Research & Practice for Persons with Severe Disabilities2005, Vol. 30, No. 1, 3-10

copyright 2005 byTASH

CLASSIC TASH ARTICLE VReprinted from The Journal of The Association for the Severely Handicapped, Volume 15(3), Fall, 1990.

Toward a Technology of "Nonaversive"Behaviolral Support

Robert H. HomerUniversity of Oregon

Glen DunlapUniversity of South Florida

Robert L. KoegelUniversity of California at Santa Barbara

Edward G. CarrState University of New York at Stony Brook

Wayne SailorSan Francisco State University

Jacki AndersonCalifornia State University, Hayward

Richard W. Albin and Robert E. O'NeillUniversity of Oregon

Nonaversive behavior management is an approach tosupporting people with undesirable behaviors that inte-grates technology and values. Although this approachhas attracted numerous proponents, more adequate def-inition and empirical documentation are still needed.This article presents an introduction to the nonaversiveapproach. Important definitions are suggested, and threefundamental elements are presented: (a) an emergingset ofprocedures for supporting people with severe chal-lenging behavior; (b) social validation criteria empha-sizing personal dignity; and (c) a recommendation forprohibition or restriction of certain strategies. Theseelements are defined in hopes of stimulating furtherdiscussion and empirical analyses ofpositive behavioralsupport.

DESCRIPTOR: nonaversives

In recent years, a broad-based movement hasemerged in support of nonaversive behavior manage-ment. This movement reflects a commitment to thevalue that people with severe disabilities who exhibit

Preparation of this manuscript was supported in part by theUnited States Department of Education, Cooperative Agree-ment G0087C023488. The opinions expressed herein do notnecessarily reflect the position or policy of the United StatesDepartment of Education, and no official endorsement by theDepartment should be inferred.

Requests for reprints should be sent to Robert H. Homer,Ph.D., Specialized Training Program, 135 Education Building,University of Oregon, Eugene, Oregon 97403.

challenging behaviors should be treated with the samerespect and dignity as all other members of the com-munity (Evans & Meyer, 1985; Gast & Wolery, 1986;LaVigna & Donneilan, 1986; McGee, Menolascino,Hobbs, & Menousek, 1987). It also reflects a concernthat many people who perform undesirable behaviorhave been, and are being, subjected to dehumanizinginterventions that are neither ethical nor beneficial(Durand, 1988; Guess, Helmstetter, Tumbull, &Knowlton, 1987). Nonaversive behavior managementseeks alternatives to the emphasis on behavioralsuppression through aversive contingencies and callsinstead for a focus on positive procedures that educateand promote the development of adaptive repertoires(Evans & Meyer, 1985). However, defining the criticalelements and empirical basis for the nonaversive ap-proach remains a major challenge (Mulick, in press).

An important feature of the current focus on non-aversive behavior management is that the basic con-cepts are being promoted from several different per-spectives. There is no specific technique or procedurethat distinguishes the approach. Rather, different pro-ponents offer not only varying procedural recommen-dations, but different theories of behavior in its support(Carr, 1988; Donnellan, LaVigna, Negri-Shoultz, &Fassbender, 1988; Durand & Crimmins, 1988; Evans& Meyer, 1985; McGee et al., 1987). This article is aresponse to these varying presentations of nonaversivebehavior management. To begin such a discussion,however, it is necessary define critical terms.

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Defining "Aversive"l and "Nonaversive"The term "nonaversive behavior management" is an

unfortunate label. In our view, the term is operationallyinaccurate, and functionally misdirected. Of greatestconcern is the inconsistency between the technical andethical standards for labeling an event as aversive. Tech-nically, the term "aversive" refers to a class of stimulithat are followed by escape or avoidance responses(Azrin & Holz, 1966; Bandura, 1969; Johnston, 1988;Van Houten, 1983). A slap or an electric shock isaversive if a person moves away or avoids being slappedor shocked. Similarly, a hug or a brussels sprout isaversive if a person consistently moves away from, oravoids it. In many traditional behavioral programs,aversive stimuli are used as punishers in an effort todecrease targeted behaviors.

