Aromatic Ammonia

Response-contingent aromatic ammonia is an aversive olfactory treatment procedure that has been shown to be effective in suppressing aggressive and self-injurious behaviors that have proven unresponsive to other [Page 675]approaches. The underlying principle for its efficacy is the punishing effect of the ammonia's noxious odor. Treatment involves applying a crushed capsule of 0.33 cc alcohol 36% (Burroughs Wellcome Co.) or a small handheld vial of ammonia under the child's nose immediately after the child exhibits the undesirable response. Exposure is limited to approximately 3 seconds or until the child exhibits evidence of inhalation, for example, coughing. Medical consultations are necessary before and during treatment to safeguard against possible side effects, including mucous membrane irritation and allergic reactions. The therapist may need to hold the child's head securely during administrations to help ensure inhalation and to prevent the child from coming in direct contact with the ammonia. Using a vial may be preferred over the capsule to further reduce the risk of the child and others coming in direct contact with any ammonia residue after the capsule is broken. The capsules or vial should be readily available for immediate contingent exposure. In addition, the therapist should conceal the ammonia in the palm of his or her hand so that the child is unable to discriminate when punishment contingencies are in effect. Administrations can begin during designated treatment sessions with the child or during the child's normal routine. Treatment may be restricted to as few as two 10-minute sessions a day with successful results. Restricted administrations should be considered for cases exhibiting high rates of the target behavior because of the risks associated with excessive and prolonged exposure. As the response rate declines, the relative frequency of the contingency is increased so that every response is punished. If longer durations of administrations are necessary to achieve effects, then this may indicate a poor prognosis for complete suppression, and a revised treatment plan or other clinical options may be considered.

Research on treatment outcome has revealed rapid and sustainable suppression of self-injurious behaviors with developmentally delayed children. Complete elimination of the response has been achieved but is not always observed. Treatment gains tend to be situation specific, thus requiring that contingencies be applied across settings and caretakers. In addition to being effective alone, ammonia is effective in strengthening the effects of milder forms of aversive treatment such as facial screening and in reducing the recovery of target behaviors when treatment is discontinued. Although observed to be effective primarily with developmentally delayed children in institutionalized settings, aromatic ammonia has been successfully applied in laboratory settings with nondevelopmentally delayed cases. In addition to being effective, aromatic ammonia is simple to use, easy to obtain, economical, portable, concealable, can be implemented quickly without removing the child from the immediate context in which the response occurs, and is more acceptable than more intense aversive procedures such as shock. Family members, teachers, and other caregivers can be trained easily in the procedure. However, as with all aversive procedures, contingent ammonia should only be used when positive reinforcement and less restrictive approaches such as differential reinforcement of other behavior (DRO), overcorrection, and time-out have been tried unsuccessfully. Approval from ethical boards and the family is needed before initiating treatment, and staff/child care workers should agree that the aversive procedure is less harmful than providing no treatment at all because of the dangerousness of the child's behavior problem either to the child or others.

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