Controlling extremely dangerous aggressive outbursts when functional analysis fails

This article describes and illustrates a treatment program aimed at addressing intermittent extremely dangerous aggressive behavior in an 11-year-old girl who was blind, multiply handicapped, and profoundly mentally retarded. In the month preceding treatment she had injured a peer, a paid careprovider, and her mother. Functional analysis produced no clear antecedents to aggression. Punishment was used to introduce a superordinate contingency. Differential reinforcement of alternative behavior combined with contingent restraint reduced, then eliminated aggression. Follow-up at an age equivalent of 4 years, 6 months indicated a continued absence of aggression. Results are discussed in regards to the balance between research methodology, agency policy, right to effective treatment, and social validity.