Positive reinforcement as treatment for problem behavior maintained by negative reinforcement.

Carter et al. (2013) wrote a narrative review. They looked at studies where problem behavior was kept going by escape from demands. The twist: only positive reinforcement was used to treat it. No extinction, no escape blocking.

The authors pulled together early lab and clinical cases. They wanted to see if goodies alone could cut escape behavior.

The review found a pattern. In several small studies, giving preferred items or attention reduced escape-maintained problem behavior. Extinction was never part of the package.

The data were thin but consistent. Positive reinforcement sometimes replaced the need to escape.

HENDRY et al. (1963) showed the flip side. Rats on an escape schedule quit working without added positive reinforcement. The 2013 review flips that idea: if you add strong positive reinforcers, humans may also stop escaping.

Gardner et al. (2009) extends the story. Two children kept doing math while still allowed short breaks. High-quality attention overrode the escape pull, matching the review’s claim.

Dickson et al. (2005) used differential negative reinforcement of compliance (DNRA). Problem behavior dropped even though escape was still available on a lean schedule. This clinical case fits the review’s theme: manipulate reinforcement, not just remove escape.

Frank-Crawford et al. (2021) compared big end-of-work breaks with tiny frequent ones. Accumulated positive and negative reinforcers worked as well as distributed ones. The study echoes the review: positive reinforcers can stand in for escape without hurting success.

Before you add extinction, test a favorite toy, snack, or praise. If it cuts problem behavior, you spare the client from escape blocking and the staff from escalation. Start with a brief reinforcer assessment during the usual demand. If it fails, you can still add extinction later.