School of Shock : Rotenberg Center Director Matthew Israel Responds

It is hard to put into words the atrocities that take place at the Judge Rotenberg Center. Everything is treated as a "behavior", shocks are the answer for everything. So, it doesn't matter if a behavior is symptomatic of a disorder, or developmentally appropriate, children are shocked nonetheless. Children with the developmental age of a toddler are shocked for soiling themselves. Ironically, this is called "having an inappropriate". Aphasic children are shocked for having the symptom of repeating themselves, a common aphasic tendency. Dr. Israel convinces people that this is a sign of aggression, and labels it as "nagging". He absolutely treats these children like guinea pigs, and seems to perceive himself as above the laws of basic human decency. One girl was shocked for the so-called behavior of calling staff "Mommy". He claims the use of shock is limited to severe aggression, and that is a lie. You shock children for, say, "having an untidy appearance" and expect people to believe you are reserving this treatment for self-abusive or violent behavior. It's a blatant lie. I hope people can see through the lies, and do what needs to be done to stop this sick man.

Withhold breakfast and then have their teachers zap them when their blood sugar gets low.

Make the teachers so scared to stand up for a student that they will zap any student without question when some anonymous voice on the phone direct directs them to do so.

Take high functionling children who are given the choice of jail or aversive treatments at JRC. How is this constitutional?

Avoid all peer review.

Why does it continue? Lobbying.

How will it be stopped? Lobbying. Why is this in MJ rather than being dealt with by the APA? If you know a phycologist, suggest they get their professional societies get involved.

I agree with Dr Israel and what he does for the few children with such a severe form of autism. JRC is not for all children with this affliction, only the ones who have tried all other treatment options with no success. What they do at JRC helps greatly improve the quality of life for those who need it. For those who say it must be bad because it's the only school in the country to use G.E.D therapy is not looking at the whole picture. Would you rather the number of children with this severe form of autism increase to support 2, 3 or 100 schools like JRC, then it would be acceptable treatment? I’m thankful we only need one school like JRC at this time.

RESPONSE TO THE MOTHER JONES EDITORS………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
[This is Part 2 of a 2-part document. For part 1, see the following post. For a properly formatted version of the entire document, please see http://www.judgerc.org/ResponsetoMJEditorsReply.pdf ]
………………………………………………………………………………………………………………………………………………………………………………………………………………………………….(Continued from previous post) The authors of the New York Report asserted that they did not see a lot of students socializing. This is largely because they chose to observe the students in the classroom setting where they are expected to study rather than socialize. Had they observed the students on field trips, in the residences, on the playground, etc., they would have had a very different report. The authors of the New York Report were consultants with an anti-aversive philosophy who were sent to do a negative report of JRC. It is not surprising, therefore, that they tried to characterize the fact that students were busily engaged in their academic work in a negative way—i.e., that they were not socializing sufficiently. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….The editors try to justify their sensationalized use of the term “isolation” on the front page of Mother Jones in two ways. First, they quote me as stating that JRC students must earn the opportunity to socialize. But earning the opportunity to socialize clearly does not mean that one is in isolation at other times, prior to earning that opportunity. Students who have not earned such opportunities may simply be in their classroom or residence with ten other students. Second, the editors correctly note that disruptive students are sometime shifted to conference rooms where they do their work with a staff member present in the room. But if a staff member or teacher is present in a conference room, supervising the student as he/she does assigned academic work, in what sense can this properly be called “isolation?”

