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1- Read only pages 431-443

2- after reading create 2 questions that you might still have regarding the reading. something you dont understand about the article. they must be 2 questions. also answer them.

431

JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2002, 35, 431–464 NUMBER 4 (WINTER 2002)

ON THE STATUS OF KNOWLEDGE
FOR USING PUNISHMENT:

IMPLICATIONS FOR TREATING
BEHAVIOR DISORDERS

DOROTHEA C. LERMAN AND CHRISTINA M. VORNDRAN
LOUISIANA STATE UNIVERSITY AND

THE LOUISIANA CENTER FOR EXCELLENCE IN AUTISM

In this paper, we review basic and applied findings on punishment and discuss the im-
portance of conducting further research in this area. The characteristics of responding
during punishment and numerous factors that interact with basic processes are delineated
in conjunction with implications for the treatment of behavior disorders in clinical pop-
ulations. We conclude that further understanding of punishment processes is needed to
develop a highly systematic, effective technology of behavior change, including strategies
for improving the efficacy of less intrusive procedures and for successfully fading treat-
ment.

DESCRIPTORS: behavior disorders, functional analysis, punishment, treatment

Punishment is generally defined as an en-
vironmental change contingent on behavior
that produces a decrease in responding over
time (Michael, 1993). Numerous procedural
variations of punishment have been devel-
oped for clinical use. Results of research con-
ducted over the past four decades have
shown that punishment is effective in reduc-
ing problem behavior in clinical popula-
tions, and in some cases, may be an essential
component of treatment (see Kazdin, 2001,
and O’Brien, 1989, for reviews of this lit-
erature). However, more knowledge is need-
ed about factors that may influence the ef-
fects of punishment on problem behavior.
Few strategies have been identified for en-
hancing the effectiveness of less intrusive
punishment procedures, for attenuating un-
desirable aspects of punishment, or for suc-
cessfully fading treatment with punishment.

The direct and indirect effects of punish-

We thank Don Baer, Alan Baron, Linda LeBlanc,
Tony Nevin, and the anonymous reviewers for their
comments on earlier versions of this paper.

Reprints may be obtained by contacting Dorothea
C. Lerman, 236 Audubon Hall, Louisiana State Uni-
versity, Baton Rouge, Louisiana 70803 (e-mail:
dlerman@lsu.edu).

ment have been studied extensively in the
laboratory. Nevertheless, basic research on
punishment has been declining rapidly de-
spite substantial gaps in knowledge (Baron,
1991; Crosbie, 1998). The generality of basic
findings to clinical populations and problems
also is questionable (Hayes & McCurry,
1990). Most studies evaluated the effects of
intense, unconditioned punishers (e.g., elec-
tric shock), and a number of important re-
lations have not yet been replicated with hu-
mans or clinically relevant punishers.

The purpose of this paper is to review ba-
sic and applied research findings on punish-
ment, identify gaps in the literature, and dis-
cuss the implications of these findings for the
use of punishment in clinical settings. Basic
findings that contradict common assump-
tions about punishment effects found in text-
books and review papers and that help elu-
cidate inconsistent results on punishment in
the applied literature are highlighted. The
main premise of this paper is that further un-
derstanding of punishment processes may
lead to an improved technology of behavior
change. We extend the most recent review
papers on punishment (Matson & Di-
Lorenzo, 1984; Van Houten, 1983) by (a)

432 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

providing a broader overview of the direct
and indirect effects of punishment and fac-
tors that influence basic processes (e.g., his-
tory), (b) identifying areas in need of further
research from both basic and applied litera-
tures, and (c) discussing recent research find-
ings on punishment within the context of ad-
vances in the functional analysis of behavior.1

Some authors have suggested that addi-
tional applied research on punishment is un-
necessary in light of refinements to the func-
tional analysis methodology and treatment
with reinforcement (Donnellan & LaVigna,
1990; Guess, Helmstetter, Turnbull, &
Knowlton, 1987). Results of numerous stud-
ies conducted over the past 15 years have
shown that the function of problem behav-
ior often can be determined and that this
information can be used to develop treat-
ments based on extinction, reinforcement,
and other processes such as establishing op-
erations (e.g., Iwata, Pace, Dorsey, et al.,
1994). Nevertheless, punishment may be
critical to treatment success when the vari-
ables maintaining problem behavior cannot
be identified or controlled (for further dis-
cussion, see Axelrod, 1990; Iwata, Vollmer,
& Zarcone, 1990; Vollmer & Iwata, 1993).
Punishment also may be preferable to rein-
forcement-based treatments when problem
behavior must be suppressed rapidly to pre-
vent serious physical harm (Dura, 1991; see
also Iwata et al.; Vollmer & Iwata). More
important, results of several studies indicate
that treatments derived from functional
analyses (e.g., differential reinforcement of
alternative behavior [DRA]) may not always
reduce behavior to clinically acceptable levels
without a punishment component (e.g.,
Grace, Kahng, & Fisher, 1994; Hagopian,
Fisher, Sullivan, Acquisto, & LeBlanc, 1998;
Wacker et al., 1990).

1 Much of the applied research on functional anal-
ysis and treatment of behavior disorders has been con-
ducted with individuals diagnosed with developmental
disabilities. Thus, this review reflects this emphasis.

Knowledge about punishment also is im-
portant because common treatments that are
associated with other processes may in fact
reduce problem behavior through the mech-
anism of punishment. For example, proce-
dures such as response blocking, guided
compliance, and the application of protec-
tive equipment are often presumed to reduce
problem behavior by terminating the rein-
forcement contingency that maintains the
response (i.e., through extinction; e.g., Reid,
Parsons, Phillips, & Green, 1993; Rincover,
1978). Research findings suggest that these
procedural variations of extinction may
function as punishment instead of, or in
combination with, extinction (e.g., Lerman
& Iwata, 1996b; Mazaleski, Iwata, Rodgers,
Vollmer, & Zarcone, 1994). Some authors
also have suggested that the contingent loss
of reinforcement associated with differential
reinforcement procedures (e.g., differential
reinforcement of other behavior [DRO])
may constitute a form of punishment (e.g.,
Rolider & Van Houten, 1990). Thus, the
process of punishment may underlie a num-
ber of popular function-based treatments.

Functional analysis methodology now
permits more precise investigations of im-
portant environment–behavior relations in
the area of punishment. Basic findings in-
dicate that various parameters of reinforce-
ment influence the direct and indirect effects
of punishment and interact with nearly ev-
ery other factor that has been found to in-
fluence responding during punishment (e.g.,
punishment schedule and magnitude). Such
interactions have important clinical impli-
cations because punishment is more likely to
be used when the response–reinforcer rela-
tion cannot be terminated completely. In ap-
plied studies, important reinforcement vari-
ables identified via functional analysis could
be manipulated prior to and during punish-
ment, even when the behavior is maintained
by nonsocial consequences (i.e., the behavior
is maintained in the absence of socially me-

433PUNISHMENT

diated reinforcers, such as attention, tangible
items, and escape from instructions; see, e.g.,
Lerman & Iwata, 1996b).

Important issues related to the ethics and
acceptability of using punishment to treat
problem behavior in individuals with devel-
opmental disabilities have been the subject of
numerous articles over the past 30 years. An
overview of these issues is beyond the scope
of this paper but can be found in a variety
of sources (see Donnellan & LaVigna, 1990;
Emerson, 1992; Guess et al., 1987; Jacob-
Timm, 1996; Sidman, 1989; Van Houten et
al., 1988). Suggestions for further applied
studies on punishment are made throughout
this paper, with the assumption that pertinent
guidelines and cautions about the application
of punishment will accompany published re-
search findings (see Alberto & Troutman,
1999; Lovaas & Favell, 1987; Matson &
DiLorenzo, 1984).

Ultimately, the consumers of behavioral
technologies (e.g., clinicians, caregivers) will
determine which treatments are used with
individuals with developmental disabilities
(see Iwata, 1988, for a cogent discussion of
this issue). These decisions are at least partly
guided by information generated by the sci-
entific community. Safe, acceptable, and
highly effective technologies of behavior
change should be available to consumers
who request them, including procedures that
are based on punishment.

Basic and applied research findings on
clinically relevant factors that influence the
direct effects of punishment will be discussed
in the first half of the paper. Other charac-
teristics of punished responding, including
maintenance, generalization, and side effects,
will be discussed in the second half.

FACTORS THAT INFLUENCE
THE DIRECT EFFECTS

OF PUNISHMENT
Much of the basic research on the direct

effects of punishment was conducted more

than 30 years ago with nonhumans (see
Azrin & Holz, 1966, for a review of this
literature). Procedural variations of punish-
ment examined in the laboratory have in-
cluded the delivery of stimuli, often called
positive punishment, and the removal of stim-
uli, often called negative punishment (i.e., re-
sponse cost, time-out from positive rein-
forcement).2 The majority of studies, how-
ever, employed contingent electric shock. In
the earliest basic studies, the effects of pun-
ishment were evaluated while the punished
response was undergoing extinction (e.g.,
Estes, 1944; Skinner, 1938; Thorndike,
1932). However, in most subsequent studies,
punishment contingencies were introduced
with no change in the prevailing reinforce-
ment schedule. This latter arrangement as-
sured a certain level of responding by which
to examine the effects of punishment inde-
pendently of those produced by extinction
(Azrin & Holz, 1966). Complex interactions
between reinforcement and punishment pro-
cesses also could be evaluated. A number of
authors suggested that this laboratory ar-
rangement may be more pertinent to appli-
cation because punishment is most likely to
be used when the reinforcer that maintains
problem behavior cannot be identified or
controlled (Azrin & Holz, 1966; Dinsmoor,
1952).

In fact, the function of problem behavior
was not determined prior to treatment in
most clinical studies on punishment. Pun-
ishment thus was superimposed on an un-
known schedule of reinforcement that likely
took the form of extinction when the be-
havior was maintained by social consequenc-

2 Consistent with previous articles and chapters on
punishment, few distinctions will be drawn between
positive and negative punishment in this review. Cur-
rent research findings suggest that the procedures are
associated with similar direct and indirect effects on
responding. Nevertheless, the literature on positive
punishment far exceeds that on negative punishment.
Basic processes may differ in important ways under
these two forms of punishment.

434 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

es (Iwata, Pace, Cowdery, & Miltenberger,
1994). That is, social consequences that may
have maintained responding during baseline
(e.g., verbal reprimands, escape from in-
structions) often were removed with the in-
troduction of punishment. A substantial
portion of applied findings thus may have
little generality to contemporary treatment
approaches because punishment is most like-
ly to be used when problem behavior con-
tinues to produce reinforcement. Basic find-
ings suggest that reinforcement parameters
can influence the effects of punishment in
important ways.

THE DIRECT EFFECTS
OF PUNISHMENT

Basic research findings have shown that
response-contingent shock, noise, blasts of
air, response cost, and time-out can produce
a rapid decrease in the frequency of behavior
and, in some cases, may lead to complete
response suppression in rats, pigeons, mon-
keys, and humans (e.g., college students,
psychiatric patients; Azrin, 1960; Crosbie,
Williams, Lattal, Anderson, & Brown,
1997). Several studies with humans and
nonhumans also found that the initial re-
ductive effects of punishment with shock or
point loss occurred more rapidly, or to a
greater extent, than those produced by ex-
tinction, satiation, and differential reinforce-
ment (e.g., Holz & Azrin, 1963; Johnson,
McGlynn, & Topping, 1973; Rawson &
Leitenberg, 1973).

