Multiple factors in the long-term effectiveness of contingent electric shock treatment for self-injurious behavior: a case example.

One adult in a state facility kept hitting his head so hard he detached both retinas. Doctors had tried helmets, arm splints, meds, even sedation. Nothing worked for long.

The team added a brief 50-mA shock to the arm each time he hit. They also tracked pain levels, drug changes, and staff turnover for five years.

Hits dropped from 200 per hour to near zero in the first week. The low rate held for the next five years.

Shock was needed only a few times per month after year two. Flare-ups always followed tooth pain, dosage changes, or new staff who hesitated.

Catania et al. (1974) got the same drop in SIB with simple DRO and candy loss. Their kids were younger and milder, showing shock is a last step when reinforcement alone fails.

Patton et al. (2020) found that heavy psychotropic loads can create the very crises we try to stop. The present case kept meds lean and watched side effects, which kept shock rare.

Lancioni et al. (2009) reviewed 41 studies and warned that even effective stereotypy fixes may fail if pain, meds, or staff drift. The five-year data prove those factors matter day to day.

You probably will never use shock, but the rules still apply. Track health first, taper redundant meds, and train every new staff member. When behavior returns, look at pain, dosage, and team fidelity before you add new procedures.