A review of empirical support for differential reinforcement of alternative behavior.

The authors pulled every DRA paper they could find from 1980 to 2008. They kept only studies that used DRA to cut destructive behavior or food refusal in people with developmental delays. The final pile held 116 single-case experiments.

Each paper was scored against the Task-Force rules for “well-established” treatments. The team asked: did DRA beat baseline, did others copy the effect, and did it work in more than one lab?

DRA passed every test. The review labels it “well-established” for both destructive behavior and food refusal. The evidence spans mild to severe cases and many settings.

Briggs et al. (2019) extends the story. They show DRA still works when you skip extinction—just boost reinforcer size or quality. That option was too new to appear in the 2009 data set.

Ulloa et al. (2020) adds a practical twist. They found the same DRA-plus-extinction package keeps working even when staff follow only 20–40 % of the steps. This tells us the treatment is sturdy, not fragile.

Brown et al. (2020) sounds like a contradiction at first. They saw equal resurgence whether extinction was used or not. The key is timing: during treatment, extinction gives faster suppression; after treatment ends, relapse risk is the same either way.

You now have a green light to use DRA for hitting, self-injury, or plate-throwing at the table. If parents or staff refuse to block escape, try Briggs’ big-reinforcer route. If integrity slips, Gabriella’s data say you still have wiggle room. Expect some resurgence later and plan booster sessions accordingly.