Token reinforcement: Translational research and application

Common Practices used to Establish and Implement Token Economies in Clinical and Instructional Settings: A Survey of BACB Certificants

Token economies are among the most widely used procedures in behavior analysis and research on token economies has spanned over 80 years. Several textbooks have outlined the essential components of token economies and suggested how they can be trained and implemented in practice. However, procedures evaluated in applied research can vary from how those procedures are implemented in clinical practice. It is conceivable that the way in which token economies are implemented in clinical settings does not resemble the procedures described in research and behavior analytic textbooks. We surveyed 255 board certified behavior analysts and board certified assistant behavior analysts about their commonly used practices when training and implementing token economies with individuals with autism and other neurodevelopmental disorders. Results suggest that certain aspects of token economies in practice often bear only superficial resemblance to how they are described in textbooks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00800-5.

Computational mechanisms underlying motivation to earn symbolic reinforcers

Reinforcement learning (RL) is a theoretical framework that describes how agents learn to select options that maximize rewards and minimize punishments over time. We often make choices, however, to obtain symbolic reinforcers (e.g. money, points) that can later be exchanged for primary reinforcers (e.g. food, drink). Although symbolic reinforcers are motivating, little is understood about the neural or computational mechanisms underlying the motivation to earn them. In the present study, we examined how monkeys learn to make choices that maximize fluid rewards through reinforcement with tokens. The question addressed here is how the value of a state, which is a function of multiple task features (e.g. current number of accumulated tokens, choice options, task epoch, trials since last delivery of primary reinforcer, etc.), drives value and affects motivation. We constructed a Markov decision process model that computes the value of task states given task features to capture the motivational state of the animal. Fixation times, choice reaction times, and abort frequency were all significantly related to values of task states during the tokens task (n=5 monkeys). Furthermore, the model makes predictions for how neural responses could change on a moment-by-moment basis relative to changes in state value. Together, this task and model allow us to capture learning and behavior related to symbolic reinforcement.

Pavlovian learning and conditioned reinforcement

Conditioned reinforcers are widely used in applied behavior analysis. Basic research evidence reveals that Pavlovian learning plays an important role in the acquisition and efficacy of new conditioned-reinforcer functions. Thus, a better understanding of Pavlovian principles holds the promise of improving the efficacy of conditioned reinforcement in applied research and practice. This paper surveys how (and if) Pavlovian principles are presented in behavior-analytic textbooks; imprecisions and knowledge gaps within contemporary Pavlovian empirical findings are highlighted. Thereafter, six practical principles of Pavlovian conditioning are presented along with empirical support and knowledge gaps that should be filled by applied and translational behavior-analytic researchers. Innovative applications of these principles are outlined for research in language acquisition, token reinforcement, and self-control.

Quantitative Indices of Student Social Media Engagement in Tertiary Education: A Systematic Review and a Taxonomy

Recent studies have evaluated the use of social media as learning aids in tertiary education. Emerging research in this area has focused primarily on non-quantitative approaches to student social media engagement. However, quantitative engagement outcomes may be extracted from student posts, comments, likes, and views. The goal of the present review was to provide a research-informed taxonomy of quantitative and behavior-based metrics of student social media engagement. We selected 75 empirical studies comprising a pooled sample of 11,605 tertiary education students. Included studies used social media for educational purposes and reported student social media engagement outcomes (source databases: PsycInfo and ERIC). We used independent raters and stringent interrater agreement and data extraction processes to mitigate bias during the screening of references. Over half of the studies (52%, n = 39) utilized ad hoc interviews and surveys to estimate student social media engagement, whereas thirty-three studies (44%) used some form of quantitative analysis of engagement. Based on this literature, we present a selection of count-based, time-based, and text-analysis metrics. The proposed taxonomy of engagement metrics resulting provides the methodological basis for the analysis of social media behavior in educational settings, particularly, for human operant and behavioral education studies. Implications for future research are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10864-023-09516-6.

