A Viewpoint on Token Economies

Bo Hejlskov Elvén is a Swedish clinical psychologist and author of several books on challenging behavior. He is also part of the Studio 3 Low Arousal Approach group. You may have heard Bo present at one of our Canadian conferences in Vancouver, Halifax, or Edmonton.

Bo has a wonderful website where he blogs in English on a variety of topics around disabilities. His insight into challenging behaviour can change minds and perceptions on how we view and support people with disabilities. He is our guest blogger this week on the subject of token economies.

Token economies had a negative effect on our daughter in her school years and she is now talking about it in detail as a young adult. She always felt she was being punished for having autism and felt misunderstood. It made her mistrustful of her teachers and aides who used this system as she could never depend on it for a positive outcome or reward for trying her best on any given day.

In this blog, Bo Hejlskov Elvén talks about the negative effects of token economies and how they play out. We can do better and not using them can help us build a stronger, more positive relationship with the person we are supporting.

On Token Economies

by Bo Hejlskov Elvén

In many care settings I visit, primarily in the field of children, different systems are being used to reward good behaviour. The simplest ones are about getting a biscuit if you go for a walk, and the most complex ones are made up of smileys or coins you can get for certain desirable behaviours and then you can exchange these smileys or coins for different experiences, excursions, sweets or gadgets. This way of thinking comes from some studies mainly of school situations, where children receive rewards from participating in learning situations.

It is easy to understand why staff use token economies. They’re usually extremely effective just when they’re introduced, and staff often experiences a significantly better motivation in the people they work with. But it rarely stays that way, and there are also some side effects that very well might mess things up in the long run. In 2012, the Swedish National Board of Health wrote a report describing how in supervision of various care settings they’d found that token economies in many cases weren’t being used according to available research, but rather had become systems of punishment. They also concluded that there is no scientific evidence for using token economies in social work.

The negative side effects you may encounter are:

1. Legitimizing effects. A young man I worked with found it hard to get to school on time. He was often half an hour late. The staff in his student home introduced a token system where he received a token for every day he was in time for school. The tokens could then be exchanged for movie tickets, 5 tokens for each movie ticket. The system had a good effect the first week, and already the first weekend he could go to the movies. The same outcome next weekend. The third weekend he didn’t come to school at all on Monday, and on Tuesday at 10 o’clock the school staff called and asked him if he wasn’t coming to school. He said, ”No, there are no good movies this week”. The system had meant that he shifted the focus from going to school to going to the movies, and removed the bad conscience he usually had when he didn’t get to school on time. And the total absence increased.

2. Joy reduction effect. When I received my first salary, it was an amazing feeling. For each time I got my salary the first year it decreased. Nowadays it’s mostly a relief to get it. So the joy of reward has decreased over time. Perhaps because when I was young, I wasn’t sure I was worth the salary. Nowadays, I think, like most people, that I’m worth more! The same is true when reward is an integral part of pedagogy. After a few years, inflation has become so great that it costs one video game a week to make everyday life work, but the reward doesn’t bring any joy to the child anymore because the child thinks s/he is worth it. I find it extremely sad to see a 13-year-old who isn’t thrilled about a reward. How poor quality of life it must be, a joyless life.

3. Inflation effect. All token economies involve a negotiation. We assess how little reward we can offer to get the behaviour we want. If the child accepts the reward, it works; although all negotiations mean that after a while the child may try to increase the salary. It often happens over time. The child requires bigger and bigger rewards for the same behaviour, but becomes less and less happy for the reward.

4. Punishing effect. We often describe it as a reward to get a smiley if you arrive on time. It becomes a system when you can exchange ten smileys for an activity or the like. If a child is late, and therefore doesn’t get a smiley, it is often perceived as a punishment by the child. And, unfortunately, punishment doesn’t have the positive effect we think it has. A great part of the Swedish National Board of Health’s criticism was that the child described it as a penalty while the staff described it as missing a reward. It can also sometimes lead to conflicts, if the child doesn’t think the wrongdoing was on purpose.

5. The oppositional effect. A reward is basically a part of a power relationship. The adults decide what to reward and even when the child has lived up to it. It puts the child and the adult in an oppositional relationship. Some psychologists try to avoid this by discussing everything with the child and letting the child him/herself make suggestions for rewards and when they are to be distributed, and that is good, but in most cases it is the adult who decides.

Oppositional relationships mean that someone has to win. Initially, the adult is set to be the winner, but I have experienced many children who don’t buy it but actively oppose the adults. I don’t think that’s strange, but it means that the pedagogical alliance is in danger. In my work, we instead aim for cooperation, and then the reward systems can be a problem. The systems counteract the cooperation due to the built-in power structure.

I find it interesting  to think about what it is in the method itself that makes us so easily start using it in the wrong way. One reason may be that token economies are very close to regular upbringing. I have in another blog post written about hitting the skill ceiling, and perhaps that’s what happens. When a method is very similar to the methods we resort to when we hit the skill ceiling, it can be difficult to know exactly where the boundary goes.

Then we have a common human tendency to try to repeat the experience of success. Often there will quickly be a positive effect of rewards, and we want to repeat the rush of success. But that rush is like the initial rush of alcohol: It cannot be maintained. At first, it’s awesome, but then we become more and more unwieldy while trying to get the first kick again. And we continue to believe that’s possible long after we really should’ve realized we won’t. Another difficulty is that the child doesn’t want to shut down the system. They get gadgets, sweets or experiences. Removing the system would mean the end of that.

In some cases, I have removed the token economies. We’ve done this by continuing to pay the reward while also making it clear that the child doesn’t have to do anything to deserve it. We usually say that we think the child definitely deserves the nice things, but no longer needs to work for it. After a while, often months, we can then replace them with more substantial experiences and excursions. Often we see the joy return, the alliance being built up and the trust in the staff increase quite quickly. But also the desire to do the right thing.

Sometimes when I talk about token economies, some psychologists oppose. They argue that there is evidence, and they think that the Swedish National Board of Health’s interpretation of the research situation is wrong. I’m not going to go into that discussion. What I think is important is that in my work I rarely see those work, but find that there are other collaboration-based methods that do. They also have evidence. The fact that there is evidence for a method doesn’t mean that it’s always the right thing to do because other factors also are in play. So, I usually argue that psychologists very well might be able to make a token economy work, but the majority of token economies are not made by psychologists with 5 years of education and three years of psychotherapist training in CBT. Most of them are rather made by teachers and treatment assistants with significantly less education, and often training in another field than behavioral therapeutic methodology, which means that the vast majority of reward systems for natural reasons are quite amateurish. That should be enough of an argument to stay clear of them.

This blog post should not be seen as a criticism of CBT, applied behaviour analysis or behaviorism. It should be seen as a criticism of a specific application that is difficult to handle and has side effects. But I also want to take care to say that most of the problems you try to solve with token economies and reward systems can be solved more easily. Please read what I’ve written about making demands in both mine and Ross Greene’s books on how to work with children with special needs.