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USE OF MINI-MEALS TO TEACH NEW SKILLS ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….The use of mini-meals to reward desired behaviors is a well-accepted procedure in applied behavior analysis. For example in teaching new skills to an autistic child, it is desirable to be able to reward the student for imitating speech sounds or displaying other skills with a small portion of food. In order for these food portions to be effective as rewards it is important that the student not be satiated with food when this teaching is conducted. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….In order for JRC to be able to use mini-meal rewards in this way or as rewards for behavioral contracts in which student refrains from problem behaviors for a pre-set period of time, JRC must obtain approval from a Probate Court for this aspect of the treatment program. Numerous safeguard measures are taken to make sure that the student enjoys good nutrition and maintains good health and weight when such procedures are used. To characterize this court-authorized use of mini-meal rewards as “food deprivation” is to sensationalize and falsely portray this procedure as an extreme disciplinary punishment rather than as the carefully monitored and medically supervised motivating program that it really is. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….USE OF OTHER THERAPIES BEFORE ADDING SKIN-SHOCK TO A STUDENT’S POSITIVE-ONLY PROGRAM. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….The editors quote me correctly as stating that the average student, with whom skin shock is employed at JRC, is first tried on a program that consists only of positive rewards and educational procedures for an average of eleven months before JRC considers adding skin shock to the student’s program. The editors then note, again correctly, that JRC might sometime decide, based on the severity of a prospective student’s problems, that it is very likely that JRC will need to employ supplementary aversives shortly after the student arrives. These two statements are not in conflict. In some cases, it might be two or three years before the need to supplement with aversives is recognized. In other cases we might recognize the need much more quickly. The average amount of time before aversives are supplemented is eleven months. In either case—whether JRC’s clinicians recognize the need shortly after admission or only after several years of trying positive-only procedures—JRC must obtain permission from the parent (who can withdraw permission at any time), a probate court, a physician, a psychiatrist, a Human Rights Committee and a Peer Review Committee before aversives can be employed. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….SAFEGUARDS ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….The editors denigrate the safeguards that JRC has put in place by asserting that they “are apparently required as the result of JRC’s settlement with the State of Massachusetts.” The Settlement Agreement we entered with Massachusetts requires us to go to court for the use of any aversives. It does not require the pre-approval by a physician, psychiatrist, Human Rights Committee, Peer Review Committee, and parent. And even if it did, isn’t the important thing that the safeguards are in place and working rather than that they might be required by regulation or court settlement? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Regarding the statement from the NYSED Report questioning JRC’s level of professional monitoring, the statement quoted was made without factual basis. JRC employs fourteen Doctoral and Masters level clinicians, (in addition to myself,) each of whom oversees the treatment of the 5-20 students in their case load. Each has been trained in behavioral psychology, some are licensed psychologists and many are Board Certified Behavior Analysts. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….FADING OUT REWARDS/SKIN-SHOCK TREATMENT ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….The editors quote correct statistics of students currently at JRC; however, they neglect to inform the reader that most of the students who have progressed to the point where they no longer need skin shock have also graduated from JRC and therefore are not included in the statistics that they cite. This criticism is like criticizing a hospital because it does not have many patients who no longer need to be in the hospital. Those whom the hospital served successfully have already left the hospital. Those who are still in the hospital are obviously still there because they continue to need its services. JRC is essentially a behavior hospital. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….As for the fact that some students do need the continued availability of skin shock on a more than temporary basis, this is just an unfortunate fact of life. Some impairments require a “prosthetic” type of treatment that may be needed on a long-term basis. This is true, for example, for persons who have require an artificial limb, need eyeglasses to correct their vision, need a hearing aid, need insulin for diabetes treatment or require the long-term use of psychiatric medication. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….OMITTED PORTION OF MY RESPONSE TO “SCHOOL OF SHOCK.” ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….In publishing, online, my reply to the School of Shock article, the editors omitted the following email which appeared at the very end of my reply: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………. -----Original Message-----
From: website@judgerc.org [mailto:website@judgerc.org]
Sent: Thursday, September 27, 2007 3:53 PM………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
To: Burt, Sarah………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
Subject: Comments Submitted by Prefer to be Anonymous………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Comments: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Dear Judge Rotenberg Center, ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….I am glad that you exist. I became aware of your organization from an article critical of your organization forwarded to me by my son. The author's intent in this "Mother Jones" article was quite clear but I'm afraid it had the opposite effect; I'm a parent of an autistic child and I know things about children like these that most people just don't understand. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Please let Dr. Israel know that even if his work isn't understood and appreciated by everyone, those of us who have been there understand.

Submitted by: Prefer to be Anonymous
Title:
Agency: N/A
Interested in:
Learned of JRC from: News article
Address: PO Box 0
City: Wichita
State: KS
Zip Code: 67202

On Tuesday of this week I submitted by email my responses to the Editors' Reply to my original response to the "School of Shock" article. I asked the editors to publish these further responses in this online version of Mother Jones, in the spirit of giving both sides of the issues and of not engaging in censorship. As of this morning, three days letter, the editors had chosen not to honor my request. For that reason I have posted my responses in this Comment section (See the two long posts from me just preceding the post before this one.)

I have identical twin brothers with severe life-threatening behaviors extreme and rare even for persons on the autism spectrum. I have been practicing psychiatry over ten years and I specialize in persons on the autism spectrum. Yet, I have only seen a handful of cases which can be classified as severe as my brothers. My daughter is also autistic. She is five, nonverbal but I am thankful she does not have the behaviors which my brothers exhibited, although I am in tremendous debt paying $90,000 for one year tuition for her school, plus speech, occupational and physical therapy. For her first month of school I had to drive her every morning and start my job at 11 AM, leave at 7:30 PM, get home at 9PM and do the same the next day. Thank goodness my extended family has been supportive. Her school does not employ the use of aversives and she does not need it. I did try to get her into a public school which was appropriate for her, but they only accepted seven children from all of New York City last year and my daughter ended up on the lottery wait list. When I attended the lottery there were many parents in tears. If NYSED (New York State Education Department) truly cared about these children there would be an appropriate placement for each and every child. Public school programs here many times are not providing the services which are in the child's federally mandated Individual Education Plan. New York City public school autism programs are also using methods with no scientific evidence such as the Miller method and the Option method when there are methods with scientific evidence. Using an invalidated method when there are validated methods to treat a condition is unethical. I do not understand how people can take NYSED reports seriously when many of their own public schools are not in order.