A Comprehensive Systematic Review of Procedures and Analyses Used in Basic and Preclinical Studies of Resurgence, 1970-2020

Resurgence is the return of a previously reinforced response as conditions worsen for an alternative response, such as the introduction of extinction, reductions in reinforcement, or punishment. As a procedure, resurgence has been used to model behavioral treatments and understand behavioral processes contributing both to relapse of problem behavior and flexibility during problem-solving. Identifying existing procedural and analytic methods arranged in basic/preclinical research could be used by basic and preclinical researchers to develop novel approaches to study resurgence, whereas translational and clinical researchers could identify potential approaches to combating relapse during behavioral interventions. Despite the study of resurgence for over half a century, there have been no systematic reviews of the basic/preclinical research on resurgence. To characterize the procedural and analytic methods used in basic/preclinical research on resurgence, we performed a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We identified 120 articles consisting of 200 experiments that presented novel empirical research, examined operant behavior, and included standard elements of a resurgence procedure. We reported prevalence and trends in over 60 categories, including participant characteristics (e.g., species, sample size, disability), designs (e.g., single subject, group), procedural characteristics (e.g., responses, reinforcer types, control conditions), criteria defining resurgence (e.g., single test, multiple tests, relative to control), and analytic strategies (e.g., inferential statistics, quantitative analysis, visual inspection). We make some recommendations for future basic, preclinical, and clinical research based on our findings of this expanding literature.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-022-00361-y.

Using an App-Based Token Economy to Increase Engagement in Daily Living and Vocational Tasks with Adults with Developmental Disabilities

The token economy is an evidence-based practice that improves outcomes across populations, settings, and behaviors. Nonetheless, their complex nature frequently leads to ineffective implementation. In addition, little is known about the extent to which token economies are effective for increasing engagement in adults with disabilities. Therefore, we conducted a multiple probe across participants to evaluate the effectiveness of a token economy using an app (i.e., Class Dojo) to increase engagement with daily living and vocational tasks in adults with disabilities. All participants increased their engagement with tasks following the introduction of the intervention and maintained higher than baseline levels of engagement up to 6 weeks after the intervention ended. Staff members completed an anonymous survey to indicate their perception of the feasibility and effectiveness of the intervention. Social validity results indicated that some staff members found the intervention effective, but time-consuming and challenging.

An evaluation of the teach-back method for training new skills

There are several effective training packages (e.g., behavioral skills training, video modeling, and self-instruction packages) available to train staff. Despite their efficacy, these training procedures require substantial time or preplanning and resources to create materials. Teach-back, an empirically validated method used in the healthcare setting to enhance communication between clinicians and patients, does not require any preplanning or materials. However, this method has yet to be investigated in the context of training and supervision. The purpose of this experiment was to evaluate the efficacy of teach-back in training participants to implement preference assessments and a token economy. The teach-back method improved procedural integrity to at least 88%, and the addition of vocal-verbal feedback resulted in all participants achieving 100% integrity in all skills. We discuss the implications of these findings.

A Rapid Assessment of Sensitivity to Reward Delays and Classwide Token Economy Savings for School-Aged Children

Delay discounting tasks measure the relation between reinforcer delay and efficacy. The present study established the association between delay discounting and classroom behavior and introduced a brief measure quantifying sensitivity to reward delays for school-aged children. Study 1 reanalyzed data collected by Reed and Martens (J Appl Behav Anal 44(1):1-18, https://doi.org/10.1901/jaba.2011.44-1, 2011) and found that 1-month delay choices predicted student classroom behavior. Study 2 examined the utility of the 1-month delay indifference point in predicting saving and spending behavior of second-grade students using token economies with two different token production schedules. Collectively, results showed (a) the 1-month delay indifference point predicted classroom behavior, (b) children who discounted less and had greater self-regulation, accrued and saved more tokens, and (c) a variable token production schedule better correlated with discounting than a fixed schedule. Implications are discussed regarding utility of a rapid discounting assessment for applied use.

A Systematic Review of Treatment Maintenance Strategies in Token Economies: Implications for Contingency Management

Contingency management (CM) interventions are based on operant principles and are effective in promoting health behaviors. Despite their success, a common criticism of CM is that its effects to not persist after the intervention is withdrawn. Many CM studies evaluate posttreatment effects, but few investigate procedures for promoting maintenance. Token economy interventions and CM interventions are procedurally and conceptually similar. The token economy literature includes many studies in which procedures for promoting postintervention maintenance are evaluated. A systematic literature review was conducted to synthesize the literature on treatment maintenance in token economies. Search procedures yielded 697 articles, and application of inclusion/exclusion criteria resulted in 37 articles for review. The most successful strategy is to combine procedures. In most cases, thinning or fading was combined with programmed transfer of control via social reinforcement or self-management. Social reinforcement and self-monitoring procedures appear to be especially important, and were included in 70% of studies involving combined approaches. Thus, our primary recommendation is to incorporate multiple maintenance strategies, at least one of which should facilitate transfer of control of the target behavior to other reinforcers. In addition, graded removal of the intervention, which has also been evaluated to a limited extent in CM, is a reasonable candidate for further development and evaluation. Direct comparisons of maintenance procedures are lacking, and should be considered a research priority in both domains. Researchers and clinicians interested in either type of intervention will likely benefit from ongoing attention to developments in both areas.

