Respondent characteristics associated with adherence in a general population ecological momentary assessment study

OBJECTIVES

Ecological momentary assessment (EMA) has seen an explosion in popularity in recent years; however, an improved understanding of how to minimise (selective) non-adherence is needed.

METHODS

We examined a range of respondent characteristics predictors of adherence (defined as the number of EMA surveys completed) in the D2M EMA study. Participants were a sample of n = 255 individuals drawn from the longitudinal z-proso cohort who completed up to 4 EMA surveys per day for a period of 2 weeks.

RESULTS

In unadjusted analyses, lower moral shame, lower self-control, lower levels of self-injury, and higher levels of aggression, tobacco use, psychopathy, and delinquency were associated with lower adherence. In fully adjusted analyses with predictors selected using lasso, only alcohol use was related to adherence: beer and alcopops to higher adherence and spirits to lower adherence.

CONCLUSIONS

These findings provide potential insights into some of the psychological mechanisms that may underlie adherence in EMA. They also point to respondent characteristics for which additional or tailored efforts may be needed to promote adherence.

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.

Effects of inter-trial interval on sign-tracking and conditioned reinforcer efficacy in female rats

Previous nonhuman studies have reported that sign-tracking to a conditioned stimulus (CS) is increased when the intertrial interval (ITI) duration is increased. Separate studies indicate that individual differences in sign-tracking (vs. goal-tracking) at a fixed ITI (and CS duration) is predictive of the conditioned reinforcer efficacy of the CS. The present study evaluates, for the first time, if increasing the ITI increases rats' sign-tracking and the conditioned reinforcing efficacy of the CS. Forty-five female rats were randomly assigned to one of three groups that completed appetitive Pavlovian training with ITIs of 14, 24, or 96 s. Subsequently, they completed tests of conditioned reinforcement. Replicating previous findings, longer ITIs increased sign-tracking to a lever-CS and, extending the literature, conditioned reinforcer efficacy of that CS was highest at the longest ITI used during Pavlovian training. Implications for behavioral interventions using conditioned reinforcement are discussed.

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.

How a token-based game may elicit the reward prediction error and increase engagement of students in elementary school. A pilot study

Student engagement is essential to academic success and student-wellbeing. In the past, fostering engagement though extrinsic rewards has often been found to be of limited effectiveness over the long term. However, extrinsic rewards are important for improving engagement with non-intrinsically rewarding activities. Thus, in the present study a mechanism that is meant to prolong the effects of extrinsic rewards was investigated: the reward prediction error. This error occurs when rewards are awarded contrary to the awardee’s expectations. In a quasi-experiment, 39 elementary school students participated in a classroom-based game, which was supposed to motivate them to solve math exercises. It combined reinforcement with elements of luck, which were supposed to elicit the reward prediction error. After 2 weeks, the intervention group had completed significantly more math exercises compared to a pretest and, importantly, also more correctly solved exercises than a control group. This suggests that game-based reinforcement that elicits the reward prediction error might help to increase student engagement over the medium term. It furthermore highlights the importance of applying gamification elements not only digitally but also in analog settings.

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.

Increasing selection of and engagement in physical activity in children with autism spectrum disorder

Children with autism spectrum disorder (ASD) engage in reduced levels of physical activity relative to neurotypical children. Researchers conducted 2 studies to 1) evaluate the influence of the number of physical activity options and effort on choice and 2) develop a token-based intervention to increase physical activity engagement and evaluate whether the opportunity to access the intervention supported responding similar to physical or sedentary activity alone. Four children with ASD participated. Additional physical activity options alone did not increase physical activity selection, but increased effort reduced selection of sedentary activity. Tokens increased physical activity for 2 participants. A combination of physical and sedentary activities maintained as much as or more responding than either activity in isolation for all participants. Limitations and potential areas of future research on choice and physical activity are discussed.

Token Economy-Based Hospital Bed Allocation to Mitigate Information Asymmetry: Proof-of-Concept Study Through Simulation Implementation

Background

Hospital bed management is an important resource allocation task in hospital management, but currently, it is a challenging task. However, acquiring an optimal solution is also difficult because intraorganizational information asymmetry exists. Signaling, as defined in the fields of economics, can be used to mitigate this problem.

Objective

We aimed to develop an assignment process that is based on a token economy as signaling intermediary.

Methods

We implemented a game-like simulation, representing token economy–based bed assignments, in which 3 players act as ward managers of 3 inpatient wards (1 each). As a preliminary evaluation, we recruited 9 nurse managers to play and then participate in a survey about qualitative perceptions for current and proposed methods (7-point Likert scale). We also asked them about preferred rewards for collected tokens. In addition, we quantitatively recorded participant pricing behavior.

Results

Participants scored the token economy–method positively in staff satisfaction (3.89 points vs 2.67 points) and patient safety (4.38 points vs 3.50 points) compared to the current method, but they scored the proposed method negatively for managerial rivalry, staff employee development, and benefit for patients. The majority of participants (7 out of 9) listed human resources as the preferred reward for tokens. There were slight associations between workload information and pricing.

