Chapter 6: Reinforcers as Opportunities for Behavior

- Reinforcers such as food vary in effectiveness depending on deprivation.

- Reinforcers as inevitably oversimplified if we treat them merely as stimuli.
- Deprivation and satiation are important ways but not the only ways to change the
effectiveness of stimuli as reinforcers or punishers
- Conditioned reinforcer – is one that become effective by virtue of its relation to some
other reinforcer (e.g. the light that comes on when a pigeon feeder is operated will
eventually become a conditional reinforcer because of its relation to food delivery)
- Generalized conditional reinforcer – e.g. money often works as a conditional reinforcer
and because of its relation to so many other possible reinforcers (all the things we have
bought with it)
- Unconditional reinforcer – a reinforcer that doesn’t depend on a relation to other
reinforcers
o e.g. obvious biological events such as food, water, and sexual contact
- reinforcers have been distinguished on the basis of their relation to responses.
- Intrinsic reinforcer – (automatic reinforcer) is one that has a neutral relation to the
responses that produce it. E.g. when a musician plays because of the music that the
playing produces)
- Extrinsic reinforcer – (contrived reinforcer) – has an arbitrary relation to those
Reponses (e.g. when a musician plays for money)
- The term extrinsic has also been applied to stimuli presume to function as reinforcers
because their function has been instructed – such stimuli are often ineffective reinforcers
- Incentive functions – e.g. coming to a locked door doesn’t make it more likely that you
will find a key in your pocket but you are more likely to ask for a key – or unsalted soup
example – in each case something that has been neutral (the salt of key) has become
reinforcing – the term incentive can be applied to both the establishing and to the
discriminative functions of stimuli.
- The Relativity of Reinforcement
- Reinforcers don’t work because they make the organism feel good or because the
organism likes them.
- Some events that superficially seem rewarding may not function as reinforcers – others
that seem the opposite have powerful reinforcing effects.
- The effectiveness of a reinforcer depends on its relation to the responses that produce it.
- what if the probability of a response goes up if it provides an opportunity to engage in
another response more probably than itself?
- If response A is more probable than response B, an opportunity to engage in A will
reinforce B.
- Food is an effective reinforcer for a food deprived rat.
- Reinforcers cannot be defined independently of the responses that they reinforce.
Reinforcers are relative and their reinforcing properties are determined by the responses
for which they provide an opportunity.
- Deprivation makes reinforcers effective because the probability of a response ordinarily
goes up when we restrict the organism’s opportunities to engage in it.
- A less probable response can be reinforced by the opportunity to engage in a more
probably response.
- Reinforcement is a relation and not a theory or hypothesis.
 - Rate and probability of responding have long seemed closely linked.
- Reinforcement doesn’t produce learning, it produces behaviour.
- Sensory reinforcement – (p.83).
- Phenomena such as sensory – motor learning demonstrate that reinforcement doesn’t
explain learning, rather, it is part of the description of what is learned
- Organisms learn the consequences of their own behaviour

Chapter 6 Study Guide

1) Be able to provide your own example of, define and distinguish conditional reinforcers,
generalized conditional reinforcer, unconditional reinforcer, intrinsic reinforcer, and extrinsic
reinforcer.
Conditioned reinforcers – has become effective by virtue of its relation to some other
reinforcer
Generalized conditional reinforcer - conditioned reinforcer that has many other
possible relations with other reinforcers.
Unconditional reinforcer – a reinforcer that does not depend on a relation to other
reinforcers
Intrinsic reinforcer – natural relation to the responses that produce it (e., as when a
musician plays because of the music that the playing produces)
Extrinsic reinforcer – has an arbitrary relation to those responses (e.g. when a musician
plays for money).

2) What are “incentive” functions? Provide your own example.

- Incentive functions – e.g. coming to a locked door doesn’t make it more likely that you
will find a key in your pocket but you are more likely to ask for a key – or unsalted soup
example – in each case something that has been neutral (the salt of key) has become
reinforcing – the term incentive can be applied to both the establishing and to the
discriminative functions of stimuli.

