This study focuses on outpatient behavioral management of oppositional-defiant teenagers that engage in aggressive behaviors. Sixteen subjects, 13 male and three female, are followed through an alternating treatment, single case design, ABCD: baseline; cognitive therapy coupled with the REST (Real Economy System for Teens) program for parental outpatient behavioral management; combined cognitive, REST, and response cost; and finally REST with response cost to control aggressive behaviors. The response cost was designed to control aggression. Response cost involved the parents identifying seven reinforcers, objects, and activities that are important to the teen. They are rank ordered, with item one being most important and item seven being least important. An aggressive act means the loss of an item for 1 year, beginning with item seven and progressing upward.
This study finds that aggressive behaviors do not decrease with cognitive therapy and the REST program. When the more stringent response cost program is implemented in addition to the cognitive and REST techniques, the acts of aggression do respond to treatment. Thus, it is concluded that adding a stringent parent management response cost program offers a tool therapists can use in treating aggressive, oppositional-defiant teenagers on an outpatient basis without the need for hospitalization.