Self-Injurious Behavior Inhibiting System

The Self-Injurious Behavior Inhibiting System (SIBIS) is an apparatus used as a treatment method to stop or lessen self-harm. Invented by Dr. Robert E. Fischell, Glen H. Fountain, and Charles M. Blackburn in 1984, the device uses an electric shock as an aversive stimulus, offering a potential solution to self-injurious behavior.

Components
When a child administers a blow to the head, the SIBIS device is used to effectively recognize the self-injurious behavior and to eventually extinguish it. This is possible because the SIBIS device is composed of two wirelessly connected parts: the "sensor module" and the "stimulus module". The sensor module serves to both detect an impact to the head and to protect the head from the damage that the impact could potentially incur. The sensor module is placed on either the body part receiving the impact (such as the head) or on the body part delivering the impact (such as the arm or knee). Wherever it is placed, the sensor module senses the impact of the blow and sends out an electrical signal. This electrical signal triggers the stimulus module, allowing for the aversive stimulation, the shock, to be delivered.

Specifications
SIBIS is designed to swiftly reduce the rate of SIB via an aversive stimulus through a positive punishment contingency. Only 5 cm × 3 cm × 1 cm in size, the stimulus module delivers an 85 V electrical shock at 3.5 mA of current to the subject each time the patient strikes his or her head sufficiently hard enough to register on the velocity impact detector. The delivered shock is designed not to be very painful, but rather an uncomfortable response to the SIB. The impact detector of the apparatus can be adjusted, allowing for the reduction of punishment over time and the eventual dismissal of the apparatus from the child's punishment schedule.

Benefits of SIBIS
In numerous cases, SIBIS has drastically reduced the occurrence of self-injurious behavior in under a week; in some cases, self-injury has been reduced within the first day of the trial. Researchers can attribute this success to the SIBIS device's two main strengths:
 * 1) SIBIS allows for the delivery of the aversive stimulus immediately following the self-injurious behavior, thus eliminating any third variable that might come into play, and
 * 2) SIBIS prevents a child from utilizing escapism and relieving himself or herself of the aversive task he or she is faced with.

Thomas R. Linscheid and colleagues have demonstrated an example of the efficacy of SIBIS. A multiple baseline study of five individuals with severe SIB was conducted in which the dependent variable was hits per minute and the independent variable was the SIBIS unit. The results showed that shortly after the implementation of SIBIS, self-injury dropped drastically in all five subjects. An effect worth noting was that during the baseline of the study, patients gestured for the return of SIBIS; the patients were more calm and relaxed once the unit was returned.

Ethical debate
The utilization of SIBIS is controversial, thus making it the center of ethical debates. Dr. Brian A. Iwata refers to SIBIS as a “default technology." More specifically, Dr. Iwata states that default technology is a last resort to behavior modification after all other methods have been exhausted. Moreover, it is strongly advised that SIBIS should only be used after a full functional analysis of the problem behavior has been completed.

Though the American Psychological Association and the National Association of School Psychologists have attempted to direct school psychologists in the administration of behavioral treatment, the use of SIBIS has proven to be a very controversial topic in the public school system. Those that oppose the SIBIS device as a form of treatment in a school setting claim the shock delivered to the subject qualifies as corporal punishment. However, researchers claim that "aversive therapy" adheres to a systematic "treatment plan" that is carefully constructed to diminish the dangerous, and sometimes even life-threatening, actions exhibited by children with self-injurious behavior. The researchers claim that corporal punishment, unlike an aversive stimulus treatment plan, uses the administration of pain as a "disciplinary action" in order to punish an unwanted behavior.

Schools in some states, such as Michigan, have found SIBIS to be lawful and have allowed its use within the classroom setting. Three stipulations are met, however:
 * 1) The participant, or the participant's parents, must be fully aware as to what he or she is consenting and the implications it may incur.
 * 2) The participant, or the participant's parents, must be competent and capable of making decisions regarding his or her health.
 * 3) The participant, or the participant's parents, must voluntarily consent to the treatment method without coercion or intimidation.