- Something neutral has become reinforcing when it was needed. Such as arriving at a
locked door, you are more likely to reach into your pocket, although that doesn't make it
any more likely that the key will be in your pocket.
The eliciting, discriminating and reinforcing stimuli can also have establishing operations
-

3) In your own words, discuss what is meant by “the effectiveness of a reinforcer depends on its
relation to the responses that produce it.”

the relativity of reinforcement – e.g. the cat running around a wheel, water tube and
drinking (what becomes more probable? – across people, time and contexts).
The premack principle -
 - what if the probability of a response goes up if it provides an opportunity to engage in
another response more probably than itself?
- If response A is more probable than response B, an opportunity to engage in A will
reinforce B.
e.g. food is an effective reinforcer for a food-deprived rat.

4) Describe the two methods to analyze reinforcement discussed by Catania

- Effects on resistance to change vs. Response rate
- Activating and coupling
o General activation or arousal effect – when a rat that had not been eating is now
able to eat again
o Coupling – determines the particular response class that comes to be strengthened
by the reinforcer

5) What does it mean to say, “each consequence sets up the occasion for new responses?”
Provide an example.
- Response- reinforcer contingencies are all around us, but are easily overlooked – we open
up a book to read it, we listen to hear what someone says, we reach towards a pencil to
pick it up – each consequence sets up the occasion for a new response
o When we are finished reading one page, we turn to the next, when we’ve heard
what has been said, we ask a question or make a comment – each case involves
behaviour maintained by its consequences, each may be discussed in the
vocabulary of reinforcement (seeing reinforcers looking, hearing reinforces
listening etc.)

Chapter 7: Consequences of Responding: Punishment

Chapter Notes:
- Punishment – the consequences of responses makes responding less likely.
- A stimulus that reinforces responding when responses produce it may serve the opposite
function when those responses remove it – its removal may punish the responding.
o e.g. Money may reinforce when a child is paid for completed a chore, but its
remove may punish when a child’s allowance is taken away for a misdeed.
- These relations are often grouped together as instances of aversive control.
- Aversive control includes both punishment and negative reinforcement (reinforcement by
removal or prevention of aversive stimuli).
- Whether in phylogeny or ontogeny, use it or lose it applies. What becomes non-functional
is no longer use and is lost.
- Punishment in ontogenic selection is an analog of the effects of harmful variations in
phylogenic selection.

Vocabulary of Punishment
- Punishment is arranging a response consequence that makes the responding less likely.
- The stimulus arranged as a consequence is called a punisher.
o E.g. level pressing would be punished, and the shock would be the punisher
 o Paralleling the vocabulary of reinforcement
- Punishment has been applied to both procedures and outcomes.
- Restrict the term punishment to the vocab of procedures or operations and to describe
outcome directly in terms of changes in responding.
- Responses, not organisms, are punished.
o E.g. the rat was not punished the lever pressing was punished.
- Everyday usage of the word punishment is too often used with retribution rather than
with changing behaviour.
- Spanking (p.89)

Comparing Reinforcement and Punishment

- The effect of punishment is the opposite of reinforcement.
- Figure 7-1 Effects of Reinforcement and Punishment (p.90).
- Reinforcement and punishment are symmetrical: the former increases responding
whereas the latter decreases it, but their effects continue as long as the procedures are
maintained and disappear after they end.
- Punishment was incorporated into Thorndike’s early versions of his Law of Effect.
Thorndike argued then that behaviour could be stamped out by annoyers as well as
stamped in by satisfiers.
- Statements of Thorndike’s law that included the punishment component were called the
Strong Law of Effect.
- Later, Thorndike withdrew the punishment component and the version that remained
which included only the stamping in of behaviour was called the Weak Law of Effect.
- Thorndike accepted his findings as general evidence against the effectiveness of
punishment.
- The argument based on recovery (figure 7-2) was that punishment wasn’t to be taken
seriously as a way of changing behaviour because it suppressed responding only
temporarily.
- Yet by this criterion, then reinforcement should also be judged ineffective.
- Yes, an extreme punisher can suppress behaviour for a long time, but as a rule
punishment continue to work only as long as punishment contingency continues.
- We have reasons to believe that techniques other than punishment should be used, but if
this is correct it is because Thorndike was right for the wrong reasons.
- The more intense and immediate a punisher, the more effective it is.
- A punisher introduced at its maximum intensity suppresses responding more effectively
than a punisher introduced at low intensity and then gradually raised to maximum
intensity.
- A reduction in responding can only be studied if some responding already exists. A
response that is never emitted cannot be punished.
- The effects of punishment depend on what maintains responding – example – punishment
by shock will probably reduce food-reinforced level pressing less if a rat is severely food-
deprived than it is only mildly food-deprived.
- The punishment effect must depend on the relation between responses and punishers and
not simply on the delivery of punishers
- Punishments have been called passive avoidance (prejudices)
 - Both punishment and reinforcement have temporary effects – when they’re discontinued,
responding returns to earlier levels