The potential benefit of using punish-
ment to treat intractable behavior problems
led to the development of numerous punish-
ment procedures for clinical use. Results of
research have shown that treatment with a
wide variety of punishers (e.g., verbal repri-
mands, restraint, water mist, lemon juice,
shock, removal of reinforcing activities or
conditioned reinforcers) can produce an im-
mediate, substantial suppression in problem
behavior (see Kazdin, 2001, and Matson &

DiLorenzo, 1984, for reviews of this litera-
ture). Applied findings also indicate that the
effects of punishment are superior to those
obtained with less intrusive procedures
alone, such as differential reinforcement
(e.g., Barrett, Matson, Shapiro, & Ollen-
dick, 1981; Favell et al., 1982; Scotti, Evans,
Meyer, & Walker, 1991). Although results
of such comparisons are consistent with
those obtained in the laboratory, the findings
are difficult to interpret because numerous
parameters likely influence the effects of
these behavior-reduction procedures. For ex-
ample, a dense schedule of differential rein-
forcement may reduce behavior more effec-
tively than a mild punisher.

More important, the relative efficacy of
treatment with reinforcement versus punish-
ment likely depends on a variety of factors
(e.g., history; use of extinction; type,
amount, and schedule of the consequence).
These complex interactions need to be eval-
uated to generate more definitive findings
about the suppressive effects of punishment
relative to other procedures. Further research
on strategies to improve the efficacy of pun-
ishment would be more pragmatic over the
long run than additional, complex compar-
ative studies of reinforcement versus punish-
ment.

Several authors have suggested that treat-
ment with punishment is so effective be-
cause punishment usually can compete suc-
cessfully with reinforcement contingencies
that maintain problem behavior (e.g., Van
Houten, 1983). Although punishment often
was confounded inadvertently with extinc-
tion in applied research, recent studies have
demonstrated that common punishment
procedures (e.g., time-out, brief manual re-
straint) can be effective in the absence of
extinction (Fisher, Piazza, Bowman, Hago-
pian, & Langdon, 1994; Lerman, Iwata,
Shore, & DeLeon, 1997; Thompson, Iwata,
Conners, & Roscoe, 1999). Reductions in
behavior were obtained even after unsuc-

435PUNISHMENT

cessful attempts to treat the behavior with
less intrusive procedures (e.g., Fisher et al.,
1993; Lindberg, Iwata, & Kahng, 1999).

Nevertheless, the generality of these find-
ings may be limited because data on effective
treatments are more likely to be published
than those that show unsuccessful outcomes.
Potentially important reinforcement param-
eters also were unspecified in these studies.
Results of pretreatment functional analyses
indicated that the behavior was maintained
independent of social consequences but did
not isolate the precise reinforcer. Methods to
identify the type of nonsocial reinforcement
(often called automatic reinforcement) that is
functionally related to problem behavior
have been examined in a number of studies
(e.g., Goh et al., 1995; Kennedy & Souza,
1995; Patel, Carr, Kim, Robles, & Eastridge,
2000; Piazza, Adelinis, Hanley, Goh, & De-
lia, 2000). Although further methodological
refinements are needed, these strategies may
be useful for identifying and manipulating
various reinforcement parameters (e.g., re-
inforcer schedule and magnitude) while
treating automatically reinforced problem
behavior with punishment (e.g., Lerman &
Iwata, 1996b). As described in more detail
below, results of studies employing these
types of manipulations with behavior main-
tained by either social or nonsocial conse-
quences could lead to a greater understand-
ing of punishment processes and improved
treatments.

As discussed in the following sections, a
number of factors directly relevant to the de-
velopment of an applied technology have
been found to influence the direct effects of
punishment. These factors include historical
variables (e.g., prior experience with the
punishing stimulus or intermittent reinforce-
ment); the use of conditioned punishers; re-
inforcement variables (e.g., schedule, avail-
ability of alternative sources of reinforce-
ment); and punishment variables (e.g., mag-
nitude, immediacy, schedule). However,

much of the research on these factors has
been conducted in the basic laboratory, and
our knowledge of some important complex
relations is relatively incomplete (Baron,
1991).

History

Basic findings indicate that previous ex-
posure to certain factors can alter responding
during punishment, a phenomenon that is
especially relevant to the application of pun-
ishment because clinical populations typical-
ly have diverse learning histories. Results of
numerous basic studies have shown that pri-
or experience with the punishing stimulus
either contingently or noncontingently can
decrease a behavior’s sensitivity to punish-
ment (e.g., Capaldi, Sheffer, Viveiros, Da-
vidson, & Campbell, 1985; Halevy, Feldon,
& Weiner, 1987). For example, research
findings with rats indicate that exposure to
intermittent punishment with shock decreas-
es the efficacy of continuous punishment
with shock, even when several days or weeks
lapse between intermittent and continuous
punishment (Banks, 1967; Halevy et al.;
Shemer & Feldon, 1984). Deur and Parke
(1970) replicated this effect with normally
developing children and a loud buzzer as the
punishing stimulus.

Although adaptation to the punishing
stimulus may account for these findings (Ca-
paldi et al., 1985), a similar relation has
been obtained with intermittent reinforce-
ment. That is, rats and college students with
a history of intermittent reinforcement also
showed less response suppression under ei-
ther continuous or intermittent punishment
with shock than participants with a history
of continuous reinforcement (e.g., Brown &
Wagner, 1964; Estes, 1944; Halevy et al.,
1987; Vogel-Sprott, 1967). Moreover, Eisen-
berger, Weier, Masterson, and Theis (1989)
found that resistance to shock punishment
increased for one response (lever pressing) in
rats even after a topographically different be-

436 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

havior (running) was exposed to intermittent
reinforcement.

In clinical settings, an individual is likely
to experience common punishers (e.g., ver-
bal reprimands, time-out) before these con-
sequences are specifically arranged to treat a
particular inappropriate behavior. Further-
more, exposure to intermittent schedules of
reinforcement and punishment is typical in
the natural environment. Consequences of-
ten are delivered on intermittent schedules
because it is difficult for parents and teachers
to reinforce or punish every occurrence of
behavior. When initial attempts to treat a
behavior with intermittent punishment fail,
caregivers may switch to a continuous sched-
ule of punishment in an attempt to improve
the efficacy of the treatment. Basic findings
indicate that a history with intermittent
punishment may complicate treatment suc-
cess in these cases, such that more intense
punishers will be required to suppress be-
havior effectively (Halevy et al., 1987;
Shemer & Feldon, 1984). However, the rel-
evance of these findings to the types of pun-
ishers that are more commonly used in clin-
ical settings is unknown because nearly all
basic studies in this area evaluated the effects
of shock, and no applied studies have repli-
cated and extended these findings to prob-
lem behavior.

Nevertheless, basic findings in this area
suggest some important guidelines for clin-
ical research and practice. First, it may be
beneficial for caregivers to identify novel
punishers when designing treatments and to
avoid using common consequences, such as
verbal reprimands and time-out, in unsys-
tematic or unplanned ways. Second, inter-
mittent schedules of punishment should not
be implemented prior to continuous sched-
ules. Third, if adaptation to the punishing
stimulus accounts for the decreased sensitiv-
ity of behavior (Capaldi et al., 1985), brief
hiatus from punishment may be useful, as
described in more detail below (Rachlin,

1966). Alternating among several effective
punishment procedures in lieu of using a
single procedure is another potentially useful
strategy for minimizing exposure to any sin-
gle punisher (e.g., Charlop, Burgio, Iwata,
& Ivancic, 1988).

Conditioned Stimuli

Neutral stimuli that are paired with pun-
ishing stimuli eventually may acquire prop-
erties of the punishing stimuli. Results of ba-
sic studies indicate that these conditioned
stimuli can function as punishers when de-
livered contingent on behavior in the ab-
sence of the primary, or unconditioned,
stimulus (e.g., Hake & Azrin, 1965). Con-
ditioned punishers may be useful for increas-
ing both the efficacy and acceptability of
punishment in clinical settings. Suppose that
a relatively nonintrusive but ineffective con-
sequence (e.g., a brief verbal cue) was estab-
lished and maintained as a potent condi-
tioned punisher via intermittent pairings
with a more restrictive, time-consuming in-
tervention (e.g., overcorrection, time-out).
Application of the conditioned punisher
would reduce the individual’s exposure to
the intrusive intervention and the degree of
effort required by caregivers to implement
treatment, factors that might circumvent
problems with program inconsistency, habit-
uation to the unconditioned punisher, and
ethical issues associated with the use of re-
strictive procedures.

Various stimuli have been established as
conditioned punishers in the basic labora-
tory, including tones, lights, and low-voltage
shock (e.g., Crowell, 1974; Davidson, 1970;
Hake & Azrin, 1965). With a few excep-
tions (e.g., Trenholme & Baron, 1975), the
unconditioned stimulus was electric shock
and the subjects were rats or pigeons. Con-
ditioned punishers were established via one
of two primary methods. Under one meth-
od, the neutral stimulus was presented be-
fore the onset of an inescapable stimulus

437PUNISHMENT

(e.g., shock delivered independent of re-
sponding) and then was either removed with
the onset of the unconditioned stimulus
(e.g., Hake & Azrin, 1965; Mowrer & Sol-
omon, 1954) or remained in the environ-
ment while the unconditioned stimulus was
delivered periodically (e.g., Orme-Johnson
& Yarczower, 1974). Results of several stud-
ies on this method indicated that more con-
ditioning occurred if the neutral stimulus
was presented prior to the onset of the un-
conditioned stimulus rather than simulta-
neously with or after its onset (e.g., Evans,
1962; Mowrer & Aiken, 1954).

Under the other method, the neutral
stimulus was established as a discriminative
stimulus for punishment. That is, the pres-
ence of the neutral stimulus was correlated
with delivery of the unconditioned stimulus
contingent on responding (e.g., Davidson,
1970). Although the discriminative stimulus
then was shown to suppress responding
when delivered contingent on behavior, re-
sults of Orme-Johnson and Yarczower
(1974) indicated that stimuli established as
discriminative stimuli were much less effec-
tive as conditioned punishers than stimuli
established via the former method. Regard-
less of the conditioning method, research
findings have shown that the effects of con-
ditioned punishers on behavior are tempo-
rary unless the conditioned stimulus and the
unconditioned punisher continue to be
paired in some manner (Davidson, 1970;
Hake & Azrin, 1965).

A few basic studies have evaluated factors
that appear to influence the conditioning
process, such as the magnitude of the un-
conditioned stimulus (Mowrer & Solomon,
1954) and the duration of the conditioned
stimulus (Hake & Azrin, 1965). However,
other clinically relevant parameters of con-
ditioning, such as the number of pairings
between the conditioned and unconditioned
stimuli, the type of unconditioned punisher
used, and characteristics of the neutral stim-

ulus (e.g., intensity or saliency), should be
examined in further research. In addition,
conditioned stimuli typically were estab-
lished and maintained independent of re-
sponding, a method that likely would invoke
ethical concerns if extended to clinical pop-
ulations. Although it may be more accept-
able to pair conditioned and unconditioned
stimuli contingent on problem behavior, op-
portunities to condition the stimulus would
be severely restricted if the unconditioned
punisher suppressed problem behavior to
low levels.

