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This case study describes the use of functional assessment in combination with experimental functional analysis as methods for informing and evaluating individualized treatment in a large residential treatment setting for adolescents. The case of John, a normally developed 12-year-old male, illustrates how functional information can be used to derive a simple treatment that can be effective in modifying previously intractable and highly disruptive behavior. Challenges associated with maintenance of treatment over time are described in relation to John’s follow-up status. Finally, recommendations are made about the utility of functional methodologies within residential care settings and the need for ongoing experimental evaluation testing limits of such methodologies.

Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the "nonresponse" of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.