Dr. Remo's 4 Interventions: Combining Pharmacological & Behavioral Therapies - Essay Sample

Introduction

The theoretical orientations and four interventions used by Dr. Remoc are interconnected in that they all apply multiply approaches to rectify the disorder. According to Dr. Remoc, combinational therapies bolster the victim's chances of recovery and coping. The two most prevalent combinational therapies include pharmacological treatment and behavioral therapy or psychotherapy (Rajeh, Amanullah, Shivakumar, & Cole, 2017, p. 131). All the four interventions used by Dr. Remoc depict combination therapies rather than stand-alone therapy approaches. Single therapy approaches would entail the use of either drug therapy or behavioral therapy as the only approach to treat Billy. Every individual method has its benefits and weaknesses. This makes reliance on only one approach subjective, which may jeopardize the entire recovery process. When administered, stimulants(drug therapy) lead to a more attentive and focused impulse control mechanism. The drugs achieve their impact by mediating the biological pathways of impulse control. Such improved attention aim at remediating negative behaviors caused by ADHD (Rajeh et al. 2017, p. 134). This necessitates behavioral therapy to assist the victim in understanding their behaviors, impacts of such behaviors, and the need to adapt to certain desired behaviors. The ABC(Antecedents, Behavior, Consequences) model is most commonly used for behavioral therapy. Parenting and social environments are essential antecedents for behavior, while rewards are consequences of such behaviors. Social skills enable learning of alternative responses to attain the outcomes (Rajeh et al. 2017, p. 132). Medication and parental training help modulate behavioral antecedents. The continued application of this hybrid therapy approach leads to the positive reinforcement of alternative behaviors through positive behavioral autonomy. Dr. Remoc successfully employs this in the four interventions of medication monitoring, parental training, social skills training, and the token economy.

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Efficacy of Integrating the Two Orientations and Potential Problems With Medication as the Only Treatment for Children with ADHD

From the study, it is evident that the integration of the two orientations, drug therapy, and psychotherapy, is an efficient method of treating ADHD. This approach provides a more comprehensive strategy to address all the domains of the disorder. This disorder stems from both biological and social factors. Therefore, the management of ADHD requires efficient mediation of both psychological(behavioral) and nervous(natural) facets. Stimulant medications act as central nervous system(CNS) tranquilizers to reduce the states of anxiety and tension. The reduction in pressure and anxiety allows the patient to gain focus and impulse control (Mulqueen, Bartley, & Bloch, 2015, p. 118). After the drug has facilitated the attainment of focus and stimulation, behavioral therapy helps in the rectification of spontaneous and negative behaviors associated with ADHD. If only drug therapy were applied, the patient would be calm and focused but still indulge in harmful behaviors due to the absence of negative behavioral reinforcement brought by the disorder. On the other hand, behavioral therapy solely applied would not achieve positive outcomes since the patient would be too agitated, nervous, and inattentive to follow through the therapy session (Hamblin & Gross, 2012). Therefore, combination therapy achieves high efficacy by transcending the weaknesses of individual approaches for a more holistic intervention.

Medications are an excellent treatment option for ADHD. Nonetheless, drugs may present various problems for children, primarily if relied upon as the only treatment plan. ADHD medications produce alleviate anxiety and tension over short periods. They thus require continued use to maintain relatively long term benefits. Prolonged use of such drugs may lead to dependence (Rajeh et al. 2017, p. 131). Also, most impacts of ADHD are social and behavioral. By only addressing the physiological states of the disorder, medications have a narrower scope of effectiveness than behavioral or combination therapy. Some researchers have proposed that the use of certain drugs may have devastating impacts on the developing brain of children. Due to the differences in individual biological systems, different children react differently to ADHD medications. In some children, the side effects of these drugs can be so severe as to cause other health complications or exacerbate the impact of ADHD (Rajeh et al. 2017, p. 135). It is thus imperative to conduct a safety assessment on a child before placing them on ADHD medications.