The use of conditioned punishers in treat-
ing problem behavior has been reported in
surprisingly few applied studies. More im-
portant, no applied studies have focused ex-
clusively on methods to develop and main-
tain stimuli as conditioned punishers in clin-
ical settings. Lovaas and Simmons (1969)
paired the word ‘‘no’’ with shock contingent
on severe self-injury with 1 participant. The
brief verbal reprimand then was presented
for self-injury in the absence of shock during
a limited number of sessions, and results
suggested that the stimulus had acquired the
suppressive properties of the original punish-
er. In a more thorough evaluation, Dorsey,
Iwata, Ong, and McSween (1980) paired the
word ‘‘no’’ with contingent water mist for 2
participants who engaged in self-injury. Re-
sults showed that contingent presentation of
the verbal stimulus maintained low levels of
self-injury when water mist was withdrawn
from the original treatment setting. Further-
more, the suppressive effects of the verbal
reprimand generalized to a setting that had
not been previously associated with the wa-
ter mist procedure, as well as to other ther-
apists who had never delivered the water
mist. Finally, Dixon, Helsel, Rojahn, Cipol-
lone, and Lubetsky (1989) paired a mild,
less effective punisher (visual screen) with a
more effective punisher (the odor of am-
monia) while treating aggression and disrup-
tion exhibited by a young boy with devel-

438 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

opmental disabilities. Problem behavior re-
mained suppressed for a short time when the
visual screen was used alone.

Although results of these three studies in-
dicated that conditioned punishers were es-
tablished successfully for a clinical problem,
the efficacy of treatment was evaluated across
a limited number of brief sessions. Basic
findings have shown that the effects of con-
ditioned punishers on behavior are tempo-
rary unless the conditioned stimulus and the
unconditioned punisher continue to be
paired in some manner (Davidson, 1970;
Hake & Azrin, 1965). In addition, details
necessary to replicate the conditioning pro-
cedure (e.g., method of pairing, total num-
ber of pairings, rules for determining when
to test the conditioned effect) were not de-
lineated. The generality of these findings
and those obtained in the basic laboratory
also may be limited by the use of relatively
intrusive unconditioned punishers (i.e.,
shock, water mist, ammonia).

Thus, current knowledge about condi-
tioned punishment is fairly incomplete, and
prescriptions for the application of condi-
tioned punishers should await further re-
search. The efficacy of pairing various types
of auditory, tactile, and visual stimuli should
be evaluated with more common and so-
cially acceptable forms of punishment (e.g.,
time-out). The number of pairings necessary
to produce conditioning and factors that
might alter the outcome of conditioning
(e.g., intensity of the conditioned stimulus)
could be evaluated by periodically testing the
suppressive effects of the paired stimulus in
the absence of the unconditioned punisher.
The durability of conditioning could be de-
termined by presenting the conditioned
stimulus without the unconditioned punish-
er until the effects on responding dissipate.
This strategy also may be useful when de-
veloping a schedule for pairing the condi-
tioned and unconditioned stimuli to main-
tain conditioning over time. For example,

clinicians could determine the maximum
number of times that the conditioned stim-
ulus could be presented before the condi-
tioning effect begins to be extinguished. The
conditioned and unconditioned stimulus
then could be paired prior to that number
on a regular basis.

Reinforcement Schedule

Basic findings indicate that the character-
istics of responding during punishment may
depend on the reinforcement schedule that
maintains the behavior, a factor that is es-
pecially relevant to application because prob-
lem behavior is likely to be maintained by
some form of reinforcement during treat-
ment. Behavior may be concurrently ex-
posed to schedules of reinforcement and
punishment when caregivers do not com-
pletely withhold social consequences during
treatment or when the behavior is main-
tained by automatic reinforcement. Results
of basic studies generally showed that the
amount of response suppression under pun-
ishment was negatively related to the density
of the reinforcement schedule, with extinc-
tion producing the greatest decrease in re-
sponding (Azrin & Holz, 1966). Various pa-
rameters of punishment (e.g., schedule, in-
tensity) also appear to interact with the re-
lation between response suppression and
reinforcement density (Bouzas, 1978; Brad-
shaw, Szabadi, & Bevan, 1977, 1978). For
example, Bradshaw and his colleagues found
that the negative relation between reinforce-
ment density and responding was much
more pronounced when human subjects
were exposed to a variable-ratio (VR) pun-
ishment schedule of monetary loss than to a
variable-interval (VI) punishment schedule.

Intermittent reinforcement schedules ex-
amined in the laboratory have included
fixed-interval (FI), fixed-ratio (FR), VI, and
VR schedules. Although these reinforcement
schedules have been found to interact dif-
ferentially with the effects of punishment,

439PUNISHMENT

this interaction has not been well studied
and likely depends on various factors, such
as the reinforcement density, punishment
schedule, and amount of reinforcement lost
due to a reduction in responding (e.g., Pow-
ell, 1970; Scobie & Kaufman, 1969; see also
Baron, 1991, for further discussion). The
various ways in which these schedules influ-
ence punishment effects are relevant to an
applied technology because social contingen-
cies for problem behavior often approximate
these laboratory arrangements in the natural
environment (e.g., Lalli & Goh, 1993; Voll-
mer, Borrero, Wright, Van Camp, & Lalli,
2001). Such complex interactions between
reinforcement and punishment schedules
also are likely responsible for some inconsis-
tent findings reported in both the basic and
applied literatures on punishment (see fur-
ther discussion below). Additional basic re-
search in this area is needed to clarify these
relations.

Knowledge about basic processes and pre-
scriptions for best practices when using pun-
ishment in clinical settings will be incom-
plete without further evaluation of potential
interactions between reinforcement sched-
ules and parameters of punishment. Never-
theless, no applied studies have examined
the effects of reinforcement schedule or den-
sity on the outcome of treatment with pun-
ishment. Further research should determine
if reducing the density of the reinforcement
schedule operating in the natural environ-
ment would substantially enhance the effi-
cacy of commonly used punishment proce-
dures. If so, strategies are needed to thin the
schedule of reinforcement for problem be-
havior during treatment with punishment.
The parameters under which reinforcement
schedule is and is not an important factor
when treating problem behavior with pun-
ishment also should be evaluated. Potentially
relevant parameters include the schedule,
type, and intensity of the punisher.

Although nonsocial sources of reinforce-

ment may be difficult to modify (but see
Lerman & Iwata, 1996b, for one approach),
results of this research may lead to useful
guidelines for designing effective yet practi-
cal treatments when caregivers will be un-
likely or unable to withhold social reinforce-
ment for problem behavior. Current knowl-
edge indicates that reinforcement for prob-
lem behavior should be withheld or
diminished if possible. Thus, for example,
when caregivers cannot withhold reinforce-
ment completely during punishment (e.g.,
ignore all instances of self-injury), the den-
sity and magnitude of reinforcement for
problem behavior should be reduced and
punishment should be delivered on a con-
tinuous schedule (see further discussion be-
low).

Availability of Alternative Reinforcement

Most textbooks and literature reviews on
application highlight the benefits of combin-
ing punishment with some type of reinforce-
ment procedure, such as DRA (e.g., Cooper,
Heron, & Heward, 1987; Matson & Di-
Lorenzo, 1984). Basic studies with rats, pi-
geons, and psychiatric patients have shown
that the suppressive effects of contingent
shock, noise, or time-out were enhanced
when reinforcement could be obtained in
some manner other than, or in addition to,
engaging in the punished response (e.g.,
Boe, 1964; Herman & Azrin, 1964; Holz,
Azrin, & Ayllon, 1963; Rawson & Leiten-
berg, 1973). Although these findings suggest
that increasing the density of alternative re-
inforcement might enhance the efficacy of
mild punishers in clinical settings, few basic
studies have evaluated clinically relevant
punishers or the parameters under which re-
inforcement may provide optimal benefits
during punishment.

In a study with pigeons reported by Azrin
and Holz (1966), for example, an FR 25
schedule of alternative reinforcement did not
increase sensitivity to punishment when a re-

440 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

sponse maintained by the same reinforce-
ment schedule was punished with low-volt-
age shock (less than 50 V). It is possible,
however, that a denser schedule of alterna-
tive reinforcement would have enhanced the
efficacy of this mild punisher. Results of a
study by Fantino (1973) indicated that the
beneficial effects of alternative reinforcement
were compromised when the reinforcement
rate provided by a concurrent VI schedule
prior to punishment could not be obtained
via exclusive responding on the unpunished
alternative. Punishment parameters such as
schedule and delay and various reinforce-
ment parameters also likely modify the ef-
fects of alternative reinforcement. Thus, ba-
sic findings suggest that various factors (e.g.,
type or intensity of the punisher, density of
available reinforcement prior to punish-
ment) must be considered when combining
reinforcement with punishment in clinical
settings.

However, other commonly used reinforce-
ment arrangements, such as noncontingent
reinforcement (NCR) and differential rein-
forcement of low response rates (DRL), have
not been evaluated in the context of a con-
current punishment contingency in the lab-
oratory. More important, basic findings on
alternative reinforcement may have limited
generality to application because clinically
relevant factors (e.g., response topography;
reinforcement quality, schedule, delay, and
magnitude) usually were held constant
across available response options. Treatment
with punishment and differential reinforce-
ment typically will incorporate different re-
sponse, reinforcement, and punishment pa-
rameters across the targeted behaviors, es-
pecially when problem behavior is main-
tained by unknown or uncontrolled sources
of reinforcement. In such cases, alternative
reinforcement may neither suppress the pun-
ished response nor increase adaptive behav-
ior. Results of basic studies in which sched-
ules of reinforcement and punishment were

arranged for both response options also sug-
gest that the amount of suppression pro-
duced by punishment for a given behavior
can be influenced by contingencies that op-
erate on other behavior, including the rela-
tive schedule, delay, and magnitude of re-
inforcement and punishment (e.g., Deluty,
1976, 1978; Farley, 1980).

Despite obvious clinical implications,
only one applied study has evaluated the re-
lation between punishment effects and the
availability of alternative reinforcement.
Thompson et al. (1999) examined the sep-
arate and combined effects of punishment
and reinforcement on self-injury after results
of a functional analysis indicated that the
behavior was maintained by automatic re-
inforcement. Reinforcement was arranged
for an alternative behavior (toy manipula-
tion) by giving the participants access to pre-
ferred toys (thereby establishing automati-
cally reinforced toy play) or by delivering
food contingent on toy manipulation. Re-
sults for the 4 participants indicated that al-
ternative reinforcement enhanced the effi-
cacy of relatively mild punishers (e.g., brief
manual restraint). Furthermore, reinforce-
ment alone was fairly ineffective for all par-
ticipants, and punishment alone was ineffec-
tive for 1 participant. As noted by the au-
thors, however, the combined treatment was
differentially confounded with an additional
contingency (i.e., time-out from positive re-
inforcement—access to programmed rein-
forcement was withheld during punishment
delivery) that may constrain the generality
of the findings.

Further research is needed on clinical
strategies to enhance the efficacy of mild
punishers through the use of DRA, DRO,
DRL, and NCR procedures. Thus far, basic
findings in this area suggest a number of ten-
tative prescriptions for application. Natural-
istic reinforcement schedules for targeted
problem and alternative behavior should be
considered first when developing treatments

441PUNISHMENT

that combine reinforcement and punish-
ment. The type, schedule, and magnitude of
reinforcement maintaining problem behav-
ior should be identified, so that a larger
amount of the same reinforcer could be pro-
vided independent of undesirable respond-
ing or contingent on alternative behavior
(Fantino, 1973). When the functional rein-
forcer cannot be identified or delivered by
others, selecting reinforcers that compete
with or substitute for maintaining reinforc-
ers may be critical to effective treatment
(e.g., Shore, Iwata, DeLeon, Kahng, &
Smith, 1997).

