These answers draw in part from “Shining a Light on Aversive Procedures: Stakeholder Perspectives and Policy Action” by Noor Syed, PhD, BCBA-D, LBA/LBS (BehaviorLive), and extend it with peer-reviewed research from our library of 27,900+ ABA research articles. Clinical framing, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →CESS involves the delivery of a brief electrical stimulus to the skin contingent on the occurrence of a target behavior, typically severe self-injurious or aggressive behavior. The controversy stems from multiple concerns: the procedure causes pain, self-advocates who have experienced it report lasting psychological harm, questions exist about its long-term effectiveness versus reinforcement-based alternatives, and many professionals and advocacy organizations consider it incompatible with contemporary standards of ethical treatment. The FDA attempted to ban CESS devices in 2020, but the ban was vacated by a federal court, leaving state-level advocacy as the primary pathway for elimination.
The Shining a Light initiative is a coalition-based advocacy effort focused on eliminating aversive procedures and promoting ethical, evidence-based services for individuals with developmental disabilities. The initiative brings together stakeholders including self-advocates, family members, behavior analysts, other professionals, and policymakers to advocate for systemic change. Through public education, legislative engagement, and collaborative advocacy, the initiative aims to build consensus around the elimination of CESS while simultaneously advocating for expanded access to affirming services and supports.
The Ethics Code for Behavior Analysts (2022) does not explicitly prohibit specific procedures but establishes principles that bear directly on the use of aversive interventions. Code 2.14 requires consideration of least restrictive procedures. Code 2.15 mandates minimizing risk of behavior-change interventions. Code 3.01 requires thorough behavior-analytic assessment before intervention. Code 2.01 requires providing effective treatment. Together, these codes create a framework that demands rigorous justification, thorough exploration of alternatives, and ongoing monitoring when any restrictive procedure is considered.
Behavior analysts bring unique expertise to policy discussions about behavioral interventions, disability services, and evidence-based practice. Code 4.07 encourages promoting an ethical culture, which can include policy advocacy. Effective advocacy involves presenting data-driven arguments, sharing clinical expertise in accessible language, collaborating with diverse stakeholders, and supporting legislative efforts aligned with ethical practice standards. BCBAs can contribute through professional organizations, direct legislative engagement, coalition participation, public testimony, and educating policymakers about evidence-based alternatives to aversive procedures.
Families who support CESS often have loved ones with severe, treatment-resistant self-injurious or aggressive behavior that poses immediate safety risks. These families may report that CESS was the only intervention that produced meaningful behavior reduction after years of unsuccessful attempts with other approaches. Their perspective highlights a critical systemic issue: when positive behavioral support services are inadequate, inaccessible, or poorly implemented, families may feel they have no alternative. Addressing the root causes of this desperation through expanded access to quality services is essential for reducing reliance on aversive procedures.
Evidence-based alternatives include functional communication training, which teaches replacement behaviors that serve the same function as the challenging behavior. Differential reinforcement procedures systematically increase appropriate behavior while reducing challenging behavior. Antecedent modifications address environmental triggers. Comprehensive behavioral support plans combine multiple strategies tailored to the individual. Trauma-informed care approaches address historical factors contributing to behavior. Crisis prevention and de-escalation protocols reduce the need for reactive interventions. These approaches often require intensive staffing and training but produce durable outcomes without the risks associated with aversive procedures.
Stakeholder survey data provides social validity information that should complement efficacy data when making treatment decisions. When multiple stakeholder groups report concerns about specific procedures, this data indicates that the procedures may not meet the standard of social acceptability that ethical practice requires. Survey findings about barriers to accessing services can inform advocacy efforts and organizational decision-making. Data about stakeholder priorities can guide the development of service models that better meet community needs. BCBAs should treat stakeholder perspectives as empirical data rather than opinions to be weighed against professional judgment.
Multiple systemic factors contribute, including insufficient availability of intensive positive behavioral support services, inadequate training for direct support professionals, high staff turnover in residential settings, limited access to board-certified behavior analysts, funding structures that do not adequately support comprehensive behavioral services, and crisis-driven decision-making when behavior poses immediate safety risks. Long waitlists for services mean some individuals go years without appropriate behavioral support, during which time challenging behavior may escalate. Addressing these systemic failures is essential for creating conditions where aversive procedures are truly unnecessary.
BCBAs have an ethical obligation under Code 4.07 to promote ethical practices. When encountering aversive procedures, practitioners should first seek to understand the clinical rationale and documentation supporting the procedure. If concerns remain, they should raise them through appropriate channels, including supervisors, human rights committees, and organizational leadership. Document your concerns and the steps you take. If internal advocacy is unsuccessful and ethical violations are occurring, the Ethics Code provides guidance on reporting obligations. Throughout this process, maintain a focus on the client's wellbeing and the availability of evidence-based alternatives.
The legal status of CESS varies by jurisdiction. The FDA issued a final rule in 2020 banning electrical stimulation devices for self-injurious and aggressive behavior, but this rule was vacated by the D.C. Circuit Court of Appeals in 2021, leaving federal regulation uncertain. Individual states have taken different approaches, with some banning or restricting aversive procedures through legislation or regulation, while others have no specific restrictions. This patchwork of state-level policy is why organizations like NYSABA are pursuing state-specific advocacy strategies to eliminate CESS and expand access to affirming services.
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Shining a Light on Aversive Procedures: Stakeholder Perspectives and Policy Action — Noor Syed · 1 BACB Ethics CEUs · $20
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.