Behavioral covariation in the treatment of delusional verbalization with contingency management.

A 23-year-old female with the dual diagnosis of mild mental retardation and emotional disturbance was referred for treatment because of frequent disruptive outbursts. A brief inpatient behavior analysis suggested that delusional verbalization reliably preceded all other aberrant behaviors. Consequently treatment focused mainly on delusional verbalization; the additional aberrant behaviors were observed for behavioral covariation. The treatment package consisted of verbal instructions, modeling of appropriate eating behaviors, contingent verbal reprimand and a 2-min removal of food, and differential reinforcement of other behaviors. The design was a multiple baseline across settings. Results indicate a marked decrease in delusional verbalization in all settings, and, a correlated decrease for disruption, screaming, and out-of-seat behaviors.