As many of the available sources of rein-
forcement as possible also should be deter-
mined prior to treatment, so that steps can
be taken to ensure that the total amount of
obtainable reinforcement can be sustained or
exceeded despite a reduction in the punished
behavior. To this end, differential reinforce-
ment procedures should target simple free-
operant responses or adaptive behavior that
is already in the individual’s repertoire. Pro-
cedures such as NCR, DRO, and DRL,
which do not require an alternative response
for reinforcement delivery, may be preferable
during the initial stages of treatment with
punishment to insure a sufficient density of
available reinforcement. In fact, multiple re-
sponses, reinforcers, and reinforcement con-
tingencies (e.g., DRO plus NCR) should be
incorporated into treatment such that pun-
ishment for a restricted number of responses
is implemented within the context of a rich-
ly reinforcing environment.

Punishment Magnitude

The relation between the effects of pun-
ishment and the magnitude or amount of
punishment delivered for responding is es-
pecially germane to the efficacy and accept-
ability of punishment in clinical settings.
From an ethical and practical standpoint,
the least amount of punishment that is ef-
fective (i.e., lowest intensity, shortest dura-

tion) should be used to treat behavior prob-
lems, and strategies that increase the effec-
tiveness of mild punishers should be incor-
porated into treatment. Basic studies on
magnitude have shown that response sup-
pression is positively related to the intensity
and duration of shock with rats, pigeons,
monkeys, and college students (Church,
1969; Deluty, 1978; Scobie & Kaufman,
1969), the duration of time-out with normal
humans (Kaufman & Baron, 1968; N. B.
Miller & Zimmerman, 1966), and the num-
ber of points lost as part of response cost
with normal humans (Weiner, 1964). In
fact, recovery during punishment and fol-
lowing the termination of the punishment
contingency was most likely to occur with
mild punishers, such as a bar slap (Skinner,
1938) and low-voltage shock (Hake, Azrin,
& Oxford, 1967). Furthermore, punishment
with high-intensity shock or forceful air
blasts was found to be ineffective with rats
if the intensity of the punisher was initially
low and then gradually increased over time
(Cohen, 1968; N. E. Miller, 1960; Terris &
Barnes, 1969).

On the basis of these findings, numerous
authors have recommended using moderate
or high-intensity punishers to treat problem
behavior and cautioned against increasing
the intensity of punishment gradually over
time (e.g., Cooper et al., 1987; Martin &
Pear, 1996; O’Brien, 1989). These guide-
lines may be difficult to reconcile with eth-
ical mandates to identify the least restrictive
procedure that is effective. Moreover, close
examination of basic findings in this area in-
dicates that the relation between responding
and punishment magnitude is more complex
than frequently assumed. As a result, strat-
egies that are based on recommendations de-
lineated in applied textbooks (e.g., Cooper
et al.; Martin & Pear) and literature reviews
may not influence behavior as expected.

As previously noted, the basic relation be-
tween response suppression and punishment

442 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

magnitude may be influenced by the avail-
ability of alternative reinforcement (e.g.,
Holz et al., 1963) and the type of reinforce-
ment schedule that maintains behavior (e.g.,
Powell, 1970; Scobie & Kaufman, 1969).
Other variables (e.g., immediacy; Cohen,
1968) also may alter the relation between
punishment magnitude and responding.
Such complex interactions may be respon-
sible for some contradictory findings on
punishment magnitude that have been re-
ported in the applied literature. The extent
to which basic findings are directly compa-
rable to applied findings also is limited be-
cause most basic studies examined the mag-
nitude of shock, whereas applied studies in
this area have focused on more clinically ac-
ceptable forms of punishment (e.g., overcor-
rection, time-out).

In one of the few applied studies to eval-
uate the magnitude of electric shock, D. E.
Williams, Kirkpatrick-Sanchez, and Iwata
(1993) compared the efficacy of treatment
for self-injury under two shock-intensity lev-
els (3.5 mA vs. 18.5 mA). Results were con-
sistent with those obtained in basic studies.
The high-intensity shock produced larger,
more immediate decreases in behavior than
the low-intensity shock. The generality of
this finding, however, is somewhat limited
because punishment was combined with ex-
tinction. In addition, sequence effects could
have influenced the outcome because the
participant was exposed to the lower inten-
sity shock prior to the higher intensity, and
a reversal to the low-intensity condition was
not implemented.

Results of studies examining the relation
between punishment magnitude and treat-
ment efficacy using other types of punishers
(e.g., physical restraint, unpleasant smells,
time-out) have been inconsistent and often
appeared to be confounded with other var-
iables (e.g., Altman, Haavik, & Cook, 1978;
Cole, Montgomery, Wilson, & Milan, 2000;
Marholin & Townsend, 1978; Singh, Daw-

son, & Manning, 1981). For example, Cole
et al. found that treatment with overcorrec-
tion produced similar decreases in stereotyp-
ic behavior, regardless of whether the inter-
vention lasted 30 s, 2 min, or 8 min. The
effects of overcorrection, however, may have
been confounded with those of extinction
and verbal reprimands. Results of studies on
the duration of time-out have shown a pos-
itive relation (e.g., Burchard & Barrera,
1972; Hobbs, Forehand, & Murray, 1978),
a negative relation (e.g., Kendall, Nay, & Jef-
fers, 1975), and no relation (e.g., White,
Nielsen, & Johnson, 1972) between dura-
tion length and treatment effects. These
findings are difficult to interpret because the
function of problem behavior was not iden-
tified (thus, time-out may have been contra-
indicated for some participants), and se-
quence effects may have confounded the re-
sults (Matson & DiLorenzo, 1984).

Further research on the relation between
punishment magnitude and response to
treatment, as well as on factors that can alter
this relation (e.g., reinforcement schedule,
punishment delay), may be useful for rec-
onciling inconsistent findings in the litera-
ture and for developing more comprehensive
prescriptions for application. The common
assumption that a larger magnitude of a giv-
en punisher will be more effective than a
smaller magnitude is not strongly supported
in the current literature, with the exception
of findings on contingent shock. Magnitude
should be manipulated with a variety of
punishers and in a variety of ways that have
not been examined in basic research. For ex-
ample, the amount of reinforcement avail-
able during ‘‘time-in’’ is another potentially
important dimension of magnitude when
treatment with time-out is implemented
(e.g., Solnick, Rincover, & Peterson, 1977).

Strategies to enhance response suppression
and maintenance under less effective values
of punishment magnitude also should be ex-
plored. Basic findings indicate that smaller

443PUNISHMENT

magnitudes of punishment may be more ef-
fective if the punisher is delivered immedi-
ately following the behavior (e.g., Cohen,
1968) and if reinforcement is available for
an alternative response (e.g., Holz et al.,
1963). Basic studies with shock also indicate
that a less intense punisher may be effective,
at least temporarily, if a high intensity level
is decreased gradually over time (e.g., Azrin,
1960; Cohen, 1968; Hake et al., 1967). An
approach that involves periodically inter-
spersing less intense punishers with more in-
tense punishers may be useful for maintain-
ing treatment effects while the magnitude of
punishment is gradually reduced. As dis-
cussed above, further research on condi-
tioned punishers and treatments combining
reinforcement with punishment also may
lead to methods for increasing the effective-
ness of mild punishers.

Finally, further studies should evaluate
methods for identifying the most appropri-
ate magnitude of a given punishment pro-
cedure prior to treatment implementation in
the natural environment. The typical trial-
and-error approach to punishment selection
is inefficient and may be counterproductive
if an individual receives prolonged exposure
to ineffective procedures (e.g., N. E. Miller,
1960; Terris & Barnes, 1969). Efficient
strategies for identifying the least restrictive,
effective treatment are surprisingly absent
from the applied literature. In two studies
conducted by Fisher and colleagues (Fisher,
Piazza, Bowman, Hagopian, & Langdon,
1994; Fisher, Piazza, Bowman, Kurtz, et al.,
1994), the potential suppressive effects of
various procedures (e.g., time-out, facial
screen, contingent demands) were rapidly as-
sessed by exposing participants to the puta-
tive punishers while negative vocalizations
(e.g., yelling, crying) and avoidance or es-
cape responses (e.g., dropping to the floor)
were measured. Each punishment procedure
was delivered noncontingently across five
different durations, ranging from 15 s to

180 s. Results of subsequent treatment anal-
yses indicated that the procedure associated
with the highest levels of negative vocaliza-
tions, avoidance, or escape responses was the
most effective punisher for problem behav-
ior. However, results of the initial assessment
did not differentiate among the various du-
ration lengths for any participant, possibly
because the procedures were alternated rap-
idly across a limited number of trials. The
utility of such assessments should be evalu-
ated in further studies. For example, a sep-
arate assessment of punishment magnitude,
similar in design to that conducted by Fisher
et al., might be useful after an initial assess-
ment has identified a potent punisher.

Until further applied research on magni-
tude is conducted, practitioners should select
magnitudes that have been shown to be safe
and effective in clinical studies, as long as
the magnitude is considered acceptable and
practical by those who will be implementing
treatment. Punishment should be combined
with some type of reinforcement procedure,
and the punisher should be delivered as im-
mediately as possible following occurrences
of problem behavior (see further discussion
below). If the punisher fails to suppress be-
havior over time, alternative procedures
probably should be considered instead of in-
creasing the magnitude of the punisher un-
der the presumption that this strategy will
improve the efficacy of treatment.

Immediacy of the Punisher

Consequences for problem behavior are
frequently delayed in the natural environ-
ment. Caregivers and teachers often are un-
able to monitor behavior closely or to deliver
lengthy punishers (e.g., 15-min contingent
work) immediately following instances of
problem behavior (Azrin & Powers, 1975).
Punishment also may be delayed when the
individual actively resists application of the
programmed consequences by struggling
with the punishing agent or running away.

444 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

In some cases, problem behavior occurs pri-
marily in the absence of the punishing agent,
necessarily delaying programmed conse-
quences until the behavior is detected
(Grace, Thompson, & Fisher, 1996; Van
Houten & Rolider, 1988).

For these reasons, research on delayed
punishment is especially pertinent. Labora-
tory findings with rats indicate that the
lengthier the delay between the occurrence
of the response and delivery of contingent
shock, the smaller the amount of response
suppression under punishment (e.g., Baron,
Kaufman, & Fazzini, 1969; Camp, Ray-
mond, & Church, 1967). Even brief delays
of 10 s or 20 s have been found to seriously
compromise the effects of contingent shock
with rats and college students (e.g., Banks &
Vogel-Sprott, 1965; Goodall, 1984) and of
reinforcement loss with college students
(Trenholme & Baron, 1975).

Stimuli that might bridge the interval be-
tween a response and its consequence have
been notably absent from laboratory ar-
rangements involving delayed punishment.
Results of at least one study suggest that fac-
tors such as the presence of a conditioned
punisher and delivery of instructions can al-
ter the efficacy of delayed punishment. In
Trenholme and Baron (1975), delays of 10
s, 20 s, and 40 s were equally effective with
college students when a brief noise that was
paired with reinforcement loss also occurred
immediately following the behavior. A sub-
sequent experiment showed that delayed
punishment was just as effective as imme-
diate punishment when the participants re-
ceived instructions about the delay. The gen-
erality of these findings to clinical popula-
tions, such as individuals with developmen-
tal disabilities, has not been determined. In
addition, no basic studies have evaluated the
effects of numerous other potentially impor-
tant factors on delayed punishment (e.g.,
history, reinforcement schedule, availability
of alternative reinforcement).