Behavioral Assessment and Treatment of Aerophagia

Aerophagia is characterized by excessive air swallowing and can have serious negative effects on one’s health. We present the assessment and treatment of a 16-year-old girl, Khloe, with developmental disabilities and aerophagia. The initial assessment indicated that aerophagia occurred primarily to access attention in a divided attention context; however, our function-based treatment did not result in a clinically significant reduction in problem behavior. We then conducted a second assessment that indicated that Khloe’s aerophagia indeed occurred primarily in a divided attention context, but that it persisted independent of social consequences. We concluded that the divided attention context served as a motivating variable for aerophagia. Our second treatment consisted of differential reinforcement of other behavior, noncontingent access to competing stimuli, and graduated exposure to contextual variables (i.e., people and divided attention) that occasioned aerophagia. The treatment was successful in reducing rates of aerophagia. We discuss implications for assessment and treatment, as well as recommendations for clinicians and students.

Adapting Direct Services for Telehealth: A Practical Tutorial

Due to the pandemic brought on by the novel coronavirus (COVID-19), consumers of applied behavior-analytic interventions may be experiencing disrupted access to services. In response to the need for services, behavior analysts and therapists may find themselves treading unchartered waters as they use telehealth to provide direct intervention to consumers. Direct service provision via telehealth extends beyond the bounds of existing telehealth research, which primarily focuses on caregiver training and consultation. In the transition to telehealth, behavior analysts can consider how to adapt an existing evidence base of behavior-analytic strategies from a face-to-face format to intervention via a teleconferencing platform (i.e., Zoom). In this tutorial, we provide practice recommendations, task analyses, and a curated list of Zoom walk-throughs to help behavior analysts construct conceptually systematic learning opportunities in their direct telehealth services. Leveraging teleconferencing features to provide behavior-analytic intervention directly to consumers could spur future research to support these need-inspired practices and guide telehealth applications during and beyond the current pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-020-00529-5.

Improving Beverage Choice in Adults with Developmental Disabilities: Implementation of a Token Reinforcement System in a Community Residential Setting

Individuals with developmental disabilities (DD) are twice as likely to have obesity than non-disabled individuals. Replacing the consumption of sugar sweetened beverages (SSBs) with water has many health benefits, including weight reduction. In this study, a token reinforcement system was implemented to increase water consumption and decrease the consumption of SSBs with 14 adult participants with DD living in a community-based independent supported living (ISL) center. Token reinforcement reduced the consumption of SSBs, with associated reductions in calorie consumption and body weight. Findings are especially important for treatment settings where resources for individualized meal planning and staffing to support comprehensive behavioral interventions may be limited.

Extending stimulus preference assessment with the operant demand framework

This study extended earlier research on stimulus preference (SP) and reinforcer efficacy (RE) using the behavioral economic concept of elasticity. The elasticity of demand for different items can be used to simultaneously compare RE across stimuli and schedules of reinforcement. Highly preferred stimuli were identified via SP assessments and evaluated using progressive-ratio reinforcer assessments. Reinforcers were then evaluated across the ranges of elasticity in individual reinforcer evaluations. Results indicated that schedules associated with the ranges of elasticity (e.g., inelastic vs. elastic) corresponded with rates of the targeted behavior (i.e., work) and these trends were consistent with behavioral economic predictions. These findings encourage further inquiry and replication of operant demand methods to identify potential boundary conditions for stimuli identified using SP assessments. Discussion is provided regarding the efficiency of reinforcer assessment and the utility of schedules found to exist in the elastic and inelastic ranges.

Single-case experimental designs: Characteristics, changes, and challenges

Tactics of Scientific Research (Sidman, 1960) provides a visionary treatise on single-case designs, their scientific underpinnings, and their critical role in understanding behavior. Since the foundational base was provided, single-case designs have proliferated especially in areas of application where they have been used to evaluate interventions with an extraordinary range of clients, settings, and target foci. This article highlights core features of single-case experimental designs, how key and ancillary features of the designs have evolved, the special strengths of the designs, and challenges that have impeded their integration in many areas where their contributions are sorely needed. The article ends by placing the methodological approach in the context of other research traditions. In this way, the discussion moves from the specific designs toward foundations and philosophy of science issues in keeping with the strengths of the person and book we are honoring.

