Citation

YadollahiKhales G, Blenkush N, Cunningham M. BMJ Case Rep. 2021; 14(5): 2020-241204.

Copyright

(Copyright © 2021, BMJ Publishing Group)

DOI

10.1136/bcr-2020-241204

PMID

unavailable

Abstract

A small proportion of patients with intellectual disabilities (IDs) and/or autism spectrum disorder (ASD) exhibit extraordinarily dangerous self-injurious and assaultive behaviours that persist despite long-term multidisciplinary interventions. These uncontrolled behaviours result in physical and emotional trauma to the patients, care providers and family members. A graduated electronic decelerator (GED) is an aversive therapy device that has been shown to reduce the frequency of severe problem behaviours by 97%. Within a cohort of 173 patients, we have identified the four most common patterns of response: (1) on removal of GED, behaviours immediately return, and GED is reinstated; (2) GED is removed for periods of time (faded) and reinstated if and when behaviours return; (3) a low frequency of GED applications maintains very low rates of problem behaviours; and (4) GED is removed permanently after cessation of problem behaviours. GED is intended as a therapeutic option only for violent, treatment-resistant patients with ID and ASD.

Language: en

Keywords

cognitive–behavioural psychotherapy; drugs: psychiatry; healthcare improvement and patient safety; impulse control disorders