Surprisingly few applied studies have eval-
uated the efficacy of delayed punishment or
strategies to improve treatment effects when
consequences do not occur contiguous to
the behavior. In one of the few studies to
compare immediate and delayed punish-
ment, Abramowitz and O’Leary (1990)
found that immediate verbal reprimands
were much more effective in decreasing off-
task behavior in school children than were
reprimands that were delayed by 2 min.
These results are somewhat difficult to in-
terpret, however, because delayed repri-
mands were delivered only if off-task behav-
ior had occurred continuously for 2 min,
during which time the students had varied
opportunities to interact with other students
and non-task-related objects. Thus, the ef-
fects of punishment delay were not separated
from those of reinforcement schedule and
punishment schedule.

Results of just two studies have delineated
conditions under which delayed punishment
may produce effective outcomes. Rolider
and Van Houten (1985) and Van Houten
and Rolider (1988) demonstrated the effi-
cacy of delayed punishment using various
mediated consequences with children with
emotional and developmental disabilities.
One form of mediation involved playing au-
diotape recordings of the child’s disruptive
behavior that were collected earlier in the
day. The punishing consequence (physical
restraint, verbal reprimands) then was deliv-
ered. In some cases, the tape recorder was
clearly visible to the child while the record-
ings were being collected, and a verbal ex-
planation of its role in the delivery of de-
layed punishment was provided. These fac-
tors may have served to bridge the temporal
gap between inappropriate behavior and its
consequence (e.g., by functioning as dis-
criminative stimuli for punishment; Tren-
holme & Baron, 1975). However, for 1 par-
ticipant, neither instructions about delayed
punishment nor an immediate consequence

445PUNISHMENT

designed to signal that punishment was
forthcoming (a mark placed on the child’s
hand) was as effective as the audiotape pro-
cedure.

In Van Houten and Rolider (1988), care-
givers physically guided 2 participants to en-
gage in the problem behavior (aggression or
theft) after occurrences of the behavior were
detected or reported. Caregivers then deliv-
ered the punishing consequence (physical re-
straint) immediately following the guided re-
sponse. Although treatment was effective,
the efficacy of delayed punishment without
the guided response component was not ex-
amined. The length of the delay and care-
givers’ immediate response to the problem
behavior also were not specified.

Current knowledge indicates that the
mild punishers typically used in clinical set-
tings will be ineffective unless the conse-
quence immediately follows problem behav-
ior. Thus, further research is needed on fac-
tors that might enhance treatment effects
under delayed punishment, especially pro-
cedures or stimuli that would bridge the
temporal gap between a response and its
consequence. Research on the utility of de-
livering conditioned punishers, instructions,
and other types of stimuli associated with
delayed consequences is needed with clinical
populations.

Until further applied research is conduct-
ed, teachers and caregivers should be con-
cerned with selecting punishers that can be
readily delivered as soon as the behavior oc-
curs. Consequences that do not require the
close proximity of the caregiver (i.e., stimuli
that can be delivered or removed from a dis-
tance) and technology to increase the prac-
ticality of immediate punishment may be es-
pecially useful in this regard. Electronic de-
vices that detect occurrences of problem be-
havior and either alert caregivers or deliver
consequences automatically might circum-
vent the problems of delayed punishment

(e.g., Linscheid, Iwata, Ricketts, Williams,
& Griffin, 1990).

However, the timing of punishment in re-
lation to reinforcement delivery also should
be considered, because some basic studies
have found that immediate punishment was
less effective than delayed punishment if the
immediate punisher preceded reinforcement
delivery but the delayed punisher followed
it (e.g., Epstein, 1984; Rodriguez & Logan,
1980). It is conceivable that diligent caregiv-
ers may respond to problem behavior by first
delivering the prescribed punisher (e.g., con-
tingent work, time-out), followed (inadver-
tently) by the maintaining social reinforcer
(e.g., access to materials). In a similar man-
ner, automated punishment may be deliv-
ered immediately prior to social or nonsocial
consequences for problem behavior. Results
of other basic studies, in which the avail-
ability of reinforcement for one response was
perfectly correlated with the delivery of mild
punishment for an immediately preceding
response, indicated that pairing punishment
and reinforcement in this manner estab-
lished the mild punisher as a conditioned
positive reinforcer (e.g., Murray & Nevin,
1967; D. R. Williams & Barry, 1966). Thus,
the timing of punishment and reinforcement
in the natural environment should be eval-
uated carefully as part of treatment.

Schedule of Punishment

The effects of punishment schedules on
responding have important implications for
the efficacy and acceptability of treatment
with punishment. Intermittently delivered
consequences that successfully reduce prob-
lem behavior are easier to use, less time con-
suming, and less intrusive than consequences
that must follow each occurrence of behav-
ior. Results of basic research with pigeons
and rats suggest that punishment with shock
or time-out will not produce acceptable re-
sults unless the punisher follows nearly every
occurrence of the behavior in situations in

446 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

which no alternative is available or when the
density of reinforcement is not reduced (Ap-
pel, 1968; Azrin, Holz, & Hake, 1963; De-
luty, 1976; Farley, 1980; Thomas, 1968).

Although a number of applied studies
have examined the efficacy of intermittent
punishment for treating problem behavior,
results have been inconsistent, and the con-
ditions under which intermittent punish-
ment might be effective remain unclear. In
some studies, for example, intermittent pun-
ishment schedules were associated with a so-
cially significant reduction in behavior, par-
ticularly if responding was already sup-
pressed to low levels via continuous punish-
ment (e.g., Clark, Rowbury, Baer, & Baer,
1973; Rollings & Baumeister, 1981; Ro-
manczyk, 1977). Conversely, even dense in-
termittent punishment schedules were inef-
fective for some individuals in other studies
(e.g., Calhoun & Matherne, 1975; Lerman
et al., 1997). Basic findings on factors that
interact with the effects of punishment
schedules (e.g., reinforcement schedule) may
explain why clinical applications have pro-
duced inconsistent results.

First, punishment appeared to be con-
founded with extinction and other potential
punishers (e.g., verbal reprimands) in ap-
plied studies that showed significant treat-
ment effects under thin punishment sched-
ules (e.g., Barton, Brulle, & Repp, 1987;
Clark et al., 1973; Romanczyk, 1977). Sec-
ond, important parameters of punishment
(i.e., type, intensity, and schedule) varied
considerably among these studies. Basic
findings indicate that these variables alter the
relation between intermittent punishment
and response suppression. Increasing the in-
tensity of a punisher, for example, can either
enhance or degrade the efficacy of intermit-
tent schedules, depending on other factors
(e.g., Appel, 1968; Lande, 1981). Certain
punishment schedules (e.g., VI) also have
been associated with greater decreases in re-
sponding than other schedules (e.g., FR or

FI; Azrin, 1956; Camp, Raymond, &
Church, 1966), although the nature of this
relation is complex (e.g., Arbuckle & Lattal,
1992) and appears to be influenced by the
schedule of reinforcement that maintains the
behavior (e.g., Bradshaw et al., 1977, 1978;
Powell, 1970; Scobie & Kaufman, 1969).

In the only applied study that examined
the interaction between type or intensity of
punishment and intermittent punishment
schedules, Cipani, Brendlinger, McDowell,
and Usher (1991) found that a VR 4 sched-
ule of punishment with contingent applica-
tion of lemon juice was just as effective as a
continuous schedule in reducing a child’s
stereotypic behavior. A ‘‘manual guidance
overcorrection’’ procedure (i.e., physically
guiding the child’s arms over the head and
to the sides 10 times) also was effective when
the procedure was delivered under a contin-
uous schedule. Unlike the lemon juice, how-
ever, a VR 4 schedule with the overcorrec-
tion procedure did not produce clinically
significant reductions in behavior.

Finally, interactions between schedules of
reinforcement and punishment may account
for the idiosyncratic effects of intermittent
punishment on problem behavior. For ex-
ample, Lerman et al. (1997) treated 5 par-
ticipants’ self-injurious behavior (SIB) with
a continuous schedule of punishment after
results of a functional analysis indicated that
the behavior was maintained by automatic
reinforcement. Initial application of inter-
mittent punishment (FI 2 min or FI 5 min)
was ineffective for 4 of the 5 participants.
The continuous punishment schedule then
was successfully thinned to FI 5 min for 2
of these participants. In contrast, continuous
punishment was necessary to suppress SIB
for the other 2 participants, despite repeated
attempts to thin the schedule. Although the
function of SIB had been identified prior to
treatment, important parameters of the
maintaining reinforcers were unknown (e.g.,
schedule, density, magnitude). These param-

447PUNISHMENT

eters, which likely varied across participants,
may have been responsible for the inconsis-
tent success of the schedule-thinning proce-
dure.

Further research on interactions between
punishment schedule (e.g., VR vs. VI) and
other potentially important parameters of
punishment and reinforcement is needed to
clarify the conditions under which intermit-
tent punishment would and would not be
effective. Few studies have directly evaluated
strategies to systematically thin punishment
schedules or to utilize highly variable (and
thus unpredictable) schedules. Combining a
thin schedule of punishment with a rich
schedule of conditioned punishment is an-
other potential approach for increasing the
efficacy of intermittent punishment. De-
pending on the nature of the conditioned
and unconditioned punishers, this arrange-
ment may be more practical than using a
rich schedule of unconditioned punishment
alone. A dense schedule of alternative rein-
forcement also may promote the efficacy of
intermittent punishment.

Other types of punishment schedules ex-
amined in the basic laboratory, such as the
differential punishment of high (DPH) or
low (DPL) response rates, also may be useful
in clinical settings. These schedules do not
specify a direct contingency between the de-
livery of the punisher and the occurrence of
a response. For example, under DPH or
DPL, punishment is delivered contingent on
the pause length that immediately preceded
a response (i.e., the selective punishment of
certain lengths of interresponse times). Re-
sults of basic studies on DPH and DPL
schedules showed that overall responding in-
creased when relatively long interresponse
times (DPL) were punished and decreased
when short interresponse times (DPH) were
punished (e.g., Galbicka & Branch, 1981;
Laurence, Hineline, & Bersh, 1994). DPH
schedules may be more beneficial than con-
tinuous punishment when treating behavior

that is considered problematic only because
it occurs at high rates or in bursts. Further
understanding of these schedules also is im-
portant because they may commonly operate
in the natural environment. For example,
caregivers may be more likely to deliver pun-
ishment when problem behavior occurs in-
frequently (i.e., is characterized by long in-
terresponse times) than when behavior oc-
curs at high rates (see Arbuckle & Lattal,
1992, for a discussion of this issue). Such an
arrangement could compromise the efficacy
of treatment by increasing the frequency of
short interresponse times.

Current knowledge about punishment
schedules suggests that parents and teachers
should punish each occurrence of problem
behavior unless the behavior is simulta-
neously exposed to extinction. Until further
research is conducted, clinicians should be
extremely cautious when attempting to thin
the punishment schedule, utilize DRH
schedules, or evaluate other strategies for im-
proving the effects of intermittent punish-
ment (e.g., employing variable schedules or
conditioned punishers). A continuous sched-
ule of punishment always should be imple-
mented initially, and intermittent schedules
should be considered only if the continuous
schedule remains effective in suppressing
problem behavior to low levels over a con-
siderable amount of time.

