Use of differential reinforcement to reduce behavior problems in adults with intellectual disabilities: a methodological review.
Do the prep work—functional assessment and preference assessment—before you start DR with adults with ID.
01Research in Context
What this study did
Chowdhury et al. (2011) looked at 31 older papers that tested differential reinforcement with adults who have intellectual disabilities. They did not pool numbers. Instead they scored how well each study was designed and how DR was used.
The team asked: Was DR tried alone, mixed with other tactics, or skipped? They wanted to see which setup got reported most and what steps authors left out.
What they found
DR worked by itself in 15 studies. It was part of a package in 10 studies. It failed when used alone in 6 studies. The authors noted that many papers skipped functional assessment or preference assessment.
In short, half the time DR alone was enough, but basic prep steps were often missing.
How this fits with other research
Khokhar et al. (2025) now supersedes this review. Their 2025 paper looked at 42 studies and found that combining several ABA tactics gives bigger drops in problem behavior than DR alone. They also showed most adult-ID studies still lack strong design.
Single-case gems inside the 2011 pool tell the same story. Demello et al. (1992) used one DRA plan tied to a functional analysis and cut SIB, aggression, and boosted self-care for one man. Butler et al. (2021) got fast drops in stereotypy with simple DRO in an adult with autism. These successes had clear assessments up front.
The 6 failures in Monali’s count line up with Khokhar’s point: when DR is used without assessment or without extra tactics, it can fall flat.
Why it matters
Before you run DR with any adult who has ID, run a functional assessment and a preference assessment. These two steps show up in every strong single-case study and are still the most skipped steps in the wider literature. Start there and you move yourself from the ‘failed alone’ group to the ‘worked alone’ group.
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02At a glance
03Original abstract
The least-restrictive-alternative guideline for providing treatment emphasizes the use of non-aversive procedures to reduce maladaptive behaviors in individuals with intellectual disability (ID). Differential reinforcement (DR) is an excellent example of such a non-aversive, reinforcement based behavioral intervention. The purpose of this literature review was to summarize and provide a methodological analysis of studies, conducted between 1980 and 2009, using a DR contingency to reduce problem behaviors in adults with ID. A total of 31 studies were located that met the inclusion criteria. Of these, 15 reported DR to be an effective intervention when used independently. Of the remaining, 10 studies found DR to be useful as part of a treatment package, and six found a DR contingency used independently to be ineffective, and only observed treatment effects when an aversive component was added. Very few studies assessed the use of DR in older adults and in individuals with mild ID; these reflect areas of future research. A methodological analysis found that several studies did not report information on key methodological variables; for example, conducting a functional analysis and a stimulus preference assessment to guide choice of treatment and reinforcers, thinning very dense DR schedules, assessing collateral behaviors, generalization of behavior change across settings and implementers, and following up treatment outcomes over time. The overall positive findings about the effectiveness of DR are encouraging; however, more methodologically robust studies would serve to make such findings more conclusive and practically relevant for implementation in natural settings for adults with ID.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2010.11.015