The Relativity of Punishment

- Punisher – electric shock
- Example – some children engage in head banging, hand biting and other self-injurious
behaviours – a brief squirt in the face with water when applied on such behaviour is an
effective punisher
o Think about the damage of the water squirt compared to the damage these
children can do to themselves.
o Some who oppose any use of punishment find even this application unacceptable.
- Punishment is inevitable because it is arranged by many neural contingencies
- Even stimuli that normally serve as reinforcers can become punishers
o e.g. a food that is reinforcing at the beginning of a holiday feast may become
aversive by the time the meal has ended
- punishers can only be assessed in terms of the relation between punished response and
the responses occasioned by the punishers.
- The premack principle of reinforcement stated that an opportunity to engage in more
probable responses will reinforce less probable responses.
o Can be extended to punishment as well.
- E.g. drinking decreases when running is its consequence so drinking is punished by
running.
- Any given response can be reinforced or punished by any other response.

Side Effects of Punishment

- As long as human behaviour includes such problems as self-injury, our concern with such
phenomena (punishment) is justified.
- It is sometimes appropriate to compare response-produced shock with response-
independent shock rather than with no shock at all.

Discriminative Effects of Punishers

- Another side effect of punishment comes about because punishers can acquire
discriminative properties, as when a response is reinforced only when it is also punished.

Timeout as Punishment
- Punishment by timeout from positive reinforcement
- Timeout originated in experiments with pigeons and monkeys.
- As with any form of punishment, the main function of timeout is to reduce behaviour, but
it is too often applied without attention to alternative because that might be reinforced.
- Timeout procedures have been falling out of favor and are gradually being replaced by
other practices based on reinforcement rather than punishment.

The Ethics of Punishment

 - If punishment seems the only effective technique for reducing the self-mutilating
behaviour of a brain-damaged child, punishment might be a lesser evil than the
permanent damage the child might self-inflict.
- One of the ethical standards for interventions in applied behaviour analysis is to impose
the least restrictive treatment
o This means that a treatment that empowers a child by shaping the child’s
communication skills will always be preferable to one that calls for restraints or
other environmental restrictions.
- B.F Skinner came to the following conclusion:
o “we are still a long way from exploiting the alternatives and we are not likely to
make any real advance so long as our information about punishment and the
alternatives to punishment remains at the level of casual observation
- Skinner included techniques of reinforcement among his alternatives to punishment
o Effects of reinforcement often show up long after the reinforcer is delivered
whereas the effect of punishment often show up right away
o Delivering a punisher is much more likely to produce immediate consequences
than delivering a reinforcer. That means that people will more readily learn
techniques of aversive control than techniques of reinforcement, but it doesn’t
mean that aversive control techniques are better.
- Some argue against any kind of modification of behaviour, whether involving aversive
stimuli or positive reinforcers. But those who make such arguments should recognize that
our behaviour is being modified all the time, both by natural contingencies and by the
artificial ones created by those around us.
- Ignorance rarely provides good grounds for ethical judgments – so as a counterargument
is that our best defence against the misuse of behavioural techniques is to learn as much
as we can about how they work.

Chapter 7
1) In your own words, describe how punishment parallels reinforcement. Describe the
processes and provide examples.
- Punishment is arranging a response consequence that makes responding less likely.
- E.g. level press – shock – rat – the level press is said to be punished and the sock is said
to be a punisher
- The vocab of punishment also parallels reinforcement in its object – we say that
responses, not organisms are punished – (we say that responses, not organism, are
reinforced).
- As with reinforcement – our preferred usage with be to restrict the term punishment to
the vocab of procedures or operations and to describe the outcome in terms of changes in
responding.

- Reinforcement and punishment are symmetrical: the former increases responding

whereas the latter decreases it, but their effects continue as long as the procedures are
maintained and disappear after they end.
 2) The same stimulus can be used to serve opposite functions in reinforcement and
punishment. Explain how this is possible, provide two examples of your own and
label the specific principles being used.
- A stimulus that reinforces responding when responses produce it may serve the opposite
function when those responses remove it – its removal may punish the responding.
a. e.g. Money may reinforce when a child is paid for completed a chore, but its
remove may punish when a child’s allowance is taken away for a misdeed.

