Effectiveness of Token Economy Therapy in Reducing Aggressive Behaviors Among Orphanage Children: A Pilot Study

ABSTRACT

Background:

Children in orphanages often display aggressive behaviours due to limited personalized care and emotional support. Token economy therapy, which uses positive reinforcement strategies, may offer a promising behavioural intervention in such settings. This pilot study evaluates the effectiveness of token economy therapy in reducing aggression among orphanage children.

Methods:

A quasi-experimental design was adopted involving 50 children aged 6–12 years from two orphanages in Pune, India. Stratified random sampling ensured balanced representation by age and gender. The intervention consisted of 20 biweekly token economy sessions over 10 weeks, wherein desirable behaviours were rewarded with tokens exchangeable for preferred items. Behavioural assessments were conducted pre- and post-intervention using the Strengths and Difficulties Questionnaire (SDQ). Wilcoxon signed-rank test was used for statistical analysis.

Results:

Pre-intervention, 76% of children had moderate behavioural difficulties and 24% had severe difficulties. Post-intervention, 36% exhibited normal behaviour and 64% showed only mild difficulties. Mean behavioural scores significantly decreased from 34.42 (±2.64) to 16.34 (±1.72) (Wilcoxon Z = 6.18, P < 0.0001). Improvements were consistent across all academic performance categories.

Conclusion:

Token economy therapy proved effective in significantly reducing aggressive behaviours among orphanage children. Its structured, reward-based approach may offer a scalable and cost-effective behavioural intervention in institutional care settings. Further studies are warranted to confirm long-term benefits across broader populations.

INTRODUCTION

Aggressive behavior is highly prevalent among children in orphanages; this usually results from a lack of attention and personal care.[1] These behaviors may, therefore, impede emotional and social development, hence making interventions necessary.[2] Token economy therapy, based on positive reinforcement, has been effective in changing aggressive behaviors.[3] Through the awarding of tokens that can be used in exchange for tangible rewards upon desirable action, this method encourages sustained behavioral improvement.[4] Although very effective in most settings, token economy therapy is rarely used in orphanages worldwide, especially in India. The study was designed to check its effectiveness in reducing the aggressive behaviors of children dwelling in orphanages.[5]

METHODOLOGY

This study is based on quasi-experimental design and focuses on the effectiveness of token economy therapy in reducing aggression in orphanage children. This study was conducted on two orphanages in Pune, India, and it consisted of 50 children who are in the age range of 6–12 years. The researcher used stratified random sampling to ensure adequate representation in all age groups as well as gender groups.

Inclusion and exclusion criteria

Children with moderate to severe aggressive behavior, as rated by the Strengths and Difficulties Questionnaire (SDQ), are included. Children with disabilities or other medical conditions leading to behavioral problems are not included.

Procedure for treatment

Token economy therapy was divided into 20 biweekly sessions spread over 10 weeks. Every session was conducted by experienced behavioral therapists and consisted of activities that encouraged positive social behavior and the regulation of emotions. The desirable behaviors, such as sharing, obedience to instructions, and conflict resolution, were reinforced with tokens. Tokens were exchanged for rewards in the form of toys, stationery, or extra time for play, according to the choices of the participants.

Data collection

Conduct pre- and post-test using the SDQ behavioral scale. The session is complemented by maintaining observational notes of each session to see behavioral changes and interventions.

Statistical analysis

The descriptive statistics are reported regarding the demographic information and comparison of the scores at two measurement time points. Due to its nonparametric nature, behavioral scores were assessed using a one-tailed Wilcoxon signed-rank test, noting the potential for skew or kurtosis.

RESULTS

This study assessed the effectiveness of token economy therapy in reducing aggressive behaviors among 50 orphanage children. The results are summarized below, with detailed interpretations provided for each table.

Demographic characteristics of the study population

Table 1 presents the demographic distribution of participants, highlighting age, gender, admission age, years of stay, and academic performance.

Table 1.

Demographic characteristics of orphanage children

Characteristic	Category	Frequency (n=50)	Percentage (%)
Age (years)	6–8	24	48.0
	9–10	13	26.0
	11–12	13	26.0
Gender	Male	25	50.0
	Female	25	50.0
Age of admission	1–2	5	10.0
	3–4	26	52.0
	5–6	19	38.0
Years of stay	1–3	12	24.0
	4–6	26	52.0
	7–9	12	24.0
Academic performance	Poor	9	18.0
	Average	28	56.0
	Good	13	26.0

Pre- and postintervention behavioral scores

Table 2 shows the classification of aggressive behavior scores before and after the intervention, indicating a significant reduction in problem severity.

Table 2.

Classification of aggressive behaviors (pre- and post-test)

Behavior Scores	Pre-test (n=50), n (%)	Post-test (n=50), n (%)
1–20 (normal)	0 (0)	18 (36)
21–40 (mild)	0 (0)	32 (64)
41–60 (moderate)	38 (76)	0 (0)
61–80 (severe)	12 (24)	0 (0)

Effectiveness of token economy therapy

Table 3 compares the mean behavioral scores before and after the intervention, showing a statistically significant improvement.

Table 3.

Pre- and post-test behavioral scores

Measurement	Pre-test (Mean±SD)	Post-test (Mean±SD)	Wilcoxon Z Value	P
Behavioral Scores	34.42±2.64	16.34±1.72	6.18	<.0001

Behavioral scores by academic performance

Table 4 evaluates the association between behavioral scores and academic performance, showing improvement across all categories postintervention.

Table 4.

Comparison of behavioral scores by academic performance

Academic Performance	Pre-test (Mean±SD)	Post-test (Mean±SD)	P
Poor	37.33±2.65	17.89±1.54	<.0001
Average	33.96±2.33	16.25±1.58	<.0001
Good	33.38±1.85	15.46±1.51	0.003

DISCUSSION

This study, therefore, is proof of the efficacy of token economy therapy in helping to decrease the aggressive behaviors of children at an orphanage.[6] All the participants showed improvements that fall into the normal or mild categories after treatment.[7] This shows that indeed, this therapy impacts changes positively.[8] The method does this by using tokens as tangible reinforcements, bridging abstract behavioral expectations with concrete rewards.[9] The simplicity and flexibility of token economy therapy make it suitable for limited resource environments and individualized attention. It is specifically relevant in orphanage settings where structured and scalable interventions are needed to address the emotional and behavioral challenges faced by children.[10]

The findings, though promising, limit the generalizability of this pilot study because of a small sample size and short intervention period. Further research on large populations and long-term outcomes could validate these findings and be integrated into other psychosocial interventions.

CONCLUSION

This showed that token economy therapy reduced aggression in orphanage children quite significantly, thus showing the efficacy of this intervention and its cost-effectiveness and scalability. The study emphasizes the value of structured reinforcement in improving psychological well-being and fostering positive behaviors. Further studies will be required to verify the outcomes and assess long-term benefits.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.