Conclusions

Survey results indicate that the proposed method can improve staff satisfaction and patient safety by increasing the decision-making autonomy of staff but may also increase managerial rivalry, as expected from existing criticism for decentralized decision-making. Participant behavior indicated that token-based pricing can act as a signaling intermediary. Given responses related to rewards, a token system that is designed to incorporate human resource allocation is a promising method. Based on aforementioned discussion, we concluded that a token economy–based bed allocation system has the potential to be an optimal method by mitigating information asymmetry.

A Dual Incentive Value-Based Paradigm for Improving the Business Market Profitability in Blockchain Token Economy

Blockchain solves the problem of mutual trust and consensus in the business market of the token economy. In the existing paradigm of blockchain token economy, there are disadvantages of lacking the incentive mechanism, business applications and virtual token value. These shortcomings reduce consumers’ willingness to consume and the profits of the merchants. In this paper, we propose a novel “Dual incentive value-based” paradigm to improve the business market profitability in blockchain token economy. To evaluate our proposed paradigm, we propose a business study case for improving merchants’ environment state. In this case, we set up two economic models and make simulations to validate the profitability. The result shows that merchants with the novel paradigm have 32% more profit compared with those without the paradigm and at most 10% more profitable than those in existing paradigms.

Systematic Review and Meta-Analysis of Token Economy Practices in K-5 Educational Settings, 2000 to 2019

Token economy systems have been widely used as an evidence-based classroom management strategy to reinforce and improve prosocial responses. While token economies have been widely applied to educational settings, there have been mixed results regarding the effectiveness depending on the classroom type. To better understand the components contributing to the effectiveness, the researchers analyzed 24 token economy studies conducted in general and special education classrooms from kindergarten to fifth grade between 2000 and 2019. Eight token economy components and effect sizes were identified for each study and compared across different classroom types. The results showed that the token economy intervention yielded large effect sizes for both general and special education classroom types. There were differences in the usage of token components including backup reinforcer types, token production rate, and exchange production rate based on classroom types. Implications for future research and practice for educators and clinicians are discussed.

Independent Contingency and Token Economy at Recess to Reduce Aggression

School-wide behavior problems can vary significantly from structured to unstructured settings. Often problem behaviors can spike during unstructured times such as lunch and recess and the use of Tier 1 positive behavior interventions and supports (PBIS) can be used to reduce student behavior problems in these settings. Using a token economy as an independent group contingency, this study aimed to reduce student aggression in an elementary school during lunch/recess periods of the day. Students had the opportunity to earn school “dollars” during recess for demonstrating prosocial behaviors in which they were told could be exchanged for incentives at a student store (backup reinforcers). Across all grade levels, student levels of aggression were reduced between 50 and 100% from baseline levels in a 3-month period. However, as effect sizes indicated, only some intervention groups showed significant reduction of aggression. Despite the limitation of access to backup reinforcers, we theorized that the effectiveness of the present intervention was due to socially mediated contingencies among student group members as a result of receiving dollars.

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.

Art of Prevention: The importance of tackling the nail biting habit

Onychophagia, commonly referred to as nail biting, is a chronic condition that is repetitive and compulsive in nature, and generally seen in children and young adults. Multiple factors play a role in the development of nail biting, ranging from genetic components to underlying psychiatric conditions. Complications of chronic, compulsive nail biting range from obvious distortion of the nail bed unit to ungual and oral infection. Dental hygiene is typically less well-maintained in patients with nail-biting disorders, and teeth may become chipped or notched and gums many become inflamed. Treatment of nail biting involves a multidisciplinary team that provides social, psychiatric, dermatologic, and dental care. Treatment ranges from psychotherapy modalities to medication trials of selective serotonin reuptake inhibitors and N-acetylcysteine. Proper nail hygiene remains a mainstay in the prevention of the complications of chronic nail biting. Additional supportive measures include the support of self-motivational novels and television episodes that help children learn coping mechanisms.

Implementation of a Behavioral Intervention in a Juvenile Detention Center: Do Individual Characteristics Matter?

A sample of 129 (73% male) youth admitted consecutively into a juvenile detention center were used to examine individual characteristics that contribute the implementation of a behavioral intervention within a juvenile detention center. Given that a system of rewards and punishments is considered the mechanism of change within many behavioral interventions, individuals risk characteristics (i.e., proactive and reactive aggression, behavioral inhibition, subsystems of behavioral activation, callous-unemotional traits, perceived containment) were examined in relation to the rewards (i.e., positive feedback) and punishments (i.e., fines) used by the facility. Data were collected via structured interviews with youth and archival data. The number of days youth spent in detention was the only predictor of positive feedback received. Number of days in detention, sex, and race were related to fines. Behavioral activation drive was the only individual characteristic related to fines. Implications of findings are discussed.