3) Describe the features of punishment which had an influence on how punishment was
misrepresented historically and was unacknowledged as a fundamental behavioral
procedure (e.g., by Thorndike).
- Punishment was incorporated into Thorndike’s early versions of his Law of Effect.
Thorndike argued then that behaviour could be stamped out by annoyers as well as
stamped in by satisfiers.
- Statements of Thorndike’s law that included the punishment component were called the
Strong Law of Effect.
o Thorndike based his conclusions on experiments on human verbal learning –
saying right enhanced responding whereas saying wrong – has less effect than
saying nothing (suggesting that punishment was ineffective)
- Later, Thorndike withdrew the punishment component and the version that remained
which included only the stamping in of behaviour was called the Weak Law of Effect.
- Thorndike accepted his findings as general evidence against the effectiveness of
punishment.
- The argument for recovery but not believing in punishment was that punishment wasn’t
to be taken seriously because it just suppressed responding only temporarily – yet by this
than reinforcement should not be taken seriously

a) Provide examples of how punishment is also often misrepresented today

-
b) Provide examples of naturally occurring positive and negative punishment
- e.g. a food that is reinforcing at the beginning of a holiday feast may become aversive by the
time the meal has ended
- The premack principle of reinforcement stated that an opportunity to engage in more probable
responses will reinforce less probable responses.
o Can be extended to punishment as well.
- E.g. drinking decreases when running is its consequence so drinking is punished by
running.
- Any given response can be reinforced or punished by any other response.

4) In your own words, identify, describe and provide examples of the side effects of
punishment
- Another side effect of punishment comes about because punishers can acquire
discriminative properties, as when a response is reinforced only when it is also punished.
- Eliciting effects of punishers
o Response produced shock a punisher
 o We must recognize the separate effects of response-stimulus contingencies and
stimulus deliveries
o (PAGE 94-95)
- Another side effect – punishment can acquire discriminative properties – a response is
reinforced only when it is punished.
o E.g. pecking increased for being shocked when sometimes it would produce food
o Here we might say that the shock was a reinforcer however it loses its power if
the relation to food goes away
o E.g. a battered child might provoke a parent to the point of beating because the
beatings are often followed by more attention than ever follows a less traumatic
parent-child interaction.
 A parent’s attention can be a potent reinforcer and my sometimes override
the effects of consequences that would otherwise serve as punishers

5) Define, describe and provide an example of the punishment procedure in which

opportunities for reinforcement are withheld. Describe circumstances when this
procedure is and is not appropriate.
- time-out, or more fully – punishment by timeout from positive reinforcement
- whether or not a timeout is a punishment or reinforcement is difficult
o e.g. girls who threw tantrums when she was made to stop engaging in self
stimulation but then put in time out (isolation) for her tantrums – her tantrums
increased because when she was put in timeout, she could engage in the self-
stimulation hand gestures without interruption
o timeout in the daycare – should have been allowed back to play when positive
behavior was shown not to a set timer – because the timer created crying behavior
and then they were allowed back to play even though they weren’t showing
appropriate behavior
o time out procedures are falling out of practice and are being replaced with other
practices based on reinforcement, rather than punishment

