Occupational Therapists Condemn use of Electric Shock Devices on Disabled Students in US.

Occupational Therapists Condemn use of Electric Shock Devices on Disabled Students in US.

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Autistic and intellectually disabled children and adults, many of whom are people of colour, are being abused with wearable electric shock devices, in a residential institution in the US.

The Judge Rotenberg Educational Center (JRC) in Massachusetts uses these devices to administer incredibly painful and harmful skin shocks to their students, to try to control their behaviour – most of which is due to distress, misunderstanding and difficulties in communication.

In 2013, the UN described this ‘treatment’ at the JRC as torture.

In 2020, the Food and Drug Administration (FDA) had banned the use of these devices, but this ruling was overturned by the District of Columbia Circuit in July 2021, through a loophole.

This essentially means that autistic people and those with intellectual disabilities have fewer rights than lab rats.

The international occupational therapy and occupational science professions call for the complete ban on the use of these devices on all humans.

Below is our full statement and open letter to the FDA, President Biden, Vice President Harris and the Department of Developmental Services of Massachusetts:

Open letter to the FDA, President Biden, Vice President Harris and the Department of Developmental Services of Massachusetts from the occupational therapy and occupational science profession to condemn the use of and call for the complete ban of electric shock devices for behavioural control in autistic and/or intellectually disabled students.

 

(Content and links warning: Contains details of abuse)

We are a coalition of occupational therapists and occupational scientists from around the world, who condemn the use of electric stimulation/shock devices (ESDs), and specifically the Graduated Electronic Decelerator (GED), to discipline students.

The core of the occupational therapy profession is based on supporting people to participate in meaningful activities, as this is “fundamental to the facilitation and maintenance of health and wellbeing”. [i]

We help people do what they want and need to in their lives, either by teaching skills or adjusting the environment to help them function.  We find it difficult to conceive how an environment where children and adults are administered electric shocks can ever be thought to help people to function at their optimal level.

These skin shock devices, which are usually worn 24 hours a day by many of the students, are only being used at The Judge Rotenberg Educational Center (JRC), a tax-payer funded, private residential school, in Massachusetts, US. They are used to control and modify “self-injurious &/or aggressive behaviour” of autistic &/or intellectually and physically disabled people; the majority of whom are people of colour.

Some of these behaviours warranting electric shocks by the JRC have also included students cursing, shouting, refusal to take their jacket off and tensing up their body after receiving a shock. Some people have received shocks accidentally, due to a malfunction [ii].

Human rights campaigners, disability charities, including the Autistic Self Advocacy Network [iii], organisations, societies, professionals, politicians, parents of former JRC students and many others have had a long history fighting against the use of these devices [iv].

In 2006, the New York State Education Department carried out inspections at the JRC due to concerns raised and produced a detailed report. They stated that the “JRC employs a general use of Level III aversive behavioral interventions to students for behaviors that are not aggressive, health dangerous or destructive, such as nagging, swearing and failing to maintain a neat appearance.” [v]

Other reports state that after receiving shocks, some students have developed Post Traumatic Stress Disorder, third degree burns and catatonia [vi] & [vii].

Level III aversive behavioural interventions include pinching, hitting, deprivation of food, and electric shocks.

Here is a link to a recent video interview on CBS Evening News with a former student at the JRC, talking about her experience and views of being on the electric shock ‘treatment’. Warning: upsetting content - https://www.youtube.com/watch?v=oFYae6WyTWs

In 2020, the US Food and Drug Administration (FDA), described ESDs as “aversive conditioning devices that apply a noxious electrical stimulus (a shock) to a person's skin to reduce or cease such behaviors” and finally banned their use. [viii]

However, just a few weeks ago, on 6th July 2021, the United States Court of Appeals for the District of Columbia Circuit overturned this ruling[ix], effectively legalising the use of these devices; the judges stating that "the FDA lacks the statutory authority to ban a medical device for a particular use." [x]

The United Nations described GEDs being used at the JRC, not as medical devices but as instruments of torture, in their 2013 “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment” [xi]

GEDs were developed by Matthew Israel, the founder of the JRC, because he found after years of using spatula spanking, pinching and squeezes, that “you had to control the student physically, and that could lead to a struggle…. A lot of injuries were occurring”. In one day, a single student received more than 5000 shocks. [xii] The perceived need to repeat the ‘treatment’ so many times suggests that it did not work.

