavior modification after all other methods have been exhausted. Moreover, it is strongly advised that SIBIS should only be used after a full functional analysis of the problem behavior has been completed.

Though the American Psychological Association and the National Association of School Psychologists have attempted to direct school psychologists in the administration of behavioral treatment, the use of SIBIS has proven to be a very controversial topic in the public school system.[10] Those that oppose the SIBIS device as a form of treatment in a school setting claim the shock delivered to the subject qualifies as corporal punishment. However, researchers claim that aversive therapy adheres to a systematic treatment plan that is carefully constructed to diminish the dangerous, and sometimes even life-threatening, actions exhibited by children with self-injurious behavior.[10] The researchers claim that corporal punishment, unlike an aversive stimulus treatment plan, uses the administration of pain as a "disciplinary action" in order to punish an unwanted behavior.

Schools in some states, such as Michigan, have found SIBIS to be lawful and have allowed its use within the classroom setting.[10] Three stipulations are met, however:

  1. The participant, or the participant's parents, must be fully aware as to what he or she is consenting and the implications it may incur.
  2. The participant, or the participant's parents, must be competent and capable of making decisions regarding his or her health.
  3. The participant, or the participant's parents, must voluntarily consent to the treatment method without coercion or intimidation.

See also

References

  1. ↑ 1.0 1.1 "Archived copy". Archived from the original on 2011-06-12. https://web.archive.org/web/20110612225112/http://www.patentstorm.us/patents/4440160/description.html. Retrieved 2009-12-03. 
  2. ↑ Terry, Scott (2015). Learning and Memory: Basic Principles, Processes, and Procedures, Fourth Edition. Psychology Press. p. 140. ISBN 9781317350873. https://books.google.com/books?id=4s5WCgAAQBAJ&pg=PA140. 
  3. ↑ 3.0 3.1 3.2 3.3 "FDA proposes ban on electrical stimulation devices intended to treat self-injurious or aggressive behavior". April 22, 2016. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm497194.htm. Retrieved 7 May 2016. 
  4. ↑ 4.0 4.1 Spiegler, Michael (2015). Contemporary Behavior Therapy. p. 177. ISBN 9781305446359. https://books.google.com/books?id=CW5vCgAAQBAJ&pg=PA177. 
  5. ↑ Matson, Johnny L; Andrasik, Frank; Matson, Michael L (Dec 10, 2008). Treating Childhood Psychopathology and Developmental Disabilities. New York, NY: Springer Science & Business Media. pp. 32. ISBN 978-0-387-09529-5. https://books.google.com/books?id=k5RP0RNrYsEC&pg=PA32. 
  6. ↑ 6.0 6.1 Salvy, S., Mulick, J., Butter, E., Bartlett, R.K., & Linscheid, T.R. (2004). Contingent electric shock (SIBIS) and a conditioned punisher eliminate severe head banging in a preschool child. Behavioral Interventions, 19, 59–72. doi:10.1002/bin.157
  7. ↑ Kix, Paul (July 2008). "The Shocking Truth". Boston Magazine. http://www.bostonmagazine.com/2008/06/the-shocking-truth/. Retrieved 3 September 2015. 
  8. ↑ 8.0 8.1 Linscheid, T.R., Iwata, B.A., Ricketts, R.W., Williams, D.E., & Griffin, J.C. (1990). Clinical evaluation of the self-injurious behavior inhibiting system (SIBIS). Journal of Applied Behavior Analysis, 23, 53–78. doi:10.1901/jaba.1990.23-53
  9. ↑ Iwata, Brian A. (1988). The development and adoption of controversial default technologies. The Behavior Analyst/MABA, 11.2, 149-157.
  10. ↑ 10.0 10.1 10.2 Jacob-Timm, S. (1996). Ethical and legal issues associated with the use of aversives in the public schools: The SIBIS controversy. School Psychology Review, 25(2), 184–199. Retrieved from http://search.ebscohost.com.lp.hscl.ufl.edu/login.aspx?direct=true&db=psyh&AN=1996-00658-004&site=ehost-live

External links



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