Why Reward Charts Should Not Be Used in Adult Social Care for Autistic Adults and Adults with Learning Disabilities

Reward charts are widely used in education and behavioural management, but they are not suitable for adult social care settings, particularly for autistic adults and individuals with learning disabilities who have complex support needs. Research shows that reward-based systems fail to address the underlying causes of behaviour, can be counterproductive, and may undermine autonomy, dignity, and well-being.

This article presents empirical evidence explaining why reward charts should not be used in these contexts and highlights alternative, evidence-based approaches.

Limited Effectiveness and the Undermining of Intrinsic Motivation

Reward charts rely on extrinsic motivation, using external incentives (e.g., stickers, privileges) to modify behaviour. However, research consistently demonstrates that extrinsic rewards can reduce intrinsic motivation, leading to short-term compliance rather than meaningful, lasting change.

Empirical Evidence

• Deci, Koestner, & Ryan (1999) conducted a meta-analysis of 128 studies, finding that tangible rewards significantly decrease intrinsic motivation, particularly when used as a form of behavioural control.
• Kohn (1993) argues that reward-based systems encourage individuals to seek external approval rather than developing self-regulation and internalised values. Once the external reward is removed, the desired behaviour often disappears.
• Ryan & Deci (2000) developed Self-Determination Theory (SDT), which emphasises autonomy, competence, and relatedness in fostering long-term behaviour change. Reward charts actively undermine autonomy by shifting control from the individual to an external authority.

Why This Matters in Adult Social Care

• Many autistic adults and adults with learning disabilities rely on predictability and autonomy to feel safe and regulate their emotions. Reward charts introduce an external control that disrupts this balance.
• Instead of fostering self-motivation and understanding, reward systems condition individuals to behave in specific ways only when a reward is present, leading to dependency on external validation rather than genuine behaviour change.

Failure to Address the Function of Behaviour

In Positive Behaviour Support (PBS), behaviour is understood as a form of communication. Challenging behaviour often arises due to unmet needs, such as sensory, emotional, communicative, or environmental factors.

Empirical Evidence

• O’Neill et al. (1997) highlight that Functional Behaviour Assessment (FBA) is essential to determine the root causes of behaviour before implementing interventions. Reward charts do not address function; instead, they focus on modifying the external behaviour without considering the underlying need.
• Carr et al. (1994) demonstrated that PBS interventions based on function are significantly more effective than reward-based systems. Their study found that modifying environmental factors and teaching new skills led to long-term improvements in behaviour.
• Dunlap et al. (2008) found that function-based interventions resulted in more stable, long-term improvements in quality of life compared to behaviourist reward-based models.

Why This Matters in Adult Social Care

• Reward charts focus on superficial behaviour modification rather than understanding why a behaviour occurs.
• They can mask distress by encouraging individuals to suppress behaviours without resolving the underlying issue.
• Adults with complex needs require individualised, functional interventions—not generic, compliance-driven reward systems.

Impact on Autonomy, Dignity, and Human Rights

Reward charts infantilise adults by treating them as though they require external validation and control, which contradicts the principles of dignity, autonomy, and self-determination in adult social care.

Empirical Evidence

• Beadle-Brown et al. (2016) emphasise the importance of person-centred active support, where individuals are given autonomy to make choices. Reward charts work against this by setting predefined behavioural expectations rather than promoting self-determination.
• The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD, 2006) asserts that disabled people have the right to autonomy and non-discrimination. Reward systems, particularly when used to enforce compliance, can be ethically problematic by restricting freedom of choice.
• Bigby et al. (2018) highlight the Capable Environments Framework, which promotes independence and well-being without the need for external rewards.

Why This Matters in Adult Social Care

• Treating adults like children undermines their dignity and can increase resistance to support.
• Autistic adults and individuals with learning disabilities should be supported to make their own choices, not be coerced into compliance through reward-based systems.
• Reward charts often reinforce power imbalances, where staff dictate what is considered "appropriate" behaviour rather than collaborating with the individual.

Potential for Negative Psychological Consequences

Research suggests that reward-based interventions can lead to unintended negative consequences, particularly for autistic individuals who may experience anxiety, masking, or a sense of failure when they do not meet reward expectations.

Empirical Evidence

• Hull et al. (2017) explored autistic masking, where individuals suppress natural behaviours to meet social expectations. Reward charts encourage masking, which is linked to increased anxiety, depression, and burnout.
• Stewart et al. (2006) found that individuals who fail to meet reward-based goals often experience shame, frustration, and low self-esteem.
• Gore et al. (2013) caution against coercive behavioural approaches in PBS, as they can lead to distress and an increase in behaviours of concern.

Why This Matters in Adult Social Care

• Masking behaviours to earn rewards can lead to stress, exhaustion, and burnout.
• Failing to earn a reward can feel like punishment, reinforcing low self-worth and distress.
• Long-term mental health difficulties can arise when individuals feel pressured to conform rather than being supported holistically.

Alternatives: Evidence-Based Approaches to Support Positive Behaviour

Instead of using reward charts, research supports proactive, person-centred interventions that focus on long-term behavioural change and quality of life improvements.

Empirical Evidence

• Horner et al. (1990) found that PBS interventions were significantly more effective than behaviourist reward systems in reducing behaviours of concern.
• Gore et al. (2013) advocate for PBS approaches that enhance autonomy, self-determination, and environmental supports to promote meaningful behaviour change.
• Bigby et al. (2018) recommend the Capable Environments Framework, which fosters independence and well-being without relying on external rewards or coercion.

Conclusion

Instead, Positive Behaviour Support (PBS), Capable Environments, and person-centred support provide ethical and evidence-based alternatives that promote autonomy and well-being.

For instance, rather than using a sticker chart to encourage participation in activities, a PBS approach would involve understanding an individual’s preferences and structuring activities in a way that naturally supports engagement.

Ethical behaviour support must prioritise long-term well-being over short-term compliance.

Would love to hear your thoughts—have you seen reward-based approaches fail in adult social care? Let’s start a conversation about more effective, ethical alternatives.

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