What are some negative side effects of punishment?

Punishment & Consequences......Ahhhh.

So much can be said about these two concepts.

Unfortunately much of what is said or understood is incorrect, outdated, or just wrong.  Punishment may be viewed as a dirty word, when in reality our behavior is "punished" daily by variables or events outside of our control and it is how we learn.

Anyone who has regular contact with children should have a basic understanding of reinforcement and punishment, but especially if you work within the field of ABA. This is helpful and vital knowledge to have, and can change the way you teach. So lets jump in!

First, here's a definition:

Punishment- Punishment has occurred when a response is followed immediately by a stimulus change that decreases the future frequency of similar responses (Cooper & Heron, 2007, Applied Behavior Analysis).

Sound confusing?? It's really not.

Simplified definition: Punishment is part of learning.

Every behavior has a consequence to that behavior. Something good happens, something bad happens, or nothing happens (in ABA speak, even if "nothing" happens after the behavior that is still a consequence). Punishment is a necessary tool so that we can learn to avoid things, or not do things at all. If we didn't learn from consequences it would impact our lives in a negative way.
For example, if every time you skipped work your boss got very angry and yelled at you but you continued skipping work, sooner than later you will likely be fired. However if after the first time you get yelled at you stop skipping work, then you just learned something important to your well being. Basically, punishment is something intended to make a behavior decrease. We use reinforcement for behaviors we want to see go UP, and we use punishment for behaviors we want to see go DOWN.

Something is labeled a punisher only if it made the behavior go down in the future.  So if a teacher sends  a student to Time Out every day for acting up in class, and after a week the behavior has gone up then Time Out is not a punisher. Most educators intend Time Out to be punishing, but it is what happens to the target behavior that determines if punishment has occured, and not our intentions.

Punishment has gotten a bad rep and most people think of it as a negative thing intended to cause harm or hurt. That's just not true.
There are many kinds of punishment, that can be divided into 2 groups: Positive or Negative.
These groups are easy to distinguish if you think of math. Positive means you added something, and negative means you took something away.

Here is a helpful chart (I just love visuals)-

So based on what most people think about the word "punishment", which one sounds worse- positive punishment or negative punishment?

Negative punishment sounds worse. This is why its important to understand what these concepts actually mean, because doing something "bad" is what most people think of when they hear the word "punishment".  In actuality, positive punishment is the one you want to avoid, which includes things like spankings, electric shock, restraint, or aversives. Professionals in the field of ABA are ethically required to select punishment interventions carefully, judiciously, and to have parent/client consent. Punishment techniques are often only added to a behavior plan after several other options have proven unsuccessful, and it will likely be a form of negative punishment (the client loses access to something), such as Response Cost.

Punishment is a learning tool, just as reinforcement is. When implemented ethically and effectively, punishment can bring about swift change in behavior.
However, decades of research and empirical studies have clearly shown that it is always best to rely primarily on reinforcement to bring about a change in behavior, rather than move straight to punishment. In other words, first try to find something to INCREASE when looking at behavior change, not just a behavior you want to stop.

 *(For anyone interested in the history of ABA and punishment see: Life Magazine article, 1965  and read up on the recent ban of electric shock in the United States. We must learn from our history, even when it is painful to do so, in order to move forward and do better)


Let's discuss some types of punishment, now that we know what punishment is:

1.  Reprimands: Yes, this is considered punishment! Did you know that? Remember, the definition of a punisher is something that causes the target behavior to decrease. So if your client keeps ripping the therapy flashcards and you say a stern "Nice Hands", which causes the ripping behavior to decrease, then "Nice Hands" was a form of punishment. Other examples include "No", "Stop that", "Get down", etc.
2. Response Blocking: This is when the client tries to perform a problem behavior, like push a sibling down, and you physically block them from completing the action. This could be as simple as stepping in between the client and the child they are trying to push. Blocking is a non- intrusive way to prevent successful engagement in inappropriate behavior....and it's a punisher.
3. Over- Correction:  Whenever I have implemented an over -correction technique they are pretty darn effective. Basically, over -correction is when you OVER respond to an inappropriate behavior. For example, if the client throws their cup of milk against the wall, spilling milk everywhere, they would be instructed to complete the milk clean up process 3 times.  

These are all evidence based forms of punishment that may be a necessary component to a behavior plan.

Now I must mention, whenever you are implementing a punishment procedure it is imperative that you think of the behavior plan as a coin. On one side of the coin you have the punishment procedure. If you flip that coin, you must have a schedule of reinforcement so that client has a way to contact a reward. Otherwise you are setting them up for a lose- lose situation, because they get nothing for good behavior and something for bad behavior. That "something" may prove more important than the "nothing" over time. 
Continuing with the example above of the client who throws the cup of milk, it is important to provide copious attention and praise when instead of throwing the cup, the client drinks from it calmly.  "Feed" the behaviors you want to see go UP, and "starve" the behaviors you want to see go DOWN.

So finally, lets address "The Ugly" of Punishment. If done incorrectly, unethically, or without adequate supervision by a qualified BCBA,  punishment will have negative side effects or could even be harmful to the client/learner/student.
Issues usually arise from the application of punishment, which is a clinical way of saying HOW the punishment is delivered. Just like with reinforcement, if punishment is delivered too quickly, or too intensely, you are likely to cause harm.

Here are a few side effects of punishment that everyone should know about:

1. Aggression/Anger/Retaliation (Emotional Response)- This is probably the most common sign that a learner is used to a punishment-heavy environment. Aggression increases, defiance increases, and the learner may exhibit as very angry or manipulative. 
2. Escape/Damaged Relationship/Harm to Rapport Building Process- A large risk to punishment techniques is that they can destroy the purpose of rapport building: to establish a nurturing, caring relationship. The learner may start to avoid anyone who even looks like a teacher or therapist, to avoid/hate school, to avoid/hate therapy sessions, etc.  
3. Behavioral Contrast- This is an ABA term, that basically means creating a situation where X doesn't occur here , but X occurs over there and may even occur more frequently. Here is a real life example: A therapist targets kicking behavior during the the therapy session by removing attention and withdrawing reinforcement when kicks occur.  Very quickly, feet kicking begins to decrease. However, outside of therapy sessions kicks actually increase because no one else is implementing the same strategy as the therapist. The lesson the client has learned is not "Don't kick", but "Don't kick during therapy sessions".

Please remember: punishment on its own does not teach anything. Yes, you may reduce or eliminate challenging behavior but you need to also teach what to do instead of the inappropriate behavior.

Otherwise the learner could just replace the behavior you didn't like with another behavior that you really won't like. It is important to teach what TO do, not just tell someone to stop doing something.

*Recommend Reading- 

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