Regarding my brothers, one twin has lived at JRC for
almost twenty years. Before arriving there he banged his head so severely he had to have surgery to close it. He would bang his head suddenly, even during the night without a clear reason. He was in a hospital for over five months, and my parents were told his insurance was running out and they would have to flip the bill. He had no education in the hospital because he attacked the teacher. He also became very sick from the medications used to try to control his behavior. He had obesity, drooling, sedation and tardive dyskinesia. At one point he could have died from neuroleptic malignant syndrome from his haldol. The medications did not control his behavior. In the hospital he had one to one at all hours and he still needed repeat suturing for repeated head banging. The board of education requested my parents waive my brother's right to an education. They said there was no place which would take him. My mother found out through her internist about the Judge Rotenberg Center. We got him transferred within a few days of the insurance running out. He was taken off all his medications there although he still has permanent tardive dyskinesia. He is happy there and states he wants to "stay at JRC forever." He enjoys the reward store and going on trips such as the zoo, museums and special olympics. I am calm to put him in the back seat of my car with my small children and take him out. (Prior to arrival at JRC he would attack my mother while driving). He does receive skin shock on average once to twice a month. At times he will actually ask to wear the device because he knows it gives him boundaries. Most of all, head banging is a thing of the past.

I will now discuss my other twin brother. He once did very well. He had full time job for two and a half years and traveled independently. He moved into a group home during this time. One day another worker was teasing him and repeatedly was telling him he had to work until 5 PM when my brother knew that he leaves at 4 PM. This was a fixed routine for him. My brother became so agitated he grabbed the other worker's butcher knife. I understand that my brother had to be fired. Since then, he has gone down hill completely. He started to develop a compulsion regarding fires and tried to place himself and someone else on fire. He has run into traffic. He also was aggressive, tried to punch and choke others for a minor problem, i.e. a staple being out of place on a chair. He was placed on about fifteen different psychotropic medications in various combinations. He developed obesity, sedation, hypotension, tardive dyskinesia and generalized seizures, once on a subway platform during a snowstorm. The medication has not been helping his symptoms. He has been hospitalized since July. His group home understandably is unwilling to take him back and as New York does not want to fund Judge Rotenberg Center for him (and he cannot live with his closest relative) he has nowhere to go. I think even the Judge Rotenberg Center positive behavior program may be sufficient for him as there is consistency there. He did well in his day school when he was younger. Unfortunately in New York State the agencies funded to treat persons over the age of 21 do not have direct care staff appropriately trained in the principles of applied behavior analysis and consistency of a behavior plan is a problem in the agencies. My brother never required medication
when he was in his structured and consistent day school program before he was 21 or when he had his job.

My parents tried different approaches to my brothers, even took them to a doctor in Europe for a treatment. My grandfather spent about half his life savings to finance the trip. There is no medication which has shown to be 100% effective to control behavior like my brothers have. Positive behavior interventions are not sufficiently effective in all cases to suppress problem behaviors and there is a meta-analysis in 1999 that clearly shows this. As far as other methods proposed such as TEACCH and sensory integration, I think they can be helpful for some symptoms but they have never been shown to sufficiently treat the types of behaviors my brothers' have. In fact a small study on sensory integration resulted in an 11% decrease in the frequency of self-stimulatory behaviors. This does not cut it for a life threatening condition. However, there have been 111 peer reviewed articles on behavioral skin shock. I received the New York Medical College Award for Academic Excellence for my research on medication and behavioral skin shock to control life-threatening behaviors in persons with mental retardation or autism. Medication can sometimes be helpful but results are mild to moderate to decrease frequency of behavior. Behavioral skin shock gets on average an almost 100% decrease in frequency of behavior in subjects. My brother would be dead without this therapy and my other brother is dying.

To have a family member with special needs is stress enough. To be in financial debt is more stress and to have to deal with life threatening behaviors is even more stressful. I find the criticism directed toward the Judge Rotenberg Center to be further stressful. I feel my family is being judged and marginalized after all we have already been through.

I would also like to state that the reporter Ms. Gonnerman informed me that she was a reporter for the New York Times prior to questioning me although I later found out she was not an employee of the New York Times.

I have studied Psychology and I am well aware that there are very serious long term consequences of using adversive behavioral therapies. These children will have severe post traumatic stress disorders for the rest of thier lives. You can not reverse the intese psychological harm that you are inflicting.

I find it disturbing that these children are dressed in ties. That is simply not "normal."

I'm a mother of 2 children with Autism. I was literally shaking as I read these articles. IMHO, a treatment that causes severe physical pain and emotional scars that do not heal is NOT effective therapy. Call me crazy. There are in-patient treatment centers for people with severe disabilities that do not use such punishing techniques. The patients are treated like humans, not cattle. Why do we PUNISH the disabled FOR BEING DISABLED??!! Do we shock anorexics to get them to eat? Do we dump people out of wheelchairs and onto the ground to get them to walk? If a person is injuring himself, there are precautions that can be taken that don't include causing even more pain. "Johnny is banging his head against the wall. So, we'll strap him down and shock him. 'Cause that makes MORE sense! And then we'll slap him around. That'l teach him to be Autistic!" Barbaric.