Use of a token economy to increase compliance during hemodialysis.

Doctors set up a token economy for a 10-year-old on dialysis.

Each time the child followed medical instructions he earned plastic tokens.

Tokens could be traded for small toys and snacks right after treatment.

The team used an ABAB design: tokens on, tokens off, tokens on again.

Compliance jumped when tokens were available and fell when they stopped.

Gains returned and stayed strong when the system came back.

Three and six months later the child was still cooperative without tokens.

Toegel et al. (2025) later showed the same idea works for adults.

Their HIV patients earned money for undetectable virus levels and stayed healthy even when payments thinned.

Wilson et al. (1975) used tokens in a classroom and got the same fast boost in work completion, proving the trick works across settings.

Lea et al. (1977) gives a warning: when staff watch less, they hand out too many fines.

Close supervision kept the dialysis program fair and positive.

If a child refuses dialysis, you can start a token board tomorrow.

Pick one clear behavior, deliver tokens right away, and trade for small prizes.

Track data across sessions and fade to praise once the routine sticks.

The gains can last half a year or more, saving medical staff time and stress.