The problem with the technical definition is that itdoes not include a clear mechanism for distinguishingmildly aversive events from very aversive events. It ispractically impossible to provide support or instructionthat does not include at least some mildly aversiveevents. Withholding attention, redirecting from pre-ferred (albeit self-injurious) behavior, making a requestto perform a new behavior, and delivering instructionalprompts all may be aversive to some degree. If thetechnical definition of "aversive" is applied, there arefew teachers or clinicians who could argue that theyimplement a totally nonaversive approach.

Nonaversive behavior management, however, has de-veloped less as a response-to mild, or potentially mild,forms of aversive stimuli, than as an alternative to theuse of more extreme aversive events. The ideologicaluse of ';aversive" has become synonymous with proce-dures that involve the delivery of pain, withholdingbasic human needs, or social humiliation. From anethical perspective these procedures are viewed as tooextreme to be accepted as "treatment" (Guess, 1988).

At present, we do not have an adequate means ofassessing operationally the level of aversiveness or intru-siveness of an intervention for a particular individualbefore its implementation. The result is that nonaver-sive behavior management is interpreted by some in-dividuals to mean the abolition of all punishers. Forothers, nonaversive behavior management is associatedwith rejection of only those punishers that involve painor physical harm (tissue damage). For still others, amore complex definition of aversive includes presump-tions of "physical or emotional distress." A major ob-stacle to building an effective set of procedures and acoherent support philosophy is the absence of accepteddefinitions. For the purposes of this article, we will usethe term "aversive" in its technical form.

A second, and equally important, reason why thelabel "nonaversive behavior management" is confusingis that it focuses attention on the negative aspects ofthis approach. The most important and exciting ele-

ments of the nonaversive avenue to behavioral supportlie in the emphasis and precision with which positiveintervention strategies are used. We anticipate that his-tory will view these contributions as far more importantthan the rejection of the aversive procedures that cur-rently dominates efforts to define nonaversive behaviormanagement. For this reason, we join many colleaguesin preferring the label "positive behavioral support,"and will employ it for the remainder of this article.

A major issue for the positive approach to behaviormanagement is the range of different theoretical andmethodological banners that fly under the positive flag.Educative programming, positive programming, func-tional communication training, gentle teaching, func-tional equivalence programming, and nonaversive be-havior management are all variations on the positiveapproach to providing behavioral support. We view thedifferences among these, and other variations, as im-portant and constructive aspects of the movement. Aswith any developing area, time is needed to exploredifferent strategies and options. An important objectiveat this time is to define different variations and docu-ment their effects. Across the array of discussions anddescriptions of positive or nonaversive options, how-ever, we believe three main contributions are dominant:(a) the emerging positive technology; (b) an emphasison social validation and human dignity in determiningthe appropriateness of behavioral procedures; and (c)the recommendation for prohibition, or severe restric-tion, of certain classes of behavioral techniques.

An Emerging Technology of PositiveBehavioral Support

The first contribution of positive programming is anemphasis on specific procedures for managing severe,challenging behavior in community settings. It is im-portant to recognize that the positive/nonaversive ap-proach will be a hollow contribution if it does notinclude an effective set of procedures for managingchallenging behaviors. At this writing, empirical supportfor a comprehensive, positive technology is developingbut is by no means compelling (Carr, Taylor, Carlson,& Robinson, 1990). There are a number of clinicaldemonstrations in which positive procedures have beenassociated with a broad reduction in very severe behav-iors (Berkman & Meyer, 1988; Donnellan et al., 1988;Donnellan, LaVigna, Zambito, & Thvedt, 1985; Dur-and & Kishi, 1987; McGee et al., 1987). In addition,there is a growing literature providing empirically rig-orous demonstrations that specific techniques can pro-duce important behavior reduction under experimentalconditions (Carr & Durand, 1985; Durand & Carr,1987; Hormer & Albin, 1988; Hunt, Alwell, & Goetz,1988; Koegel, Koegel, Murphy, & Ryan, 1989; Koegel& Koegel, 1990; Mace et al., 1988; Singer, Singer,& Hormer, 1987; Winterling, Dunlap, & O'Neill, 1987).

