Parents Defend School's Use of Shock Therapy

The New York Times
December 25, 2007 Tuesday Correction Appended Late Edition - Final

Nearly a year ago, New York made plans to ban the use of electric shocks as a punishment for bad behavior, a therapy used at a Massachusetts school where New York State had long sent some of its most challenging special education students.

But state officials trying to limit New York's association with the school, the Judge Rotenberg Educational Center in Canton, southwest of Boston, and its ''aversive therapy'' practices have found a large obstacle in their paths: parents of students who are given shocks.

''I understand people who don't know about it think it is cruel,'' said Susan Handon of Jamaica, Queens, whose 20-year-old daughter, Crystal, has been at Rotenberg for four years. ''But she is not permanently scarred and she has really learned that certain behaviors, like running up and hitting people in the face, are not acceptable.''

Indeed, Rotenberg is full of children who will run up and hit strangers in the face, or worse. Many have severe types of dysfunction, including self-mutilation, head banging, eye gouging and biting, that can result from autism or mental retardation. Parents tend to be referred there by desperate education officials, after other institutions have decided they cannot keep the child.

While at Rotenberg, students must wear backpacks containing a device that allows a staff member to deliver a moderate shock to electrodes attached to the limbs, or in some cases palms, feet or torso, when the students engage in a prohibited behavior. Both the children's parents and a court must consent to the shocks.

Michael P. Flammia, the lawyer for Rotenberg, defended the practice in an interview.

''People want to believe positive interventions work even in the most extreme cases,'' he said. ''If they did, that is all we would use. Many of these kids come in on massive dosages of antipsychotic drugs, so doped up that they are almost comatose. We get them off drugs and give their parents something very important: hope.''

But for state officials, many behavior experts and even some former Rotenberg parents, the shock therapy at the school represents a dangerous, outdated approach to severe behavioral problems, reminiscent of the electric shock helmets used on some autistic patients into the 1980s and now discredited.

They say Rotenberg does not use shock punishments only for dangerous self-mutilation, but rather for a wide variety of actions, including shouting profanities and spitting, which are known to be effectively treated with less extreme punishments. And critics of the school say that unlike the more widely known electroconvulsive therapy, which has been used successfully in cases of severe depression and is being used experimentally on severely autistic people, applying shock as a punishment is not widely supported by the scientific community.

''People don't use it anymore because they don't need to. It is not the standard of care. There are alternative procedures that do not involve aversives like electronic shock,'' said William Pelham, a behavioral specialist and director of the Center for Children and Families at the State University of New York at Buffalo. ''And I am not talking about drugs as an alternative. I am talking about other behavioral treatments.''

Still, the parents say the shocks are making a difference in their children's lives as nothing else has. In 2006, after New York issued an immediate ban on electric shock for behavior modification, Ms. Handon was among the parents of more than 40 children who sued and won a court injunction to keep treatments going.

In January, the state, which pays for treatment of all New York students at Rotenberg to age 21, enacted a new ban on the treatment for those students, to take effect in 2009; it also set new restrictions on who can begin the therapy in the interim. But the parents amended their suit, and a trial beginning in 2008 will decide the issue.

''The point is that at Rotenberg, they still manage Crystal to control what she needs to do,'' Ms. Handon said. ''Her behaviors were not acceptable for society. Now I think I can bring her home.''

The Rotenberg Center, which says it is the only school in the nation using electric shock, has been the subject of many critical reports by the news media and state investigators.

Just last week, Massachusetts investigators issued a report saying a child at the school was shocked 77 times in three hours last summer as a result of a prank.

The report, by the Department of Early Education and Care, found that a former student pretending to be a school official demanded the punishment of two students, and that counselors administered shocks without double-checking. One of the children suffered first-degree burns.

''Our kids should not be sent there, and we will act immediately,'' Gov. Eliot Spitzer of New York said in response to the report.

But unlike many special education schools, Rotenberg, as a matter of policy, never rejects or expels a child, except an adjudicated sex offender. As a result, it continues to get referrals from around the nation.