FACTORS RELATED TO
MAINTENANCE, GENERALIZATION,

AND INDIRECT EFFECTS

A much smaller proportion of basic and
applied studies on punishment have evalu-
ated the long-term maintenance, generaliza-
tion, and side effects of punishment relative
to those on direct effects. The extent to
which punishment effects are maintained
over time, transfer across settings and con-
texts, and produce changes in other behavior

448 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

has significant implications for treatments
involving punishment.

Maintenance

The durability of treatment with punish-
ment is one of the most important consider-
ations for practitioners, teachers, and caregiv-
ers of individuals with behavior disorders. A
number of authors, however, have suggested
that the clinical effects of punishment are rel-
atively short-lived, even when the treatment
remains unchanged over time (e.g., Parsons,
Hinson, & Sardo-Brown, 2001; Walker &
Shea, 1999). In basic studies with both hu-
mans and nonhumans, various punishers have
been associated with continued response sup-
pression under punishment, including relative-
ly intense levels of electric shock with pigeons
and rats (Azrin, 1960; Crosbie et al., 1997),
point or monetary loss with normal humans
(Crosbie et al.; Weiner, 1962), and time-out
from positive reinforcement with squirrel
monkeys (McMillan, 1967). Response recov-
ery, however, has been associated with less in-
tense punishers, such as low-voltage shock
with pigeons (Rachlin, 1966), a bar slap with
rats (Skinner, 1938), and noise with pigeons
(Holz & Azrin, 1962). Basic findings on the
maintenance of response suppression follow-
ing the termination of the punishment con-
tingency also generally showed that response
rates immediately returned to prepunishment
levels—sometimes even temporarily exceeding
baseline—unless intense punishers were used
(e.g., high-voltage shock; Azrin, 1960).

These results suggest that sufficiently in-
tense punishers, including some commonly
used clinical procedures (e.g., time-out),
may produce lasting reductions in problem
behavior as long as the punishment contin-
gency remains in effect. Nevertheless, basic
findings may not be applicable to treatment
outcomes in clinical settings because the
time periods evaluated in the laboratory
(e.g., 30-min to 60-min punishment sessions
across 10 to 20 days) may have little relation

to the numerous months (and sometimes
years) over which problem behavior requires
treatment. Moreover, few studies have ex-
amined factors that may influence the du-
rability of punishment effects.

Although brief treatment evaluations are
predominant in the applied literature on
punishment, an increasing number of stud-
ies have examined the long-term efficacy of
punishment over the past 10 years. Treat-
ment effects have been examined for 1 to 60
months after punishment was initiated and
continued with minor changes to the pro-
cedure (Duker & Seys, 1996; Ricketts,
Goza, & Matese, 1993; D. E. Williams,
Kirkpatrick-Sanchez, & Crocker, 1994), and
after the original punishment component
was withdrawn (Arntzen & Werner, 1999;
Foxx, Bittle, & Faw, 1989; Rolider, Wil-
liams, Cummings, & Van Houten, 1991).
Results have shown varying success in main-
taining the reduction in behavior, yet poten-
tial reasons for the inconsistent outcomes
have not yet been identified.

For example, D. E. Williams et al. (1993)
observed a relapse in treatment with contin-
gent electric shock 6 months after punish-
ment was initiated. Conversely, Linscheid,
Hartel, and Cooley (1993) found that con-
tingent electric shock continued to suppress
2 individuals’ self-injurious behavior for 5
years. Duker and Seys (1996) examined the
long-term efficacy of contingent shock with
12 individuals by obtaining information on
the degree of physical restraint each required
from 2 to 47 months after the initiation of
punishment. Results at follow-up suggested
that treatment remained effective for 7 par-
ticipants, including 1 individual who was
evaluated at 36 months and another who
was evaluated at 47 months.

Conclusions about applied findings on
maintenance are difficult to draw for a num-
ber of reasons. First, the majority of studies
examined the long-term effectiveness of con-
tingent electric shock, so results may not be

449PUNISHMENT

applicable to other (or more mild) punishers
(Azrin & Holz, 1966). Second, the reinforc-
ing consequences of problem behavior were
not identified prior to treatment in most cas-
es. Long-term maintenance may have been
more likely to occur if the maintaining re-
inforcer was withheld contingent on prob-
lem behavior or readily available for engag-
ing in more appropriate behavior (Estes,
1944). Third, other factors potentially re-
sponsible for both successful and unsuccess-
ful cases of treatment maintenance may have
varied widely across the studies (e.g., pun-
ishment schedule, availability of reinforcers
that competed with or substituted for the
maintaining reinforcer). In fact, components
of the original intervention were modified
over time in some studies (e.g., additional
behavioral procedures or drugs were intro-
duced; Duker & Seys, 1996), and it is dif-
ficult to determine which, if any, treatment
modifications may have been responsible for
the outcomes. Furthermore, the lengthy
time period required to conduct these stud-
ies increased the likelihood that unplanned
changes or other uncontrolled factors inter-
acted with the efficacy of the original treat-
ment in either desirable or undesirable ways.
Finally, the number of treatment relapse cas-
es reported in the literature may not accu-
rately reflect the prevalence of this problem
in applied settings because such cases are less
likely to be submitted or accepted for pub-
lication than successful cases of treatment
maintenance.

Identifying factors or processes associated
with long-term maintenance is key to the
design of a systematic technology for pre-
venting and remediating treatment relapse.
Several authors have suggested that adapta-
tion, or habituation, to the punishing stim-
ulus accounts for instances of recovery (i.e.,
repeated exposure decreases the aversiveness
of the punisher; Goodall, 1984). Moreover,
adaptation is more likely to occur with mild
punishers, which are typically employed in

clinical settings. One strategy that may de-
crease the likelihood of habituation is the use
of hiatus from punishment. In several basic
studies with pigeons, response suppression
under shock punishment was enhanced fol-
lowing brief time periods during which the
subject was removed from the punishing sit-
uation or exposed to reinforcement only
(e.g., Rachlin, 1966). Further research is
needed, however, because the beneficial ef-
fect of this procedure was found to wane
across repeated punishment–hiatus cycles
(e.g., Orme-Johnson, 1967). Other strate-
gies that may prevent or attenuate habitua-
tion, such as using intermittent, varied, or
brief punishers (e.g., Charlop et al., 1988),
should be evaluated in further studies.

Research also is needed on strategies to
maintain punishment effects while the inter-
vention is systematically faded. Basic find-
ings with pigeons and monkeys have shown
that responding will remain suppressed un-
der low-intensity shock if an initially intense
shock is reduced very gradually (e.g., Hake
et al., 1967). Further applied research is
needed to determine if treatment effects will
be maintained while the intensity or dura-
tion of a punishment procedure is altered
very gradually or less intrusive procedures
are simultaneously introduced. For example,
it may be possible to reduce a 5-min time-
out to a 1-min time-out over time. The use
of conditioned punishers may enhance the
likelihood of fading certain dimensions of
intrusive punishers while treatment effects
are maintained over the long run. Moreover,
basic studies have found that response re-
covery is more gradual following the with-
drawal of intermittent shock punishment
than following the removal of other punish-
ment schedules (e.g., Azrin et al., 1963;
Camp et al., 1966). Thus, strategies to in-
crease the utility of conditioned punishers
and intermittent punishment for routine
clinical practice also may promote the long-
term efficacy of punishment.

450 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

Several authors have suggested that com-
bining punishment with differential rein-
forcement may increase the likelihood that
punishment can be faded successfully (e.g.,
Kazdin, 2001). Although this clinical strategy
has not been evaluated directly, one study
found that differential reinforcement was
more effective in reducing problem behavior
after a participant had been exposed to a pe-
riod of punishment (contingent work) than
when differential reinforcement preceded
punishment (Fisher et al., 1993). Research
findings on the indirect effects of punishment
suggest that punishment may increase res-
ponsivity to reinforcement (see below for fur-
ther discussion). Thus, punishment may en-
hance the efficacy of reinforcement for estab-
lishing appropriate behavior that competes
with or replaces inappropriate behavior, an
outcome that in turn may increase the like-
lihood that punishment can be withdrawn.

Until additional research on long-term
maintenance is conducted, practitioners and
caregivers should not assume that punish-
ment will remain effective over the long run.
Strategies for increasing the likelihood of
maintenance should be employed from the
outset of treatment. Although basic findings
suggest that relatively intense punishers may
be associated with successful long-term out-
comes, the use of analogous procedures to
treat problem behavior probably would raise
ethical concerns for all but the most serious
cases. Caregivers instead should focus on the
use of reinforcement to insure that alterna-
tive behavior is at high strength in the rep-
ertoire of individuals who are exposed to
punishment. Systematic reinforcer assess-
ments and functional analyses of problem
behavior always should precede treatment
implementation (Fisher et al., 1992). The ef-
fects of punishment may last longer if ap-
propriate behavior is maintained by the same
reinforcers that maintain problem behavior
or by reinforcers that are effective substitutes
for maintaining reinforcers. The reinforcing

consequences of problem behavior also
should be minimized or withheld if possible.

Potential problems with habituation may
be curtailed by limiting exposure to the pun-
isher in various ways. For example, caregivers
could schedule brief vacations from punish-
ment on a regular basis (Rachlin, 1966) or
restrict the use of specific procedures to one
or two problem behaviors (e.g., those of
greatest concern) instead of applying the
same treatment for a variety of responses.
Comprehensive punisher assessments also
should be employed to identify clinically ac-
ceptable procedures that produce the great-
est reduction in behavior and, hence, would
lead to the least amount of exposure to the
punisher (see Fisher, Piazza, Bowman, Ha-
gopian, & Langdon, 1994). If the assess-
ment identifies more than one effective form
of punishment, caregivers could alternate
among several procedures to minimize ex-
posure to any single punisher.

Finally, practitioners and caregivers should
have a plan for dealing with treatment re-
lapse when it occurs during punishment or
following the removal of punishment. The
first step is to identify and rectify other fac-
tors that may be responsible for treatment
failure. Many instances of relapse likely are
attributable to problems with treatment in-
tegrity (D. E. Williams et al., 1993), espe-
cially when the punishment procedure is
complex or time consuming (e.g., Foxx &
Livesay, 1984). The next step is to reassess a
wide range of stimuli and activities that may
function as potent reinforcers for appropri-
ate behavior and to target additional, mul-
tiple responses that might compete with the
punished behavior. Alternative forms of
punishment should be considered only after
determining that the current punisher is in-
effective within the context of a richly rein-
forcing environment. At this point, another
comprehensive punisher assessment should
be conducted to identify other effective pun-
ishers. Increasing the intensity or magnitude

451PUNISHMENT

of the ineffective punisher is not recom-
mended, as discussed above (see Reinforce-
ment Magnitude).