Behavioral Support

There is not, however, a data base that allows confi-dence in the ability of available positive programmingtechnology to respond to all severe behavior challenges.The technology of positive programming is still devel-oping and is just beginning to receive adequate empir-ical support. Among the different efforts to build thistechnology, however, we believe there are at least ninecommon themes that are worthy of acknowledgmentand encouragement. These are listed here.

An Emphasis on Lifestyle ChangeThe positive/nonaversive approach focuses on the

lifestyle of the individual, in addition to the frequency,duration, and intensity of the challenging behaviors(Homer, Dunlap, & Koegel, 1988). Behavioral supportshould result in durable, generalized changes in the wayan individual behaves, and these changes should affectthe individual's access to community settings, to socialcontact, and to a greater array of preferred events.Among the most important issues for a technology ofbehavioral support is recognition that the standards forassessing "success" are changing. An effective behav-ioral support plan should integrate procedures for build-ing access to activities, places, people, and events inaddition to modifying the patterns of specific desirableand undesirable behaviors (Hitzing, 1988; Homer, inpress; O'Brien, 1987).

Functional AnalysisAssessing the antecedents and consequences of a

behavior has long been advocated in applied behavioranalysis (Baer, Wolf, & Risley, 1968; Bandura, 1969;Kanfer & Saslow, 1969; Ullman & Krasner, 1965). Thetechnology of functional analysis is improving, how-ever, and much greater focus is being given to efficientprocesses for defining when challenging behaviors arelikely to occur and what events are likely to be main-taining the behavior (Carr & Durand, 1985; Durand &Carr, 1987; Durand & Crimmins, 1988; Iwata, Dorsey,Slifer, Bauman, & Richman, 1982; Touchette, Mc-Donald, & Langer, 1985). In addition, there is increas-ing emphasis on building a direct link between theresults from a functional analysis and the actual inter-vention program that is developed (Carr, 1988; Horner& Billingsley, 1988; O'Neill, Horner, Albin, Storey, &Sprague, 1988).

Multicomponent InterventionsThe positive approach to behavior management sel-

dom employs a single intervention to address a singlechallenging behavior. In most cases, interventions in-volve the simultaneous manipulation of many variables(e.g., Berkman & Meyer, 1988; Durand & Kishi, 1987).Movement of an individual to a more personal, lesssegregated setting, ignoring minor inappropriate behav-iors, providing multiple opportunities for choice mak-ing, systematic instruction on new functional behaviors,

increased access to preferred events, and staff trainingmay all be combined into one intervention plan. Aspart of the focus on lifestyle change, the nonaversiveapproach often includes complex (multicomponent)interventions that are designed to increase classes ofpositive behavior and decrease classes of undesirablebehavior simultaneously (Koegel & Koegel, 1988).

Manipulation of Ecological and Setting EventsBehavior management has long been associated with

manipulation of the events that immediately precedeand follow targeted behaviors. An exciting area ofgrowth within the field is the recognition that if broadbehavior patterns are to be affected, a greater range ofvariables must be considered. Various authors (Patter-son, 1982; Wahler & Fox, 1981) have advocated ex-panding the range of variables included in behavioralsupport plans. These recommendations are beginningto be acknowledged in the support of people with moresevere disabilities. Diet, eating schedule, exercise op-tions, sleeping patterns, rapport, noise level, density ofhousing, and predictability of daily events are beingrecognized as nontrivial variables in both the quality ofa person's life and the extent to which undesirablebehaviors are manifested (Bailey, 1987; Kern, Koegel& Dunlap, 1984; Rast, Johnston, Ellinger-Allen, &Drum, 1985). The important issue for practitioners andfamilies is that behavioral support plans are beginningto include practical, basic elements that have greatpromise for both affecting behavior change and im-proving the likelihood that positive changes endure.

Emphasis on Antecedent ManipulationsThe emerging, positive approaches to behavioral sup-

port emphasize the use of antecedent manipulations.This emphasis comes in such forms as (a) modifyingevents in a setting so that the stimuli eliciting theundesirable behavior are reduced or removed (Touch-ette et al., 1985) and (b) adding antecedent events thatincrease the likelihood of positive behaviors (Horner &Albin, 1988; Homer, Day, Sprague, O'Brien & Heath-field, in press). These are not new ideas, but the in-creased use of functional analysis information permitsthese approaches to be practical elements in behavioralsupport plans.