Currently, nearly 100 of the more than 200 children at Rotenberg are from New York State, down from roughly 140 in 2006. The school says that it also has children from 10 other states, including California and Illinois, and that it has had students as young as 10. At a cost of about $228,000 per child per year, the students receive a range of therapies, including, in the case of more than 40 of the New Yorkers, the use of electric shocks.

Just how painful those shocks are has been an area of particular debate. Technically, the lowest shock given by Rotenberg is roughly twice what pain researchers have said is tolerable for most humans, said James Eason, a professor of biomedical engineering at Washington and Lee University. The highest shock given by Rotenberg is three times the lowest amount.

The lawyer for Rotenberg, Mr. Flammia, said the current has to hurt to work. He described the highest shock as ''a hard pinch.''

But a former teacher from the school, who asked not to be named because he signed a confidentiality agreement as a condition of employment and fears he could be sued for speaking to a reporter, said he had seen children scream and writhe on the floor from the shock.

Mr. Flammia called the accusation false. If a teacher saw such things, he should have reported it, the lawyer said. No teacher ever has made that sort of report, he added.

Ms. Handon said she does not care what the critics say, not even those perturbed by the report of the prank shocking. She said her fierce loyalty to her daughter's school was not hard to understand. Crystal developed slowly as a baby. She was eventually found to be mentally retarded and placed in special education. But by the time she was 13, the local schools could no longer hold her and Ms. Handon, a divorced mother of five, was having troubles as well.

She described her daughter as ''the sweetest person,'' a child obsessed with Michael Jackson who loves to dance to ''Billie Jean.'' But Crystal's condition led to peculiar antisocial behavior, her mother said. Even after her adolescence, she would strip off her clothes and park herself naked in the living room. She would bite herself on her arms and legs until she bled, and then would peel off the scabs until she left deep black scars.

Then there were her rages. Denied something, she would throw furniture and shatter windows. Once, she ripped the door frames out of the plaster walls of her family's apartment. ''I was always afraid the landlord was going to evict us,'' Ms. Handon remembered -- not an inconsequential fear for a woman like her whohad once been homeless.

As a young teenager, Crystal was moved to residential placements, but even those special education schools could barely handle her. They would use restraints and psychotropic drugs. Crystal grew to 180 pounds and was ''so doped up,'' her mother said, ''that she could barely walk straight.''

When she was 16, education officials recommended Rotenberg. At first Ms. Handon wouldn't consider a place that used shock as therapy, but over time she began to see advantages. Rotenberg would take her child off the medicines. They would punish her only for behavior in her control, like spitting, not for bedwetting. And while the shock hurt, Ms. Handon said she believed it caused no permanent damage or health risk

In their lawsuit, the parents contend that none of the other options have been satisfactory and that other schools have simply drugged their children to remove the bad behavior, without teaching them how to behave differently. The state's perspective, however, is that Rotenberg uses shocks too capriciously, that shocks are used to curb trivial behaviors, like cursing, and that positive reinforcement would often provide similar results.

''The use of electronic skin shock conditioning devices as used at J.R.C. raises health and safety concerns,'' state evaluators wrote in 2006 after a surprise inspection. They also ''compromised'' the ''privacy and dignity'' of the students, the evaluators wrote.

Ms. Handon, however, does not share these qualms. She said she likes the fact that the school will let her visit any time, unannounced. From her computer, she can monitor Crystal's progress.

One green bar chart keeps track of the number of times her daughter has engaged in prohibited behavior; another, the number of times she was given a shock. In the past month, it appears that her daughter has been given shocks only four times, down from the 200 a month she received at first.

To Ms. Handon, this is a sign that her daughter is learning to control herself. When Crystal is too old for special education, her mother plans to keep her at home for good. In the meantime, however, she says her daughter is having too much fun.

''She loves that place,'' Ms. Handon said. ''If she knows she is returning from vacation on a Monday, on Saturday she will pack her bags and start begging to go.''