6) According to Catania, “The behavioral properties of aversive control have

implications that are consistent with ethical arguments against aversive control”
(pp. 97). Describe this argument in your own words. Describe the ethical
considerations and the standard used to assist in determining the appropriateness of
punishment procedures. Provide an example.
- If punishment seems the only effective technique for reducing the self-mutilating
behaviour of a brain-damaged child, punishment might be a lesser evil than the
permanent damage the child might self-inflict.
- Ethical precepts are concerned with the acceptable and unacceptable outcomes of our
actions which implied that the consequences of behavior cannot be ignored.
- ETHICAL STANDARD – least restrictive environment – a treatment that empowers a
child by shaping the child’s communication skills will always be preferable to one that
calls for restraints and other environment restrictions.
Vanhoutven
The Right to Effective Behavioral Treatment
- Behavioral analysts have a professional obligation to make available the most effective
treatment that the discipline can provide
- 1. An individual has a right to a therapeutic environment
o A physical and social environment that is safe, humane, and responsive to
individual needs to a necessary prereq for effective treatment.
o Age-appropriateness of activities and materials
o Adequate teachers, parents, and staff who are competent, responsive and caring
o Therapeutic environment imposes the fewest restrictions necessary
- 2. An individual has a right to services whose overriding goal is personal welfare
o Primary purpose of behavioral treatment is to assist individuals in acquiring
functional skills that promote independence.
o
- 3. An individual has a right to treatment by a competent behavior analyst.
o Possess appropriate education and experience
o Thorough knowledge of behavioral principles, methods of assessment and
treatment, research methodology and professional ethics.
o In complex and risky cases – involvement of a doctoral level behavioral analysts
may be needed
- 4. An individual has a right to programs that teach functional skills.
o Ultimate goal of all services is to increase the ability of individuals to function
effectively in both their immediate environment and the larger society.
o Requires the acquisition, maintenance and generalization of behaviors
o May require the acquisition of behaviors that allow the individual to terminate or
reduce unpleasant sources of stimulation.
o Improved function may require the reduction or elimination of certain behaviors
that serve as barriers to further independence or social acceptability.
o Unless evidence clearly exists to the contrary, an individual is assumed capable of
full participation in all aspects of community life and to have a right to such
participation.
- 5. An individual has a right to behavioral assessment and ongoing evaluation.
o Individuals are entitled to a complete diagnostic evaluation to identify factors that
contribute to the presence of a skill deficit or behavioral deficit.
o Three steps to perform this behavioral analysis
 Answers are obtained through an interview
 Direct observation under varied and relevant circumstances
 Assessment findings are incorporated into a systematic treatment plan
- 6. An individual has a right to the most effective treatment procedures available
o Behavioral analysts have an obligation to use only those techniques that have
been documented by research to be effective.
o Must search for the most optimal means of changing behavior
o In some cases, a client’s rights to effective treatment may dictate the immediate
use of quicker acting, but temporality more restrictive procedures.
 o Techniques are not considered good or bad according to whether they involve the
use of antecedent rather than consequent stimuli or reinforcement rather than
punishment.
o Positive reinforcement as well as negative can produce a number of indirect
effects

Bannerman
Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People
with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap.

- Many service providers exercise a great deal of control over the lives of clients with
developmental disabilities
- These choices may not reflect the client’s preferences
- What does the “right to habilitation” mean for people with developmental disabilities?
What are personal liberties? What are the advantages and disadvantages of allowing
citizens with developmental disabilities to exercise their personal liberties?
- Habilitation involves teaching the skills needed to live as independently as possible.
- A constitutional right to habilitation has not yet been established
- Personal liberties include freedom of speech, freedom of religion, and other rights
- “right to be let alone” – the privilege of an individual to plan his own affairs – to shape
his own life as best he pleases
- Choice or choosing described as – uncoerced selection
- Choice is not free (reinforcement/punishment history) – but perceived choice is
extremely valued by many people.
- Issues is whether service providers actually allow clients with developmental disabilities
these liberties and whether it is in the client’s best interest
o E.g. when the have a shower, what to eat for lunch, who to spend their time with.
- Personal liberties can be compromised in many ways bye service providers striving to
meet standards for habilitation.
- Choice teaching is often not taught and opportunities for choice are not often given
Arguments Opposing the Right to Choose
- The strongest argument against the right to choose is that many people with
developmental disabilities may make bad choices.
o Some have no leisure skills therefore may engage in napping in all of their free
time.
o May have incomplete lunch or attempt to take a bus to work without knowing
how.
o The argument is that people who do not have a repertoire of skills and who do not
understand the consequences of their behaviour, require intensive teaching in
these areas, before allowed to choose.
o Until that time, caregivers, parents, advocates, should aid the client in deciding
what activities can be refused and what types he or she is capable of making
o Another argument for allowing a client to choose may hinder their habilitation
progress. E.g. if a client chooses for their caregiver to help them get dressed each
 morning they may never learn on their own. Or if they choose to learn a hobby
over a vocational task, this may hinder future opportunities for employment.
Arguments in Favor of the Right to Choose
- Legislation guarantees the right to choose. People with developmental disabilities are
guaranteed the same basic rights as other citizens of the same country and same age.
- The ability of a client to exercise choice may prepare him or her to live in the community
where individuals are expected to make decisions and choices.
- Individuals frequently prefer situations in which they have choice and that choice rarely
proves detrimental to the individual

- The effects of choice are not limited to humans

- Individuals appear to participate more in activities where opportunities are available.