A Model of Support for Families of Children With Autism Living in the COVID-19 Lockdown: Lessons From Italy

Italy has been the European country most affected by the COVID-19 pandemic to date and has been in social lockdown for the longest period of time compared to other countries outside China. Almost overnight, Italian behavior analysts were faced with the challenge of setting up remotely whole-family systems aimed at maintaining adaptive skills and low levels of challenging behavior to be carried out solely by caregivers. Given these extraordinary circumstances, the protocols available from the applied behavior-analytic, parent training, and autism literature did not appear to fully meet the needs of parents having to be with their children under extreme levels of stress in a confined space with limited reinforcers for 24 hr a day, 7 days a week. To meet this unprecedented challenge, we developed a dynamic and holistic protocol that extended to the full day and that recognized the need for sustainable intervention delivered solely by parents, who were often looking after more than one child. These practices are presented in this article, together with a discussion of lessons we have learned thus far, which may be useful for behavior analysts working in other regions in which the effects of the pandemic are not yet fully realized. Although somewhat unorthodox, we include some parent comments at the end with the goal of sharing the parent perspective in real time as this pandemic unfolds across the world.

Comparing the reinforcing efficacy of tokens and primary reinforcers

Token economies are one of the most commonly used behavior-analytic interventions. Despite literature supporting the use of tokens as tools for behavior change, little is known about the efficacy of tokens compared to that of the items for which they are exchanged. Results of previous research comparing the reinforcing efficacy of tokens and primary reinforcers have shown that both produce similar effects on responding. However, published findings have been confounded given the inclusion of primary reinforcers in the token-reinforcer test conditions. In this study, we established novel tokens as reinforcers. We then conducted a conditioned-reinforcer assessment using a tandem control to ensure that the tokens functioned as reinforcers. We used progressive-ratio schedules to compare the reinforcing efficacy of the tokens to high- and low-preference edibles that were also used as backup reinforcers. For both participants, we found that high-preference primary reinforcers maintained higher response frequencies than did tokens.

An analysis of the value of token reinforcement using a multiple-schedule assessment

Token systems are widely used in clinical settings, necessitating the development of methods to evaluate the reinforcing value of these systems. In the current paper, we replicated the use of a multiple-schedule reinforcer assessment (MSA; Smaby, MacDonald, Ahearn, & Dube, 2007) to evaluate the components of a token economy system for 4 learners with autism. Token systems had reinforcing value similar to primary reinforcers for 2 of the 4 learners, but resulted in lower rates of responding than primary reinforcers for the other 2 learners. Differentiated responding across learners may warrant variation in clinical recommendations on the use of tokens. The results of this study support formal assessment of token system effectiveness, and the MSA procedure provides an efficient method by which to conduct such assessments.

Road accidents in young adults with ADHD: Which factors can explain the occurrence of injuries in drivers with ADHD and how to prevent it?

Some 1.35 million people die and more than 50 million are injured or disabled from road accidents annually across the globe. Driving is a complex task with multiple complex cognitive functions, including perception, motor coordination, and executive function. Thus, driving can be a significant challenge for patients suffering from attention-deficit hyperactivity disorder (ADHD), a common neurodevelopmental disorder with cognitive symptoms such as inattention, impulsivity, and executive dysfunction. Undoubtedly, risk of car accidents is higher in people with ADHD. The aim of this article is to explore factors that could explain the occurrence of road accidents in patients with ADHD and to highlight prevention points. Indeed, reduction of risky driving is an important priority for public health.

A Preliminary Evaluation of a Token System with a Flexible Earning Requirement

Token systems often involve a predetermined number of tokens required prior to exchange for a terminal reinforcer. The effectiveness of token systems implemented in this manner has been well documented within the literature; however, some have discussed the possibility of a fixed earning requirement creating a context in which the learner no longer emits the desired behavior once the terminal number is achieved. A possible alternative to a fixed earning requirement is selecting the earning requirement based upon learner responding and leaving the requirement unknown to the learner until the moment of exchange. The purpose of this study was to evaluate the effectiveness of a token system with a flexible earning requirement to increase the frequency of comments during snack for 3 children diagnosed with autism spectrum disorder. The results of a nonconcurrent multiple-baseline design demonstrated the flexible token system was effective at increasing the rate of comments in addition to the cumulative number of novel comments.