GEDs have a minimum amperage of 12mA and a maximum of 90mA. This can cause anything from extreme pain, burns, loss of muscle control and death. For comparison, a cattle prod gives 10mA. [xiii]

It is well documented that living under constant fear or threat of harm, real or perceived, increases physical ill health, reduces cognitive abilities and decreases mental wellbeing. [xiv]

The profession of occupational therapy is built on the premise of social justice and the human rights of all to exist in a world where they have access to necessary activities (occupations) "without risk to safety, human dignity or equity" - World Federation of Occupational Therapists. [xv]

Under the Universal Declaration of Human Rights (United Nations General Assembly 1948) [xvi], healthcare, social care and education professional have a duty of care to the people they support. This includes causing no harm, acting in a person’s best interest, ensuring their human rights have not been violated and raising our concerns if we “witness, or have reason to believe that an individual has experienced, dangerous, abusive, discriminatory or exploitative behaviour or neglect in our workplace or any other setting. [xvii]

As educators and service providers we must “challenge the beliefs and systems surrounding autistic youth that allow abuse up to and including the type that occurs at JRC to continue”. [xviii]

We call for the prohibition of research studies [xix], using or endorsing in any way, the deliberate use of such electric shock devices as a form of ‘treatment’. “We must recognize, understand, take responsibility for, and reduce the unacceptable biases that have led to autistics being considered unharmable, such that anything can be done to them.” [xx]

Many occupational therapists work with and support autistic people and those with intellectual disabilities, who have similar needs to those at the JRC, in many ways, including assessing for and acknowledging their sensory differences and needs, their environment(s) and their daily activities. We listen to and work with individuals, get to know their own unique forms of communication, strengths and triggers and recognise that each person has their own way of managing and coping with stressful situations.

From this, we try to find the cause of their distressed or coping behaviours and work with them, their relatives, carers and staff to find non harmful ways to help them. Trauma-informed [xxi] and strengths-based approaches, as well as the Low Arousal Approach (“a person-centred, non-confrontational method of managing behaviour” [xxii]) have been shown to reduce the need for physical interventions and restrictive practices. [xxiii] Punishing distress responses is inappropriate and unnecessary, as well as cruel and abusive.

In light of our professions’ social justice stance and duty of care and ethics to do no harm, we therefore call upon the FDA, the US Government and the Department of Developmental Services of Massachusetts to completely ban the use of these devices on people and to start this process immediately. 

We urge organisations to hire and work with occupational therapists who have the skills to find humane ways of working with autistic children and adults and those with learning and intellectual disabilities, and step into their humanity.

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[i] www.rcot.co.uk/file/8131/download?token=tdZhHd1T

[ii] https://nymag.com/news/features/andre-mccollins-rotenberg-center-2012-9/

[iii] https://autisticadvocacy.org/2014/08/prisoners-of-the-apparatus/

[iv] https://yorkspace.library.yorku.ca/xmlui/bitstream/handle/10315/36535/CDS00029.pdf?sequence=1&isAllowed=y

[v] https://web.archive.org/web/20140508080241/http://www.arcmass.org/Portals/0/NYJRCReport.pdf 

[vi] https://nymag.com/news/features/andre-mccollins-rotenberg-center-2012-9/

[vii] https://www.motherjones.com/politics/2007/08/school-shock/

[viii] https://www.federalregister.gov/documents/2020/03/06/2020-04328/banned-devices-electrical-stimulation-devices-for-self-injurious-or-aggressive-behavior 

[ix] https://fingfx.thomsonreuters.com/gfx/legaldocs/jznvnynkwpl/Rotenberg%20opinion.pdf

[x] https://www.nbcnews.com/health/health-care/appeals-court-axes-fda-ban-electric-shock-disabled-n1273572

[xi] https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A-HRC-22-53-Add4_EFS.pdf  p84

[xii] https://www.motherjones.com/politics/2007/08/school-shock/ 

[xiii] https://www.federalregister.gov/documents/2016/04/25/2016-09433/banned-devices-proposal-to-ban-electrical-stimulation-devices-used-to-treat-self-injurious-or Table 1 - Device Output Characteristics

[xiv] https://www.apa.org/monitor/2019/02/legacy-trauma

[xv] https://wfot.org/resources/occupational-therapy-and-human-rights

[xvi] https://www.un.org/en/about-us/universal-declaration-of-human-rights

[xvii] https://www.rcot.co.uk/file/8131/download?token=tdZhHd1T 

[xviii] https://link.springer.com/chapter/10.1007/978-981-13-8437-0_14

[xix] https://casereports.bmj.com/content/bmjcr/14/5/e241204.full.pdf

[xx] https://journals.sagepub.com/doi/pdf/10.1177/13623613211031403

[xxi] https://journals.sagepub.com/doi/abs/10.1177/1078390320980045

[xxii] http://www.open-access.bcu.ac.uk/6544/1/the-low-arousal-approach.pdf

[xxiii] https://www.studio3.org/post/reducing-restraint-in-schools

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