TREATMENT OF COMMON BEHAVIOR PROBLEMS IN A PEDIATRIC CLINIC

Abstract

123 children (median age 4.5 years) were referred from a well-baby clinic to a behavior clinic established to evaluate the suitability and efficacy of behavioral techniques as applied in a medical setting by pediatricians. The clinic's permanent staff are a behavioral psychologist and an attending pediatrician. Rotating students, house staff and fellows are taught a standard approach to history-taking and treatment in a one-hour lecture and appropriate readings. Proficiency is generally acquired in two or three supervised sessions. Thirty different individual behavior problems were treated: Trouble sleeping (N=33) and eating (25), bedwetting (19) toileting problems (11) temper tantrums and other minor disobedience (20) and others (dawdling, phobias, hairpulling, medicine refusal, functional pain, etc (36). Also referred were children (46) with multiple behavior problems, i.e. "hyperactivity" and general home and school disobedience. Parents and children were seen together in 1 to 3, 30-minute sessions. Using a parent rated behavior check list and standardized interviews, follow-ups were conducted at 2 weeks and 6 months. 75.3% of parents with single complaints reported resolution. Only 21% of those with multiple problems benefited from the contact. 90% of those parents with single problems who could give a good description of the pediatrician's advice reported resolution; only 7% of those with poor recall were successful. However, of those parents with hyperactive children, parental recall of advice made no apparent difference in success rate.