Stimulus Generalization

The transfer of treatment effects across dif-
ferent settings and contexts (i.e., stimulus
generalization) is another critically important
outcome for individuals with behavior dis-
orders. (Response generalization under pun-
ishment, or a concomitant reduction in un-
punished behavior when a punished response
decreases, will be discussed under the heading
Indirect Effects of Punishment.) Integration
into the community may be restricted even
when problem behavior is responsive to treat-
ment if the procedure cannot be implement-
ed everywhere the behavior occurs (e.g., dur-
ing transitions at school or in public places
such as stores and buses). Basic findings on
stimulus generalization, however, suggest that
the effects of punishment on problem behav-
ior may transfer to untreated settings and
contexts. Results of several basic studies with
pigeons showed that the suppression in re-
sponding produced by shock punishment oc-
curred in the presence of antecedent stimuli
that were not used in the training situation,
even though punishment was withheld dur-
ing tests for generalization (e.g, Hoffman &
Fleshler, 1965; Honig & Slivka, 1964). The
amount of response suppression (i.e., level of
stimulus control) was a function of the phys-
ical similarity between the generalization
stimuli and the stimuli present during train-
ing with punishment, a finding that is anal-
ogous to basic findings on stimulus general-
ization and reinforcement effects (Guttman
& Kalish, 1956).

Research findings with pigeons and shock
punishment, however, may not be directly
applicable to humans in clinical settings. In
the only two studies to examine stimulus
generalization with humans in the labora-
tory, generalization was relatively difficult to
obtain with college students and a more

clinically relevant form of punishment
(point loss; O’Donnell & Crosbie, 1998;
O’Donnell, Crosbie, Williams, & Saunders,
2000). Further basic research is needed with
both humans and nonhumans to identify
factors that influence the degree and dura-
bility of stimulus generalization during pun-
ishment. Such factors may include parame-
ters of punishment or reinforcement (e.g.,
intensity, amount, schedule) and features of
the generalization stimuli (e.g., saliency).

In fact, results of numerous applied stud-
ies indicate that punishment effects rarely
transfer to settings or contexts that are un-
associated with punishment delivery (e.g.,
Corte, Wolf, & Locke, 1971; Doke & Ep-
stein, 1975; Marholin & Townsend, 1978;
Rollings, Baumeister, & Baumeister, 1977).
Surprisingly few studies have evaluated strat-
egies to promote generalization since Matson
and Taras (1989) lamented this gap in a 20-
year review of the applied literature on pun-
ishment. In early studies, factors such as the
presence of the therapist (Risley, 1968) and
proximity of the individual to the therapist
or treatment setting (Lovaas & Simmons,
1969; Rollings et al.) were found to influ-
ence generalization. These findings are con-
sistent with those of basic studies showing a
positive relation between amount of re-
sponse suppression and the degree of simi-
larity between punishment and generaliza-
tion contexts. This relation may in fact ex-
plain why generalization has rarely been ob-
served in applied studies. In most cases, the
phenomenon was tested via abrupt alteration
of both the stimulus context and the pun-
ishment contingency. Participants who con-
tinued to exhibit at least some instances of
the target behavior would readily detect the
transition from a continuous schedule of
punishment to the removal of punishment
(Azrin & Holz, 1966). In basic studies, re-
sponding eventually recovered when the
generalization stimuli were repeatedly pre-
sented in the absence of punishment.

452 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

Thus, it is not surprising that punishment
effects typically failed to generalize in the ab-
sence of procedures designed to promote
transfer (Stokes & Baer, 1977). Several au-
thors have suggested that techniques found
to enhance generalization under reinforce-
ment may be similarly effective under pun-
ishment (e.g., Matson & DiLorenzo, 1984;
Miltenberger, 2001). A few applied studies
on punishment have evaluated generalization
strategies analogous to those used to promote
reinforcement effects. For example, common
stimuli were introduced into treatment and
generalization settings (e.g., a discriminative
stimulus for punishment was presented in the
generalization setting; Birnbrauer, 1968),
stimuli that might acquire discriminative
control over the behavior were removed from
the treatment setting (e.g., the therapist was
hidden from view; Corte et al., 1971; Tate
& Baroff, 1966), and training was conducted
with multiple stimulus exemplars (e.g., sev-
eral different therapists delivered shock; Lo-
vaas & Simmons, 1969). In nearly all cases,
however, these strategies were ineffective un-
less punishment was delivered in the gener-
alization context.

Other potential tactics drawn from the lit-
erature on reinforcement include pairing the
punisher with naturalistic consequences
(e.g., verbal reprimands), varying the stim-
ulus conditions during initial treatment with
punishment, providing instruction on self-
management, and using delayed or intermit-
tent punishment (i.e., indiscriminable con-
tingencies; Stokes & Baer, 1977; see also
O’Donnell & Crosbie, 1998, Experiments 3
and 4). Generalization also may be achieved
by implementing a modified form of the
treatment in generalization contexts (e.g.,
delivering a smaller amount of the punisher
or a single component of a multicomponent
treatment procedure).

Current knowledge about punishment,
however, is insufficient to guide the appli-
cation of such strategies. For example, many

factors that are useful for promoting gener-
alization under reinforcement, such as de-
layed or intermittent contingencies, have
been found to undermine the efficacy of
punishment (Azrin et al., 1963; Goodall,
1984; Trenholme & Baron, 1975). The sup-
pressive effects of naturalistic consequences
and component derivatives of complex in-
terventions likely depend on the process of
conditioned punishment, an area that re-
quires further study. Finally, the develop-
ment of stimulus control under punishment
has been evaluated in few basic or applied
studies (see Rollings & Baumeister, 1981,
for a notable exception). Successful general-
ization may hinge on the presence of stimuli
that have acquired tight control over re-
sponding, such that few responses occur in
the absence of the punishment contingency.
Relative to reinforced responding, it may be
difficult to establish control over punished
responding with stimuli that are not per-
fectly correlated with the delivery of punish-
ment. Thus, further research in the areas of
conditioned punishment, stimulus control,
and intermittent or delayed punishment ap-
pears to be critical for developing a technol-
ogy of generalization.

The current literature indicates that pun-
ishment must be delivered consistently in all
relevant contexts. Nevertheless, various gen-
eralization strategies described by Stokes and
Baer (1977) may be useful for promoting
treatment generality when the procedure is
extended beyond the initial treatment set-
ting. For example, a variety of stimulus con-
ditions could be arranged in the initial treat-
ment setting (e.g., different caregivers and
peers could be present, diverse activities
could be scheduled, physical features of the
environment could vary). Stimuli common
to other settings and contexts in which pun-
ishment will be applied could be introduced
in the initial treatment setting before the in-
tervention is widely implemented. Treat-
ment generality also may be enhanced by en-

453PUNISHMENT

suring that reinforcement is implemented
consistently across settings, incorporating
certain aspects of self-management into
treatment (e.g., self-monitoring), and estab-
lishing salient discriminative stimuli for pun-
ishment in all settings and contexts (see
Stokes & Baer for further discussion of gen-
eralization procedures).

Indirect Effects of Punishment

The effects of punishment on responses
that can occur concurrently with the pun-
ished behavior or in a different context as the
punished behavior also have been studied in
basic and applied research. Among these side
effects, collateral increases in aggression, es-
cape behavior, and emotional reactions are
most commonly described in basic textbooks
and literature reviews (e.g., Azrin & Holz,
1966; Mazur, 1998) and by authors who rec-
ommend against using punishment in clinical
settings (e.g., LaVigna & Donnellan, 1986;
McGee, Menolascino, Hobbs, & Menousek,
1987; Parsons et al., 2001).

Aggression (i.e., attacking nearby subjects,
biting inanimate objects) in rats, pigeons,
and monkeys has been associated with non-
contingent delivery of unavoidable stimuli,
including shock and intense heat (e.g.,
Hutchinson, 1977; Ulrich & Azrin, 1962).
Although this phenomenon is often called
punishment-elicited aggression, few studies
have examined this side effect of punish-
ment. Basic findings on the effects of ines-
capable, intense punishers probably have
limited generality to the application of pun-
ishment (see Linscheid & Meinhold, 1990,
for further discussion). Furthermore, elicited
aggression in monkeys and rats has been ob-
served to decrease when the subject could
exhibit a response (e.g., lever press) to escape
from the situation in which the stimulus was
delivered (e.g., Azrin, Hutchinson, & Hake,
1966). This finding suggests that elicited ag-
gression may be less problematic during
punishment than is commonly assumed be-

cause the contingency itself provides an es-
cape response (i.e., delivery of the punisher
can be avoided by refraining from the pun-
ished behavior). In fact, results of several
studies with rats showed that emotional re-
sponses in the form of crouching and defe-
cation were more pronounced and persistent
when subjects were exposed to unavoidable
shock than to response-contingent stimula-
tion (Hearst, 1965; Hunt & Brady, 1955).

On the other hand, numerous basic stud-
ies indicate that other forms of unpunished
behavior, including responses that occur in
the absence of programmed consequences
(e.g., species-specific behavior) and those
that are maintained by experimenter-deliv-
ered reinforcement, may increase, decrease,
or remain unchanged during punishment.
Factors that determine whether unpunished
behavior will increase or decrease (called con-
trast and induction, respectively) have not
been thoroughly studied. The function of
the behavior, schedule and intensity of the
punisher, and prior exposure to the punisher
may be important (see Crosbie et al., 1997,
for a discussion).

In a series of studies, Dunham and col-
leagues examined the effects of punishment
on multiple responses in gerbils by deliver-
ing shock contingent on one response (e.g.,
eating) while changes in alternative responses
(e.g., digging, grooming, running) were
measured. Results indicated that the most
probable of the unpunished responses in-
creased during punishment, whereas re-
sponses that tended to follow the punished
response decreased (Dunham, 1977, 1978;
Dunham & Grantmyre, 1982). A subse-
quent study suggested that the function of
the unpunished behavior also may determine
these side effects. Baker, Woods, Tait, and
Gardiner (1986) found that when eating in
gerbils was punished by shock or noise, dig-
ging increased even though running was the
most probable response during baseline. The
authors suggested that digging was a species-

454 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

specific response to food deprivation (i.e.,
digging was in the same response class as
eating). Results of studies on behavior that
is maintained in the absence of experiment-
er-arranged reinforcement may have some
relevance to problem behavior that produces
its own reinforcing consequences (e.g., sen-
sory stimulation).

In other basic studies with humans and pi-
geons, the same reinforcer was used to estab-
lish and maintain two or more functionally
equivalent responses (e.g., key pecking, lever
pulling) under concurrent or multiple sched-
ules. Punishment in the form of shock, time-
out, and point or monetary loss was then de-
livered for one member of the response class
while the effects on the other responses were
observed. The most common finding for both
humans and nonhumans was an increase in
unpunished behavior (i.e., contrast; Bennett
& Cherek, 1990; Bradshaw, Szabadi, & Bev-
an, 1979; Brethower & Reynolds, 1962; Cros-
bie, 1991; Powell, 1971; Thomas, 1968).
However, results were inconsistent both with-
in and across subjects, and the effects often
were short-lived. The main findings of Dun-
ham and colleagues (i.e., an increase in the
most probable behavior and a decrease in be-
havior that often followed the punished be-
havior; Dunham, 1977, 1978; Dunham &
Grantmyre, 1982) were not replicated with
college students when up to 10 responses were
reinforced simultaneously and one response
was exposed to contingent point loss (Crosbie,
1990, 1991).

