"Aversion therapy. While behavioral interventions (see Chapter 17) typically employ positive rewards to obtain the desired responses, the effects may take weeks and months of training. Self-injurious behaviors may be refractory to the usual behavioral interventions (Section IV.B ), physical restraints (below), and pharmacotherapy (Section IV.B.6). In such situations, applications of aversive techniques may result in cessation of behavior that could injure the person. Although unavailable at the Kennedy-Krieger Institute, the Johns Hopkins Hospital, the Johns Hopkins Medical Institutions, the Johns Hopkins University, Bellevue Hospital Center, and New York University, aversive therapy is reported to be an effective intervention for challenging behaviors including self-injurious behaviors. While aversive therapy is illegal in some locations and controversial in others (200), a comprehensive discussion of self-injurious behavior includes mention of this disputatious technique.

Punishment - the application of a noxious stimulus, such as an electric shock, immediately after self-injury - is a quick, effective method of eliminating the behavior (193, 201, 202). One aversive approach is the administration of a spray of water from a water pistol to the nose or face (193, 203). Other aversive techniques include the application of a small current of electricity to the skin, resulting in a small electric shock. Loud bursts of noise have also been employed as an aversive stimulus (204).

Aversive techniques are illegal in some locations and clinicians must know and follow local laws. While there is potential for abuse and misuse by untrained individuals, aversive approaches, as noted above, are sometimes effective (205). Referral of subjects to inpatient facilities experienced in the practice of aversive therapy may be appropriate for people with autism who exhibit self-injurious behaviors unresponsive to alternative treatments."

Autism Spectrum Disorders, pg 292