Outpatient behavioral management of aggressiveness in adolescents: A response cost paradigm

This study focuses on outpatient behavioral management of oppositional-defi ant teenagers that engage in aggressive behaviors. Sixteen subjects, 13 mal e and three female, are followed through an alternating treatment, single c ase design, ABCD: baseline; cognitive therapy coupled with the REST (Real E conomy System for Teens) program for parental outpatient behavioral managem ent; combined cognitive, REST, and response cost; and finally REST with res ponse cost to control aggressive behaviors. The response cost was designed to control aggression. Response cost involved the parents identifying seven reinforcers, objects, and activities that are important to the teen. They are rank ordered, with item one being most important and item seven being l east important. An aggressive act means the loss of an item for 1 year, beg inning with item seven and progressing upward. This study finds that aggressive behaviors do not decrease with cognitive t herapy and the REST program. When the more stringent response cost program is implemented in addition to the cognitive and REST techniques, the acts o f aggression do respond to treatment. Thus, it is concluded that adding a s tringent parent management response cost program offers a tool therapists c an use in treating aggressive, oppositional-defiant teenagers on an outpati ent basis without the need for hospitalization. (C) 1999 Wiley-Liss,Inc.