The association of child and adolescent variables with token economy responsiveness

Seymour Martin Shay, University of Pennsylvania

Abstract

This study investigated differences in the responsiveness of 47 child and adolescent psychiatric inpatients to two distinct token economies as associated with patient diagnostic classification, age, IQ, and treatment with psychotropic medications. The Regular Token Economy (RTE) reinforced patients for demonstrating self-care, punctuality, and program-participation behaviors. The Special Token Economy (STE) reinforced patients for demonstrating healthy alternatives to their individual pathological behaviors.^ Patients were classified by hierarchical cluster analysis of Child Behavior Checklist Internalizing and Externalizing T scores and by DSM III clinical diagnoses. Chi-squared analysis indicated no significant association between actuarial and clinical classification groups.^ Repeated-measures ANOVAs of both RTE and STE points were conducted separately for each set of classification groups. Classification groups constituted the Between-subjects factor and weekly measurement the Within-subjects factor. Standardized weekly token economy points of the RTE and STE over four weeks of time were the dependent measures. Product-moment correlations were computed to determine the relationship of age, IQ, and treatment with psychotropic medications with performance on the two token economies.^ The overall sample showed a modest but significant improvement from week one to week two in RTE performance, which was sustained over the course of the investigation without further gain. There were no significant differences in responsiveness to the RTE among either the actuarial or clinical classification groups.^ Contrasting findings were obtained for the individualized STE. While neither the overall sample nor either set of classification groups demonstrated a change in responsiveness over time, clinical classification groups did show distinct levels of responsiveness to the STE. Schizoid and Adjustment Disordered patients were significantly more responsive to the individualized token economy than were Attention Deficit Disordered patients, both initially and throughout the duration of the study. Actuarial group, age, IQ, and treatment with psychotropic medications were not significantly associated with patient responsiveness to either token economy.^ In the absence of increased contingencies which might enhance responsiveness, it appears that these token economies may have served institutional, ward-management rather than treatment objectives. ^

Subject Area

Clinical psychology

Recommended Citation

Shay, Seymour Martin, "The association of child and adolescent variables with token economy responsiveness" (1988). Dissertations available from ProQuest. AAI8816142.
https://repository.upenn.edu/dissertations/AAI8816142

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