Friday, April 20, 2007

Behavioral interventions: a bit of a fraud?

We're multi-year veterans of a range of neurobehavioral disorders. We also have medical degrees and attend a range of meetings that discuss the management of autism, ADHD, etc. Finally, we have access to a wide range of reputable and experienced psychologists, psychiatrists, social workers, medical subspecialists, etc. We have a healthy fear of longterm neurochemicals (drugs), but we use 'em and are pretty darned happy they exist. Even so, we're predisposed to prefer behavioral interventions.

Which is all to say, we ought to have a nice library of behavioral interventions at our fingertips.

If they existed.

Which, I'm beginning to suspect, they don't.

We've practiced everything we've been told, read about and invented that has any kind of evidence base, but it hasn't taken long to run out of ideas. We rely on a small set of moderately effective interventions and medication adjustment. It's been years since any specialist suggested a behavioral intervention that was new to us.

At the end of the day, I suspect there aren't that many useful behavioral interventions out there. The ones that work could probably fit on an index card, and their implementations could fit in a few short papers.

So here's my modest proposal. Until we get a wider range of behavioral therapies for ADHD, EBD, ODD, autism, CD and the rest of the alphabet -- let's be a bit more modest about how many good behavioral interventions really exist. Don't let speakers get away with vague references to "behavioral interventions" -- pin 'em to the wall and demand four examples. They won't mention the topic again ... :-).

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