A mand analysis and levels treatment in an outpatient clinic

An adolescent with severe mental retardation and fragile X syndrome who displayed destructive behavior maintained by positive reinforcement in the form of adult compliance with mands was assessed and treated in an outpatient setting. A levels system treatment was assessed, consisting of a continuum of attention and reinforcement ranging from access to the functional reinforcer in level 3 contingent upon appropriate behavior to a 10 min room time‐out for level 1 contingent upon aggressive and dangerous behavior. While the efficacy of this treatment has been demonstrated in an inpatient setting (Hagopian et al., 2002), this application extended the findings to outpatient and community settings. The levels system treatment resulted in a 98.1% reduction in destructive behavior from baseline levels. Treatment was successfully transferred to the home and school and reductions were maintained at 6 and 9 months. Treatment acceptability ratings were high across both home and school staff. Copyright © 2003 John Wiley & Sons, Ltd.