Teaching Adaptive BehaviorAmong the most important elements in a nonaver-

sive approach is attention to teaching individuals adap-tive ways of obtaining outcomes that they currentlyachieve through challenging behaviors (Carr, 1988; Ev-ans & Meyer, 1985; LaVigna & Donnellan, 1986). Thisapproach focuses on defining the behavioral "function"of challenging behaviors and teaching the individualsocially acceptable ways of achieving that function.Among the most common examples is the teaching ofcommunication skills. There are a growing number of

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clinical and experimental demonstrations in which thedevelopment of communication skills has been associ-ated with the reduction in levels of challenging behav-iors (Caff & Durand, 1985, Durand & Carr, 1987,Homer & Budd, 1985; Koegel et al, 1989). Challengingbehaviors occur as part of a complex behavioral ecol-ogy. By attending to the functions of challenging behav-iors, clinicians may be able to identify skill deficits.Focusing on the development of the identified skillsmay be an effective and efficient approach to decreasingchallenging behaviors without the use of intrusive in-terventions.

Building Environments with Effective ConsequencesPositive procedures focus less on the manipulation of

consequences than has been typical of behavioral inter-ventions. Nonaversive systems include traditional pro-cedures of consistently rewarding positive behavior andreducing rewards for undesirable behavior. Differentialreinforcement of other behavior (DRO) (Luselli, Miles,Evans, & Boyce, 1985; Rose, 1979), differential rein-forcement of incompatible behavior (DRI) (Mulick,Schroeder, & Rojahn, 1980; Steen & Zuriff, 1977), anddifferential reinforcement of alternative behaviors (Alt-R) (Carr, 1988) are cornerstones of all positive behav-ioral interventions. The positive approach, however,also includes attention to additional consequence vari-ables. One strategy has been to identify a presumedreinforcer that maintains a challenging behavior, andto deliver that reinforcer at a high rate either for desir-able behaviors, or noncontingently (LaVigna & Don-nellan, 1986).

A second, and more complex, contribution of posi-tive procedures has been to focus on the developmentof the individual's reinforcement history. People withchallenging behaviors who have lived in highly restric-tive settings may have very limited reinforcement his-tories. Very few events function as reinforcers, and therelationship between a person's behavior and positiveevents is not clear. One approach to this situation is tocreate a setting in which an array of potentially positiveevents are made available at a high, predictable rate aslong as undesirable behaviors are not performed. Theobjective is, in part, to allow some of these events todevelop into effective reinforcers. Only with the devel-opment of effective reinforcers (including social contactwith staff) is programmatic success anticipated.

Minimizing the Use of PunishersAlthough there is considerable debate about the use

of punishers, a general theme of the positive program-ming approach is that the delivery of punishers forchallenging behaviors is not desirable. The most com-mon alternative is to minimize the reinforcement ofchallenging behaviors, redirect the person to more ap-propriate behaviors, and combine this procedure withother instructional and environmental manipulations

(Evans & Meyer, 1985; Koegel & Koegel, 1989; La-Vigna & Donnellan, 1986; McGee et al., 1987). Manyadvocates of positive behavior management recognize,however, that a typical array of events (frowns, repri-mands, etc.) can be viewed technically as punishers andyet provide critical learning information.

Distinguish Emergency Procedures from ProactiveProgramming

An effective technology for supporting people withsevere challenging behaviors must provide families andstaff with specific strategies for responding when thesebehaviors occur. It is not sufficient simply to recom-mend how to ignore or avoid undesirable behaviors.Many behaviors place the person with a disability, orothers, at such severe social or physical risk that bothof these options are unacceptable. It is equally impor-tant, however, to recognize that many times the pre-ferred response to dangerous situations is not to delivera behavioral intervention designed to change the behav-ior, but just to provide sufficient temporary control toensure that no one gets hurt. An effective technology ofpositive behavioral support must include specific pro-cedures for providing support in dangerous situations.It is critical, however, that a clear distinction be madebetween crisis intervention strategies for infrequent usein emergency situations and ongoing proactive pro-gramming designed to produce substantive positivechange. Crisis intervention procedures must not beallowed to turn into on-going restraint, or be used as adefense for the absence of effective programming.

