Yadollahikhales Golnaz, Blenkush Nathan, Cunningham Miles
Neurology, University of Illinois Hospital at Chicago, Chicago, Illinois, USA.
Division of Applied Behavioral Analysis, Judge Rotenberg Educational Center, Canton, Massachusetts, USA.
BMJ Case Rep. 2021 May 7;14(5):e241204. doi: 10.1136/bcr-2020-241204.
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.
一小部分智力残疾（ID）和/或自闭症谱系障碍（ASD）患者表现出极其危险的自我伤害和攻击性行为，尽管进行了长期的多学科干预，这些行为仍持续存在。这些不受控制的行为给患者、护理人员和家庭成员带来了身体和情感上的创伤。渐进式电子减速器（GED）是一种厌恶疗法设备，已被证明可将严重问题行为的频率降低97%。在173名患者的队列中，我们确定了四种最常见的反应模式：（1）移除GED后，行为立即恢复，于是重新启用GED；（2）GED被移除一段时间（逐渐停用），如果行为恢复则重新启用；（3）GED的低频率应用使问题行为的发生率维持在非常低的水平；（4）问题行为停止后，GED被永久移除。GED仅作为针对患有ID和ASD的暴力、难治性患者的一种治疗选择。
