Table 1

Pros and cons of GED treatment

ProsCons
  • Immediately eliminates or significantly reduces targeted behaviour.

  • Eliminates or significantly reduces the need for restraint, protective equipment and PRN psychotropic medications.

  • Precise limits on intensity and duration (dosing) to ensure safety and efficacy.

  • Does not interfere with ongoing activities.

  • Reduces or eliminates the need for physical contact with a patient who is exhibiting dangerous behaviours.

  • Often associated with positive side effects: reductions in untreated problem behaviours; increases in laughing and smiling; less distressed when upset; calmer.

  • Increases the amount of time the patient can participate in leisure and educational activities.

  • Treatment can be implemented across environments, allowing patients to safely visit their home and enter the community.

  • Causes temporary pain.

  • Patient must wear/carry the equipment (battery, device and electrode).

  • Treatment may be prosthetic in nature; that is, patient may need to continuously wear the device to maintain benefits.

  • May evoke avoidance responses and anxiety between the onset of the behaviour and GED application.

  • Requires comprehensive treatment monitoring systems (eg, cameras and supervision of staff).

  • Negative public perception of the treatment.

  • Extensive administrative resources are typically needed to satisfy all safeguards.

  • The Food and Drug Administration (FDA) issued a ban on allelectrical stimulation devices in 2020. The JRC Parents Association and JRCpetitioned the FDA for a stay of action in relation to the ban and have filedan appeal of the ban with the United States Court of Appeals for the Districtof Columbia. In response, the FDA issued a partial stay allowing patientsalready using ESDs (e.g. the GED) to continue such use.

  • GED, graduated electronic decelerator; PRN, per registered nurse.