The development of a well defined technology ofpositive behavioral support will take time. There is toolittle information currently available to assert that pos-itive approaches are capable of solving all behaviorproblems or documenting that one approach is superiorto any other. Both well controlled empirical analysesand less controlled clinical analyses are needed. Theobjective for the near future should not be to forceconsensus among those developing positive strategies,but to increase the precision with which a wide array ofapproaches are evaluated empirically.

Social Validation and the Role of Dignity inBehavioral Support

The second defining element of positive behavioralsupport is the addition of a social validity standard(Wolf, 1978) for determining the appropriateness of anyintervention. Defining the appropriate use of the tech-nology within an ethical context has long been acceptedwithin applied behavior analysis (Kazdin, 1980). Twoprofessional criteria often have been defined. The firstis that any behavioral intervention must be justified inbalance with the benefit anticipated for the person withdisabilities (Irvin & Singer, 1984). Any intervention, nomatter how benign, intrudes into a person's life to somedegree. The level of intrusiveness should be in propor-

Behavioral Support

tion to the magnitude of the anticipated gain. Thesecond standard is that clinicians should use the leastintrusive intervention option that can logically be ex-pected to be successful in a reasonable time period(Foxx, 1982; Matson & DiLorenzo, 1984). This secondstandard often has led to guidelines requiring that lessintrusive interventions be documented as ineffectivebefore implementing significantly intrusive actions(Foxx, 1982; Katz bill, 1988; Lovaas & Favell, 1987).An important nuance of this standard is that the de-mand is not that all less intrusive interventions be tried,but that all less intrusive strategies that logic and currentresearch indicate may have an effect should be at-tempted.

A positive approach to behavior management fullyendorses these traditional criteria. In addition, however,the positive approach adds a "dignity" standard. Behav-ioral interventions should maintain and support thepersonal dignity of the individual. Procedures that typ-ical members of a community find excessive should beviewed with extreme caution. Because the purpose ofbehavioral interventions is to assist people in becomingfull participants in society, the procedures used toachieve this goal should be within the standards set bysociety. Requiring behavioral interventions to be so-cially valid recognizes that it is not just the type ofintervention that is important, but also the manner inwhich that intervention is implemented. By its nature,behavioral technology involves continuous on-site tech-nical and ethical judgement. Even mildly intrusive, orreinforcement-based, interventions can be used in aninhumane, undignified manner that is disrespectful andstigmatizing to the individual with challenging behav-iors. As a result, the following are recommended:

1. The appropriateness of all behavioral interventionsshould be evaluated in terms of three criteria. (a) Is thelevel of intrusiveness logically balanced by the value ofthe anticipated behavior change for the person withchallenging behavior? (b) Is the proposed interventionevaluated by competent professionals as the least intru-sive intervention likely to be successful? (c) Is the inter-vention judged by community members not to be de-humanizing, degrading, or disrespectful to the individ-ual receiving support?

2. The more intrusive an intervention, the greater theneedfor continuous public monitoring. The more intru-sive an intervention, the more important it is thatmembers of the community (e.g., human rights com-mittee) both approve the written plan for the interven-tion and observe the plan being implemented. Writtendescriptions and the labels applied to behavioral inter-vention strategies can be ambiguous. Repeated directobservation of the intervention implementation bycommunity members is critical for maintaining thesocial validity of more intrusive interventions.

3. The more intrusive an intervention. the greater the

needfor procedural regulation. The greater the social orphysical intrusiveness of an intervention, the more ap-propriate are procedural regulations that restrict (a) whomay use the intervention, (b) when the interventionmay be used, and (c) the conditions for monitoring theintervention. For example, such interventions as over-correction, psychotropic medications, or time out maybe used with minimal intrusiveness, or they may involvesevere social and physical restriction. While it would beinappropriate to eliminate all forms of these interven-tions, it is appropriate for regulatory agencies to specifyrestrictions defining when more restrictive forms maybe used, and to limit the use of these forms by peoplewho do not have adequate training in the implemen-tation of effective, ethical interventions (Lovaas & Fav-ell, 1987; Van Houten et al., 1988).

