Who performs behavior modification therapy for a 19-month-old child and what type of referral is needed?

Behavior Modification Therapy for a 19-Month-Old: Provider and Referral Pathway

For a 19-month-old child requiring behavior modification therapy, refer directly to early intervention services or your local school system for needs assessment and intervention, which will provide access to trained professionals including behavioral therapists, speech-language pathologists, occupational therapists, and physical therapists who deliver parent training in behavior modification techniques. 1

Primary Referral Pathway

• Direct referral to early intervention services is the recommended first step for toddlers under 3 years of age with behavioral concerns, developmental delays, or problem behaviors 1
• These programs provide comprehensive assessment and connect families to appropriate specialists without requiring multiple individual referrals 1
• No formal diagnosis is required before making this referral—early intervention services accept children based on developmental concerns or problem behaviors regardless of etiology 1

Who Delivers Behavior Modification Therapy

Parent Training in Behavior Modification (PTBM) is the primary intervention modality for this age group and is delivered by: 1

• Behavioral therapists or psychologists trained in early childhood behavioral interventions 1
• Early intervention specialists who work within state-funded early childhood programs 1
• Occupational therapists when sensory integration or motor concerns are present 1
• Speech-language pathologists when communication difficulties contribute to behavioral problems 1

The therapy focuses on training parents in specific techniques to modify their child's behavior, including positive reinforcement, planned ignoring, appropriate consequences, and consistent application of rewards 1

Role of the Pediatrician

Your role as the referring pediatrician includes: 1

• Brief interventions during office visits (10-15 minutes) using evidence-informed techniques while awaiting specialty evaluation 1
• Gathering information from multiple sources (parents, childcare providers) to document problem behaviors and triggers 1
• Providing anticipatory guidance about behavioral expectations for developmental age 1
• Monitoring progress and maintaining co-management with the intervention team 1

When to Consider Additional Specialist Referrals

Beyond early intervention services, consider these specific referrals based on assessment findings: 1

• Developmental-Behavioral Pediatrician: If comprehensive diagnostic assessment is needed after initial interventions fail, or if autism spectrum disorder is suspected 1, 2
• Child Psychologist or Psychiatrist: If mental health concerns in the family are contributing to the child's difficulties, or if behavioral problems are severe 1
• Audiologist: Always refer for hearing evaluation if speech/language delays accompany behavioral concerns 3

Critical Implementation Points

• Do not delay referral waiting for a specific diagnosis—behavioral interventions are effective across multiple problem behaviors and can inform subsequent diagnostic evaluation 1
• The pediatrician can initiate brief therapeutic interventions using common-factors approaches (HELP mnemonic: Hope, Empathy, Language/Loyalty, Permission/Partnership/Plan) during regular visits while the referral is processed 1
• Family involvement is essential—behavior modification at this age is delivered primarily through parent training rather than direct therapy with the child 1
• Early intervention services are typically available at no cost to families through state programs for children under 3 years 1

Common Pitfalls to Avoid

• Avoid waiting for formal psychiatric diagnosis before referring to early intervention—this delays access to beneficial services 1
• Do not refer directly to mental health specialists as the first step for toddlers; early intervention programs provide more comprehensive, developmentally appropriate services 1
• Never rely solely on clinical observation without gathering structured information from multiple settings (home, childcare) 1, 3
• Recognize that behavior modification does not require a specific mental health diagnosis to be effective and appropriate 1