Camp counselor Annie Artiga stood in a gymnasium on a rainy morning, jotting down marks on a clipboard as she watched her 10 charges play kickball.
But she wasn’t keeping score. Artiga was recording points based on each child’s behavior, as part of a six-week program for children with behavioral disorders. One child got points for sportsmanship; another lost points because she couldn’t remember the number of outs in the game.
The camp — the University of Alabama at Birmingham’s six-week Summer Treatment Program — is one of a growing number nationwide that provide intense behavioral therapy for children in a summer day camp setting.
“It addresses a lot of important areas of daily life,” said camp director Bart Hodgens, a clinical psychologist at the university. “The children are developing social skills, problem-solving skills, academic skills, and we also spend a lot of time on recreation.”
Points-and-reward system
Most of Artiga’s charges have attention deficit hyperactivity, which often impairs children’s ability to function in multiple settings — including home, school, and in relationships with peers. Symptoms include impulsiveness, hyperactivity and inattention.
The University of Alabama’s highly detailed program addresses those impairments by guiding the 24 enrolled children through a strict schedule of sports, academics and art classes. Before and after each session, staff members lead the children in a discussion about rules for the games and classroom and camp life.
Children receive points for correct answers and maintaining eye contact, among other behaviors. Those points earn the children rewards, such as permission to participate in weekly field trips.
Vicki Norris, whose 9-year-old son, William, is returning to the camp for a second year, said she found the points-and-rewards system so effective that she adopted it at home.
“I was actually able to adapt the points system for daily use, and it absolutely changed the way the whole school year went,” Norris said.
Focus on behavior modification
The camp’s therapy is based around the concept that medication is simply a quick fix for children with such disorders — and does nothing, in the long run, without behavior modification.
It follows a manual designed by William E. Pelham Jr., professor of psychology, pediatrics and psychiatry at the State University of New York at Buffalo.
“People are becoming increasingly aware that even though medication is what’s tried with most ADHD kids, medication alone is not a sufficient long-term treatment,” Pelham said. “There’s a lot of data showing that parents don’t like to medicate their kids.”
According to ADHD experts, such behavioral therapy programs have proven effective in repeated studies.
“The behavioral interventions, when combined with medication, are really what we consider to be the standard of care,” said Russell A. Barkley, a research professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y.
“We often recommend that they be combined,” said Barkley, who has written nearly 20 books on ADHD and treatment options. “Many children obviously succeed with medication alone, but the medication doesn’t address all of their difficulties.”
'A world of confidence'
Pelham said the demand for his manual has increased significantly since he developed the program in the early 1980s. He estimated there are about 100 programs across the country — including the University at Alabama’s camp — that use a version of his plan.
That program — with graduate and undergraduate staff members — costs $2,800 for each child — a sum usually paid by the families. Parents and staff said they hoped that, in the future, camps would lower their prices or insurance companies would become more willing to pay for the programs.
“I’d like to see more of these kind of camps ... and have them be more financially within reach,” said Norris, the mother of camp attendee William. “It gave him back a world of confidence — helped him develop better techniques for meeting people and approaching people.”
