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Journal of Pediatric Psychology Advance Access published online on September 26, 2008
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsn101
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© Published by Oxford University Press on behalf of the Society of Pediatric Psychology 2008.

A Token Economy for Exercise Adherence in Pediatric Cystic Fibrosis: A Single-Subject Analysis*

Rebecca S. Bernard, PhD1, Lindsey L. Cohen, PhD2 and Kathryn Moffett, MD3

1Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 2Georgia State University, and 3West Virginia University

All correspondence concerning this article should be addressed to Rebecca S. Bernard, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford University School of Medicine, Stanford, CA 94305-5719, USA. E-mail: ReBernard{at}stanfordmed.org


  Abstract

Objective In cystic fibrosis (CF), adherence to airway clearance techniques (e.g., chest physiotherapy and exercise) is poor. Exercise is important because pulmonary difficulties are associated with the highest mortality rate. Despite this, very little research has focused on exercise adherence in CF. This study examined a token economy for increasing exercise in children with CF. Methods An ABAB single-subject design evaluated a token economy for increasing and maintaining exercise in three children with CF. Patient report, parent report, and physiological measures were used to assess treatment integrity, medical stability, and changes in exercise. Results Measures suggested that treatment integrity was strong. Results indicated strong treatment effects for all participants without negative medical side effects. Follow-up of 1 and 3 months supported continued exercise for all participants. Conclusions A token economy effectively increased exercise in children with CF, and the single-subject design highlighted some of the intricacies of individualized treatment of adherence. Implications and recommendations for further research are discussed.

Key words: adherence; cystic fibrosis; reversal design; single-case designs.

*This article is based on the dissertation of Dr Bernard under the direction of Dr Cohen, at West Virginia University.

Received May 6, 2008; revision received August 27, 2008; accepted September 3, 2008


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