Adolescents participated in group decision making more often when they determined
consequences for their peers than when their teaching parents determined the
consequences.

- Problem behaviours appear to be exhibited less frequently when an individual has

opportunities for choice.
- Autistic children exhibited fewer problem behaviours when they had a choice of task,
materials and reinforcers than when the therapist made these choices and demonstrated
less social avoidance when they were engaged in activities that they preferred.

Effects of Choice on Responses to Aversive Stimuli

- Subjects who could control an aspect of an aversive situation reported less discomfort
and had less extreme autonomic responding than subjects who received the same stimulus
but had no control over it.

Individuals frequently prefer situations in which they have choice.

Choice making should be integrated into the habilitation process.
This does not mean that service providers should sit back and allow clients to “do their own
thing” because clients make a number of bad choices that would hinder habilitation.

1. Service providers should emphasize teaching independent living skills and other
functional behaviours that are preferred by the client,
2. Clients should have input in decision about what skills they will learn and how they will
be taught
3. Clients should be taught how to choose. It should be part of their learning curriculum and
subject to task analysis, planning, implementation and evaluation.
4. Clients at every functioning level should be given opportunities to make choices in their
residential and work settings.

All people have the right to eat too many doughnuts and take a nap. But along with rights come
responsibilities. Teaching clients how to exercise their freedoms responsibly should be an
integral part of the habilitation process.
Feldman
Balancing Freedom from Harm and Right to Treatment in Persons with Developmental
Disabilities.

- The most effective techniques that have been developed to teach persons with
developmental disabilities are primarily based on behavioural principles and procedures
such as contingencies of reinforcement, shaping and stimulus control.
- Some state that there is never any need to use punishment as positive-based, nonpunitive
methods are available which are more effective than punitive procedures in treating
severe behaviour problems.
- The “right to effective treatment” group proclaims that the combination of punitive and
positive based strategies are currently the most effective treatment for those individuals
who exhibit severe dangerous behavior disorders.

Freedom from Harm Position

- This position states that the use of punishment with persons who have developmental
disabilities is unethical and unnecessary.
- Non-punitive methods such as reinforcing alternative behavior produce better
generalization and maintenance of therapeutic and educational gains than punishment and
there are no side effects.
o Are these claims valid?

- Research consistently reveals that the majority of research findings indicates that
combinations of positive reinforcement and punishment strategies are more effective than
reinforcement alone in treating severe behavior problems.
- The claim that positive reinforcement-based procedures lead to better generalisation and
maintenance than punishment is also not clearly supported in the literature
- The effects of positive reinforcement and punishment are also symmetrical with respect
to maintenance. While the discontinuation of punishment procedure is likely to results in
an increase in the target behavior, termination of a reinforcement program will likely
decrease the newly learned behaviour.
- Effective maintenance strategies are needed for both reinforcement and punishment
interventions.
- The view that positive reinforcement strategies are free of negative side effects is not
entirely justified.
- Some of the problems that plaque punishment techniques may occur with nonpunitive
methods as well.

- Hidden punishment is punished in the literature e.g. hand holding to stop SIB but then int
eh same article the negative effects of restraint are talked about

- In summary, the recent efforts to promote positive procedures and decry punitive methods
have had both positive effects (e.g. the development and promotion of research on new
punitive approaches, re-emphasis on functional analysis) but also potential negative
effects (e.g. denial of right to treatment, exclusion from less restrictive settings, failure to
document active treatment variables
There are practitioners who argue that when dealing with severe behavior problems that are
causing injury, the client should receive the most effective treatment as possible and that clients
should not be exposed to treatments, also less intrusive, which are not likely to be effective and
which would simply be prolonging the suffering experienced by the individual.
- Evidence suggests that the combination of punishment of the maladaptive behaviour and
positive programming for alternative behavior is currently the most effective intervention
for severe problems and therefore should be the treatment of choice.

Intrusive and aversive procedures should only be used with appropriate consents, safeguards and
review by trained and supervised mediators

A punitive procedure should only be implemented as part of a larger program aimed at increasing
functional alternative skills.