Behavioral Approaches

Nonadherence can be addressed using behavior modification techniques that include frequent monitoring and supervision (Shemesh et al. 2008a, 2008b) and reinforcing desired behaviors by providing incentives rather than focusing on negative behaviors. Specific behavioral plans with appropriate incentives and an effective system of monitoring and rewards should be tailored for each patient. The family's (typically, a parent's) ability to implement behavioral techniques is frequently the most important determinant of success. Behavioral approaches to the treatment of nonadherence are probably more efficacious than educational efforts in some disease processes (Kahana et al. 2008). Thus, a behavioral approach should probably be considered in most (if not all) cases in which nonadherence has been identified. A specific subtype of a behavioral approach is the use of technology-based interventions (e.g., cell phone reminders). These interventions can be easy to implement on a large scale and could be relatively easy to follow, but more information is needed about their efficacy because very few studies to date have investigated their use in children (Kahana et al. 2008).

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