Behavior Therapy, Part 2
Child psychiatrist Thomas Kobylski, M.D., of McLean, Virginia, compares AD/HD to diabetes: Medications are necessary but not sufficient for either condition. For optimal results, people with diabetes need to watch what they eat and to exercise, in addition to taking medication. Children with AD/HD, he says, need medication and behavior skills to function well at home and at school.
There is an added benefit from combination treatment, says Kobylski, who is chairman of the Washington area chapter of the American Academy of Child and Adolescent Psychiatry. Studies have found that children treated with behavior therapy can take a lower dose of medication, Kobylski says.
Public relations executive Susannah Budington, who lives in Chevy Chase, Maryland, began using behavior therapy several years ago, shortly after Allison, the oldest of her five children, was diagnosed with AD/HD and started taking a stimulant.
“She’s such an enthusiastic, wonderful kid. I would never want to medicate that away," says Budington. Medication, she says, enables Allison to be less impulsive and more cooperative, but behavior therapy has helped the 12-year-old “operate as part of our family and to do things with her friends. It’s extremely important.’’
One of the biggest problems, Budington says, has been getting Allison to do her homework without incessant reminders. One of the techniques Budington and her husband recently devised involves Allison’s desire to get her ears pierced, something her parents have agreed that she can do when she turns 13. When Allison does her homework without prompting, she gets a chip she can use to move up the ear-piercing date by a week. Bad behavior means a week is added.
In sync with the school
Trish White, a manager at CHAAD, says that involving her son’s school in his behavioral program has been critical to his progress during the two years since a pediatrician told her he had AD/HD. Once a child is diagnosed with the disorder, federal law requires that the school devise an individualized education plan that accommodates the disability. That plan often includes elements of behavioral treatment, but cooperation by teachers and school systems varies, experts say.
At his Anne Arundel County, Maryland, public school, White’s eight-year-old son sits near the teacher to minimize distractions. When she senses his attention is wandering, she taps lightly on his desk to remind him to focus. Every day she sends home a simple, color-coded behavior chart telling his parents how his day went.
White also uses daily behavior charts at home. When her son is helpful or gets along with his little sister, “he gets lots of hugs and kisses,’’ she says.
But, White adds, “We continue to struggle.’’ Reading remains difficult for her son, but he is better at following directions and seems more adept at making friends.
Quinn, who has seen concern about AD/HD medications wax and wane during the years she has treated hundreds of children with the disorder, regards growing interest in behavior therapy as a positive development.
“Drugs," she says, “can do only so much."
© 2006, The Washington Post. Photo by Michel DuCille. Reprinted with permission.