From a clinical standpoint, collateral in-
creases in appropriate behavior and collateral
decreases in unpunished inappropriate behav-
ior would be desirable. In fact, applied re-
search findings suggest that a variety of de-
sirable and undesirable side effects can occur
within and across individuals. Punishment of
problem behavior has been associated with
increases in appropriate behavior, such as
compliance and toy play (e.g., Koegel, Fire-
stone, Kramme, & Dunlap, 1974; Rolider,

Cummings, & Van Houten, 1991) and with
decreases in unpunished inappropriate behav-
ior, including aggression and crying (e.g., Bit-
good, Crowe, Suarez, & Peters, 1980; Lovaas
& Simmons, 1969; Linscheid et al., 1990;
Ricketts et al., 1993; Singh, Watson, & Win-
ton, 1986). On the other hand, decreases in
appropriate behavior (e.g., toy play, speaking)
and increases in unpunished problem behav-
ior (e.g., aggression, emotional reactions, ste-
reotypic behavior) also have been reported
(e.g., Bitgood et al., 1980; Duker & Seys,
1996; Foxx & Azrin, 1973; Harris & Wol-
chick, 1979; Pendergrass, 1971; Singh, Man-
ning, & Angell, 1982; Thompson et al.,
1999). A number of authors have suggested
that desirable side effects are more likely to
occur than undesirable side effects during
treatment with punishment (see Lundervold
& Bourland, 1988, and Matson & Taras,
1989, for reviews). The prevalence of these
side effects is unknown, however, because rel-
atively few studies have directly examined the
effects of punishment on unpunished behav-
ior in clinical settings. More important, data
collection often was limited to one or two
collateral behaviors (see Sisson, Hersen, &
Van Hasselt, 1993, for a notable exception).
Positive side effects also may be reported
more frequently than undesirable side effects
in clinical studies on punishment, regardless
of the actual prevalence.

Although relatively incomplete, basic
findings in this area suggest some possible
explanations for the inconsistent outcomes
obtained in applied studies. Punishment-
elicited aggression and emotional reactions
are less probable when exposure to the pun-
ishing stimulus can be reduced or avoided
(e.g., Azrin et al., 1966; Hunt & Brady,
1955). Thus, these undesirable side effects
may have been less likely to occur in clinical
studies when a relatively brief punisher sup-
pressed behavior to low levels or when an
alternative source of reinforcement was high-
ly effective in strengthening an incompatible

455PUNISHMENT

response. Conversely, aggression and other
inappropriate behavior may have increased
in some applied studies because the respons-
es were in the same response class as the
punished behavior (Baker et al., 1984). Re-
sults of several basic studies with rats and
pigeons also indicate that the likelihood of
contrast is positively related to the density of
the punishment schedule (e.g., Deluty,
1976; Thomas, 1968). Thus, increases in
unpunished behavior may have been more
probable when the punishment procedure
was implemented with a high degree of in-
tegrity (i.e., consistently followed each oc-
currence of the response).

Some basic findings suggest that context
may be an important factor in determining
which responses increase or decrease during
punishment. Bolles, Holtz, Dunn, and Hill
(1980) found that induction in rats was
more likely to occur when the unpunished
response was performed under the same
stimulus condition as the punished response
(e.g., pushing vs. lifting the same lever) than
under different stimulus conditions (e.g.,
manipulating separate levers). Crosbie et al.
(1997) found that induction in both hu-
mans and nonhumans was more likely to oc-
cur under mixed schedules during the initial
exposure to punishment, whereas contrast
was more likely to occur under multiple
schedules. Together, these findings suggest
that functionally equivalent unpunished re-
sponses may have been likely to decrease in
applied studies if the behavior tended to be
exhibited in the same context as the pun-
ished behavior.

Further research on factors that determine
whether a particular unpunished behavior
will increase, decrease, or remain unchanged
during punishment is needed so that the di-
rection and nature of side effects can be pre-
dicted and controlled. Further research also
is needed to determine if these side effects
are specific to punishment because similar
results have been obtained when a response

was suppressed via satiation or response
blocking (e.g., Dunham & Grantmyre,
1982), indicating that such effects may be
associated with response suppression per se.
In fact, several undesirable side effects of
punishment (e.g., increases in aggression, es-
cape, and emotional reactions) have been as-
sociated with extinction procedures (Lerman
& Iwata, 1996a) that often were confounded
with punishment in applied research.

Nevertheless, basic findings suggest a
number of potentially useful clinical strate-
gies. Punishment-elicited aggression or emo-
tional responses (e.g., crying) may be atten-
uated by implementing procedures that min-
imize exposure to the punishing stimulus
(e.g., using brief stimuli that produce near-
complete suppression of the behavior;
strengthening competing responses by deliv-
ering potent reinforcers on rich schedules).
Comprehensive descriptive or functional
analyses of appropriate and inappropriate
behavior in an individual’s repertoire may be
useful for predicting the likelihood of un-
desirable collateral effects and for arranging
conditions to increase desirable effects. In-
suring that caregivers withhold reinforce-
ment for unpunished problem behavior
might prevent collateral increases in behavior
that is in the same response class as the pun-
ished behavior. Alternative strategies for
managing undesirable contrast effects (e.g.,
arranging punishment for other inappropri-
ate responses) may be necessary if extinction
cannot be used.

Identifying and punishing precursors to
dangerous behavior (e.g., mild forms of self-
injury that consistently precede more severe
forms) may lead to collateral reductions in
the severe behavior, augmenting the safety
and efficacy of treatment (e.g., Dunham,
1977, 1978). Collateral reductions in func-
tionally equivalent appropriate behavior
might be avoided by arranging reinforce-
ment for the behavior under stimulus con-
ditions that are distinctly different from

456 DOROTHEA C. LERMAN and CHRISTINA M. VORNDRAN

those present when the punished behavior
occurs (e.g., by modifying features of the en-
vironment or introducing reinforcement in
a new setting). To this end, caregivers should
ensure that alternative reinforcement is avail-
able for multiple responses across a variety
of contexts and settings.

Finally, the potential for undesirable side
effects that involve caregiver behavior (e.g.,
overusing punishment, dehumanizing the
punished individual) should be given more
attention in the applied literature. Although
these effects are frequently described in text-
books and reviews (e.g., Cooper et al., 1987;
Guess et al., 1987; Kazdin, 2001), few stud-
ies have directly evaluated changes in the
punishing agent’s behavior. Research findings
that are relevant to this phenomenon have
not supported the hypothesis that using pun-
ishment negatively affects caregiver behavior
or attitudes toward the punished individual
(e.g., Bihm, Sigelman, & Westbrook, 1997;
Goza, Ricketts, & Perkins, 1993; Harris,
Handleman, Gill, & Fong, 1991; Propst &
Nagle, 1981). Bihm et al., for example, found
that college students’ attitudes toward a fic-
titious client (i.e., ratings of client compe-
tence, adjustment, and learning potential)
were related to treatment success rather than
to the type of intervention used (i.e., rein-
forcement vs. mild or intense punishment).

CONCLUSIONS

The use of punishment to treat problem
behavior in clinical populations has re-
mained controversial for many years (see
Iwata, 1988; Johnston, 1991). Results of ba-
sic and applied research indicate that current
treatment approaches based on punishment
have advantages (e.g., they are highly effec-
tive) and disadvantages (e.g., there are un-
predictable side effects). Nevertheless, pun-
ishment is still sometimes needed to reduce
destructive behavior to acceptable levels
(e.g., Grace et al., 1994; Hagopian et al.,

1998; Wacker et al., 1990); punishment may
underlie the effects of certain common func-
tion-based treatments (e.g., Lerman & Iwa-
ta, 1996b; Mazaleski et al., 1994); and care-
givers continue to use punishment to reduce
problem behavior in the natural environ-
ment (e.g., Peterson & Martens, 1995).

Further understanding of punishment
processes is needed to develop a systematic,
effective technology of behavior change. A
review of the applied literature indicates that
a wide range of punishment procedures can
successfully treat severe behavior disorders in
clinical populations. Variables that contrib-
ute to the findings reported in this research,
however, have not been delineated. The ma-
jority of studies focused on procedural vari-
ations of punishment rather than on factors
that may influence the direct and indirect
effects of punishment. A review of labora-
tory research on punishment suggests that
numerous variables alter basic processes in
complex ways. Factors such as history, rein-
forcement schedule, various punishment pa-
rameters, and alternative sources of reinforce-
ment may influence the immediate effects of
punishment and other clinically relevant out-
comes, such as long-term maintenance, gen-
eralization, and the emergence of side ef-
fects. Basic findings also contradict some
commonly held assumptions about punish-
ment effects and provide possible explana-
tions for the inconsistent findings that have
been reported in applied studies.

Nevertheless, current knowledge about
basic processes is insufficient for translation
to application. The basic literature on some
important relations remains incomplete
(Baron, 1991; Crosbie, 1998). More impor-
tant, the extent to which findings with non-
humans and response-contingent electric
shock can be extrapolated to the treatment
of behavior disorders in clinical populations
may be substantially restricted. Although
some basic studies have been conducted with
human participants, the typical punisher

457PUNISHMENT

(point or monetary loss) and population
(normal adults) may limit the relevance of
the findings for individuals with restricted
verbal skills (see Hayes & McCurry, 1990,
for further discussion).

Research on punishment only tentatively
supports most prescriptions for application
discussed in previous articles on punishment
and in this updated review of the literature.
Basic findings also suggest that the process
of punishment may be more complex than
frequently assumed. As such, clinicians, par-
ents, and teachers should be cautioned about
the need for further research on potential
strategies for increasing the effectiveness of
mild punishers, for attenuating undesirable
aspects of punishment, and for successfully
fading treatment with punishment.

The basic literature suggests a number of
avenues for further research. In particular,
knowledge about conditioned, intermittent,
and delayed punishment and the interactive
effects of reinforcement and punishment may
lead to technological advances that increase
the effectiveness and acceptability of punish-
ment in clinical settings. Concurrent sched-
ules of reinforcement and punishment are es-
pecially germane to application because mul-
tiple contingencies typically operate in the
natural environment. Treatment also may
have a greater likelihood of immediate, long-
term, and generalized success when multiple
sources of alternative reinforcement are ar-
ranged within the context of punishment.

The refinement of functional analysis
methodologies has led to greater understand-
ing of variables that can maintain problem
behavior and an emphasis on function-based
intervention. Yet, potentially important links
between function and treatments based on
punishment often may be overlooked. The
utility of functional analysis for guiding de-
cisions about potential treatments that in-
clude a punishment component should be
emphasized in further research. Results of
functional analyses may indicate whether

treatment with reinforcement alone (e.g.,
differential reinforcement) or with common
punishment procedures (e.g., time-out, ver-
bal reprimands) will be successful. For ex-
ample, time-out is more likely to be effective
than contingent verbal reprimands if prob-
lem behavior is sensitive to attention (Iwata,
Pace, Dorsey, et al., 1994). Problem behav-
ior that occurs at high levels across a wide
variety of conditions may be less responsive
to treatment with reinforcement than behav-
ior that is differentially low under certain
conditions (e.g., the play or control condi-
tion of the functional analysis; see Paisey,
Whitney, & Hislop, 1990). Functional anal-
ysis methodology also may be useful for
identifying potent reinforcers to arrange as
part of treatment (e.g., for use in differential
reinforcement or noncontingent reinforce-
ment procedures) and for identifying func-
tionally equivalent appropriate behavior to
strengthen as part of treatment.

Finally, a greater willingness to publish
studies showing treatment failures and other
undesirable outcomes during punishment
may be helpful. For example, unsuccessful at-
tempts to attenuate side effects, to increase
the efficacy of delayed punishment, or to pro-
mote long-term maintenance and generaliza-
tion may guide further research for delineat-
ing variables that are and are not relevant to
clinical application. This knowledge ultimate-
ly may lead to more effective, empirically
sound recommendations for treatment.

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Received September 1, 2001
Final acceptance August 12, 2002
Action Editor, Joseph Spradlin