Tasks and Positive Reinforcements for Billy's Token Economy

The token economy approach extrinsically motivates the victims to reinforce desired positive behaviors in anticipation of specified rewards. The tokens are awarded to the person directly and can be renewed for a meaningful object or privilege as desired by the victims. This is an essential system for behavior modulation (Mulqueen et al. 2015, p. 119). In Billy's case, the teachers are to award him tokens for behaviors like sustained attention amid external distraction and adherence to instructions, among others. The tasks of the token economy for Billy's case include the specification of tokens, selection of the final rewards, and the determination of token exchange procedures. The tokens should be simple, inexpensive, and appropriate for a school set-up. The tokens should convey positive messages that further reinforce positive behaviors. The same criteria apply for the final rewards. Token exchange should be at a specified place and time, and violation of token exchange procedures by the participants should be accorded punitive measures like the loss of a fraction of accrued tokens. Such a definite token exchange system instills discipline and positive behavior in the child. To reinforce the token economy for positive outcomes, it is essential to clearly define the target behaviors for the system and let the participants understand the need for the system (Rajeh et al. 2017, p. 133). The participants should also be actively involved in the designing of the token system. This ensures participant buy-in and further motivates the participants toward positive behaviors.

Effectiveness of the Four Treatment Interventions

Each of the four interventions used by Dr. Remoc has a unique quality that makes it useful in addressing Billy's condition. Medications are taken periodically to maintain a uniform scale of impact. Therefore, regular monitoring is an effective way to determine the efficiency of drugs. Follow-up also allows the determination of any need to adjust the drug administration schedule for maximum efficacy (Mulqueen et al. 2015, p. 121). The family and home form the primary social environment for the child. Parents and family are the primary caregivers for children at home. Therefore, the quality of parent and family care significantly impacts the effectiveness of any other behavioral intervention implemented for the patient. Parental training seeks to boost the quality of primary care at home as a basis for positive behavioral outcomes in school and other social settings. However, the parental training program ignores the role of entire families in providing solid social foundations. Thus, family sessions should be incorporated into the plan (Rajeh et al. 2017, p. 133). Social skills are essential for Billy's positive response to the behavioral therapy approaches, and the token economy creates motivation towards behavior change. The effectiveness of these four approaches determines the overall efficiency of Dr. Remoc's treatment for Billy. This is an effective treatment master plan.

Additional Treatment Interventions

Despite the comprehensiveness of Dr. Remoc's treatment interventions, other plans can be incorporated into the program to boost the robustness of the treatment. Three such interventions include individual and family counseling, group therapy, and proper nutrition. Individual counseling raises the patient's awareness of the condition, thus helping them actively involved in the behavior therapy process (Hamblin & Gross, 2012). Counseling aims to remediate negative feelings and emotions associated with the disorder, which, in turn, motivate the patient to embrace the interventions applied. Family counseling is also essential to ease the emotional distress of handling an affected loved one. This boosts the family's ability to help their kin manage the condition effectively. Group therapy sessions permit free interactions between people with ADHD (Hamblin & Gross, 2012). Through these interactions, they develop social skills among themselves. Such skills can be expertly molded through other behavioral therapies for positive reinforcement.

References

Hamblin, R. J., & Gross, A. M. (2012). AttentionDeficit/Hyperactivity Disorders. Handbook of EvidenceBased Practice in Clinical Psychology, 1. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118156391.ebcp001010

Mulqueen, J. M., Bartley, C. A., & Bloch, M. H. (2015). Meta-analysis: parental interventions for preschool ADHD. Journal of attention disorders, 19(2), 118-124. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1087054713504135

Rajeh, A., Amanullah, S., Shivakumar, K., & Cole, J. (2017). Interventions in ADHD: A comparative review of stimulant medications and behavioral therapies. Asian journal of psychiatry, 25, 131-135. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1876201816303963