Behavioral Therapy and Medication

An evidence-based therapy to address a child’s or teen’s inattentive, impulsive, and hyperactive behaviors. This two-step process of (1) teaching parents how to support and increase their child’s positive behaviors and (2) obtaining a prescription medication aimed at decreasing these behaviors has been found to have the BEST SUPPORT in improving the behavior of children with attentional problems (such as Attention Deficit/Hyperactivity Disorder).

What should my child’s therapist be doing? 

For Behavior Therapy:

• Explaining the diagnosis and discussing the biological and environmental development of the disorder.

• Explaining some basic principles of behavior: the function of a behavior (for example, to get something or to avoid something), how behavior is “triggered” and how negative behavior can be replaced with more desirable behavior through positive or negative reinforcement.

• Teaching you (or other adults in your child’s life) the practices or skills needed to better manage your child’s challenging behavior, while increasing their positive ones.  The teaching sessions usually combine discussion, modeling by the therapist, role playing, and direct practice with your child. Key skills include:

• Defining and targeting behavior(s) you would like to change,

• Tracking and recording the negative behaviors you would like to decrease, as well as positive behaviors you would like to increase,

• Providing positive reinforcement for good behavior,

• Removing rewards for problem behavior or punishing unwanted behavior (through time-outs, loss of privileges, etc.),

• Teaching your child new skills to replace negative behaviors (like learning to ask for a break when frustrated, rather than having a tantrum).

For Medication:

• Explaining the rationale behind the use of medication treatment before beginning.

• Working with you to talk to a qualified pediatrician, family doctor, or child psychiatrist who can prescribe and monitor your child’s medication use. Stimulants (e.g., methylphenidate and dextroamphetamine) are the most commonly recommended group of medications for the behavioral and emotional problems faced by children, but some children with ADHD may respond better to non-stimulant medications, such as atomoxetine, guanfacine, tricyclic antidepressants, or bupropion. Only a qualified health professional will be able to make this determination, based on the specific medical needs of your child.

  • Both your child’s therapist (providing CBT) and your prescribing psychiatrist (or general physician) should work together to provide a coherent treatment approach. That is:

    • Therapist should know what the psychiatrist is doing and why

    • Psychiatrist should know what the therapist is doing and why

    • Therapist and psychiatrist should speak to one another every once in a while when there are changes in treatment direction (improvement, decline, etc.)

• Helping you to identify and address questions and concerns with the use of medications in your child’s treatment such as:

  • How to ensure that your child is taking their medication at school

  • How to develop a routine around medication use

  • How to talk to your child’s teacher about their condition (if needed)

What should I be doing?

• Consistently using the behavior management skills practiced in the therapy sessions at home when your child’s negative behavior you have targeted occurs;

• Looking for opportunities to reinforce your child’s good behavior through praise or small rewards;

• Building up your confidence by starting with simple problems (like asking your child to complete a chore) before tackling harder problem behavior (like fighting or skipping school);

• Using appropriate punishment (time-outs, loss of privileges, etc.) when needed rather than spanking;

• Helping your child maintain proper use of the medication prescribed by their doctor;

• Helping your child monitor their side effects (if any) and effectiveness of the medication, to be able to share this information with their doctor;

  • Actively facilitating communication between the therapist and psychiatrist through making it a clear expectation that everyone works together as a team.

  • Sign necessary consent forms so that the therapist and psychiatrist can speak to one another.

  • If either the therapist or psychiatrist feels that speaking to the other is not important, this is a bad sign and we recommend seeking a new provider.

• Asking questions of your child’s therapist and prescribing doctor (often a psychiatrist, family doctor, or pediatrician) as needed. If you are not comfortable asking the therapist questions, you can first talk things over with a friend or relative, or talk with someone from a parent support group.  They can hopefully help you feel more comfortable about approaching the therapist.

How will I know if it is working?

• You child’s behavior will improve and you will feel more confident about your parenting skills.

• Often parents report that their relationship with their child has gotten more positive after Behavioral Therapy and Medication.