Neurodiversity and Neuroaffirmative

In line with the neurodiversity and neuroaffirmative movements, we would like to draw your attention to alternative approaches to supporting autistic individuals. As a starting point please consider visiting the Therapist Neurodiversity Collective, and The Autistic Advocate. More on this to follow.

Disclaimer | By: Gavin Cosgrave | Reading Time: 4 minutes @ 200 WPM

A Large Scale Token Economy

As a result of this token system, "significant clinical reductions occurred in the use of emergency mechanical restraint, PRNs psychotropic medications and episodes of window breaking"
- Foxx (1998, p. 75)


Foxx (1998) used a token economy with inpatient adolescents in a coeducational residential unit. These adolescents were between 12 and 18 years old, and had been institutionalised because ‘their behavioural excesses were found intolerable by the community (i.e. extreme aggression and/or highly disruptive behaviour)’ (Foxx, 1998, p. 69).

The token economy system used by Foxx was more complex than one that would typically be used for an individual child because it had to account for many different adolescent’s behaviours and backup reinforcer preferences. It ran for an initial 3 month preprogramme phase, then a 6 month implementation phase and finally a 7 month maintenance phase.

Target Behaviours

In this programme, behaviours were targeted for both increase and decrease. The target behaviours included increases in pro-social behaviours and decreases in physical aggression, property destruction, window breaking and manipulative self-abuse.

Type of Tokens

Each adolescent had a printed token card that would be punched with holes by a staff member. Each of these holes was regarded as 1 token or “point”.

This method of delivering positive reinforcement for not engaging in a behaviour is called “Differential Reinforcement of Other Behaviour” or DRO for short (for the purposed of this article do not concern yourself with this terminology).

Backup Reinforcers

As backup reinforcers, a lounge area was created and supplied with snacks/drinks, magazines, a jukebox, a pinball machine etc. and access was available to those with enough points.

Passes could be purchased to go into the facility grounds or into the local town, while things like bowling, skating, movies, trips to town, staying up late on weekends and dances could also be purchased with enough points.

Reinforcement Schedule

Points were given for engaging in pro-social behaviours but were also given when an adolescent did not engage in a target behaviour that was to be decreased.

Response Cost

A response cost was used where 10 points were lost if one of the adolescents engaged in verbal aggression toward another. An example given by Foxx (1998) was ‘I’m going to beat you up’ (p. 72). Although the primary intervention was the token economy, a time-out procedure was also implemented for certain behaviours.


Comparing the 7 month implementation and 6 month maintenance phases to the initial preprogramme phase respectively, window breaking was reduced by 36% and then 64%; the number of adolescents breaking windows dropped 58% and then 76%; the use of emergency mechanical restraints reduced by 79% and then 81%; the number of adolescents being restrained dropped 61% and 72%; the number of adolescents receiving psychotropic medications dropped 17% and 32%; PRN (pro re nata) medication reduced 70% and 73%; and the number of clients receiving PRN medication reduced 70% and then 73%.

Foxx (1998, p. 75) states that ‘both programmatic goals were accomplished because significant clinical reductions occurred in the use of emergency mechanical restraint, PRNs psychotropic medications and episodes of window breaking, and these effects were maintained.’

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