Recommendations to Prohibit or RestrictClasses of Behavioral Interventions

The most hotly debated element of positive program-ming has been the recommendations that aversive be-havioral procedures be banned or restricted (Iwata,1988; Matson & Taras, 1989; Mulick, in press). At oneextreme has been a call that all interventions that (a)deliver physical pain, (b) result in harm (medical atten-tion), or (c) are judged to be disrespectful or dehuman-izing should be legally and morally prohibited. Multiplerecommendations to this effect have been made in texts(Donnellan et al., 1988; Evans & Meyer, 1985; LaVigna& Donnellan, 1986; McGee et al, 1987), newsletters(Sobsey, 1987), resolutions by professional organiza-tions (TASH, AAMR, ASA), and proposed state regu-lations/laws (Katz bill, 1988). In response has been theargument that in a small number of severe situations itis more immoral to withhold an effective, though pain-ful, intervention (e.g., electric shock), or to use lesseffective interventions that require extended time to beeffective, than to use a painful yet immediately effectiveprocedure (Mulick, in press). Of equal importance, ithas been argued that to impose prohibitions on a scienceas young and ill-defined as behavioral support is dam-aging to the development of practical, effective proce-dures.

The debate surrounding the prohibition or restrictionof interventions that use severe, aversive stimuli willnot be settled soon. An unfortunate aspect of the debateis that it focuses attention away from the more impor-tant contributions of positive behavioral support indeveloping technology and social validation standards.The positive aspects of the debate are that (a) it isforcing an in depth evaluation of acceptable, profes-sional procedures, and (b) it is adding a strong voicefrom families and consumers of behavioral support inaddition to the longstanding discussions of cliniciansand ethicists. In addition, there is a growing acceptancewithin the field that the use of aversive stimuli must be

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regulated (either by professional organizations or bylegal mandate). Lovaas and Favell (1987), for example,have provided a set of guidelines for using aversivestimuli that precludes use of these procedures in all butthe most extremely unusual situations, and then onlyby a very small number of very well trained and mon-itored clinicians. The functional difference between theprofessional guidelines recommended by Lovaas andFavell (1987) and a total prohibition of all proceduresthat involve pain or harm is minimal in terms of thenumber of people who would receive aversive stimuli.Clearly, the time has come for limiting the use of stimuliand procedures that are painful, damaging, and dehu-manizing. The debate should be not on whether to limitour use of the most severe forms of behavioral interven-tion, but on how that limitation should occur.

A consistent message for families, teachers, and com-munity service providers is that positive programmingis the expected technology. The routine use of proce-dures that deliver pain (shock, pinching, slaps), proce-dures that result in harm (bruises, cuts, broken bones),and procedures that are disrespectful or dehumanizing(facial sprays, shaving cream in mouth, foul smells) areno longer acceptable. Families, teachers, and commu-nity service personnel should turn toward (a) developingcompetence in the technology of positive programmingand (b) addressing internal policies and procedures toprevent the abuse of severe, intrusive procedures.

The resolution to the debate surrounding the use ofaversive stimuli is to develop and rigorously documentpositive support procedures that produce consistent,rapid, durable, generalized changes in challenging be-haviors while facilitating the development of broadlifestyle changes. This is a tall order, but there must beeffective strategies for creating alternatives to the use ofbehavioral procedures that are painful, harmful, ordehumanizing. The critical question is how to do thisand to ensure that all individuals gain access to the best,most humane, most effective support possible. Themarriage of ideology and science must be in the deliveryof effective, positive alternatives.

SummaryThis article describes aspects of positive behavioral

support. Our effort has been to further define thistechnology and emphasize three main elements: (a) anemerging set of procedures, (b) the addition of socialvalidation standards for acceptability, and (c) the pro-hibition or regulation of procedures viewed as exces-sively aversive or disrespectful. Through these threeelements, positive behavioral support is an integrationof technology and values. At this time, the values aremore well defined than the technology. Our hope is torefocus attention on the discussion, analysis, and appli-cation of those powerful positive procedures that willbe critical for raising positive behavioral support from

a debated approach to the established technology in ourfield.

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Received: February 8, 1990Final Acceptance: April 11, 1990Editor in Charge: John Nietupski

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