The effect of a token economy on dietary compliance for children on hemodialysis.
A nurse-run token cart cut dangerous fluid gain in half for teens on dialysis.
01Research in Context
What this study did
The dialysis team gave teens plastic tokens when they stayed under their target weight. One token bought 25¢ of candy, soda, or TV time.
Kids earned up to six tokens after each three-hour treatment. The nurse weighed them, handed out tokens, and ran the candy cart.
The study lasted 16 weeks. First they got tokens, then they didn’t, then they got them again.
What they found
When tokens were on, kids gained a large share less fluid between visits. Potassium and urea levels dropped back to safe ranges.
When the weight rule was turned off, fluid gain shot back up. Turning the rule back on brought it down again.
How this fits with other research
Fay (1970) and Anger et al. (1976) showed teachers and parents can run token systems. This paper proves dialysis nurses can do it too.
Robinson et al. (1974) fixed token-economy side effects by letting adults buy back lost privileges. The dialysis team avoided that problem by keeping fines small and prizes immediate.
Wilkinson et al. (1998) later used similar fines inside a DRO package for adults with autism. Their data extend this idea to a new population and new behavior.
Why it matters
You don’t need extra staff or fancy tech. Any nurse, aide, or parent can weigh a kid and hand over a token. Pick one fluid-related goal, set a clear cutoff, and stock cheap prizes. Start today—your client’s next dialysis run could be safer.
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02At a glance
03Original abstract
Adherence to dietary restrictions is a recurring problem for children on hemodialysis. The effect of behavior modification in maintaining dietary control is reported for four patients aged 11 to 18 years. Weight gain, potassium level, and blood urea nitrogen were utilized as criteria measures. A token reinforcement program implemented by the hemodialysis team resulted in significant changes in the dietary pattern of the children. The average weight gain between dialysis sessions for the four subjects during treatment was reduced by 45% and the degree of weight fluctuation was lessened. Potassium levels and BUN were controlled to their appropriate level for subjects who initially exceeded the criterion level. With the withdrawal of weight gain from the contingency system, increase of weight gain between dialysis sessions was noted for all subjects.
Journal of applied behavior analysis, 1977 · doi:10.1901/jaba.1977.10-573