Our difficult child was not able to respond to behavior mgmt without the medication (stimulant). Waiting just put more pressure on him and us.
The primary problem we were dealing with-at the time however was ADHD. The stimulant is quick in and quick out, so in our case we were able to see the effects of the medication immediately (not having to wait until the medication built up to a therapeutic level over time, and not having to be too concerned about the time required for the level to fall if it was the wrong medication).
It may not help you, but I'll tell you about difficult child's anxiety.
difficult child had a horrible 1st grade experience behavior-wise. Every day it was something. The day before school started in 2nd grade, we went to "Meet the Teacher Day." I had pre-purchased his school supplies through the school and they were wrapped on his desk -- two huge bundles. The fact that it included two reams of paper, 2 large kleenex boxes, reams of construction paper, etc., didn't matter. All difficult child could see was he thought was "too much work." He didn't understand that it was to be used over the whole year. He became overwhelmed and literally crawled up my body so he could be carried like a toddler and started sucking his thumb. This behavior from a kid that was going through the "don't hold my hand anymore, I'm too big" phase. I knew we were in trouble. Things went downhill from there.
I eventually started charting behaviors. It didn't take long for a pattern to emerge. Attending school was the culprit -- miraculous recovery on Friday afternoons, nosedive on Sunday afternoons. The more pressure put on him to conform and perform, the worse his anxiety symptoms became.
difficult child was going through the IEP evaluation process at the time, and the school wouldn't do much to help with-this. It was their opinion that his behaviors were "willfulness" and "policy" must be followed (discipline guidelines). Additionally, they were dragging their feet with-the evaluation process.
difficult child's anxiety got worse and worse. He really was doing the best he could to please everybody -- he just couldn't. I waited too long to blow my top. As a result, by the time I got some action from school, difficult child's anxiety was over-the-top.
As much pressure as possible was taken off difficult child -- school and home. It took about 3 weeks for him to regain his footing after school was out for the summer. About a week before 3rd grade started, his symptoms began to start up again.
He matured a lot over the summer. That factor, together with-his 504 plan which was then "officially" in effect, helped him to quickly regain some confidence and the symptoms dissapated.
Looking back, I feel that anxiety most likely factored in to his poor first grade experience, but nobody caught it. If not, I don't think he'd have had the reaction he had at the beginning of 2nd grade. Because of his survival skills (long story) he presented as a very "has it all together" little boy and the visible symptoms came on subtly over time.
Because of the way things happened, we never medicated difficult child for the anxiety. I regret that I didn't catch on earlier to what was going on.
I keep a sharp eye out now -- I know his anxiety symptoms. When he moves out of his bed and onto the floor to sleep starts biting his nails and cuticles until they bleed, it's my first red-flags that something at school is out of sync. I start charting again and send an email to the teachers suggesting that it would be a good idea to be monitor him more closely. So far, so good.
If it ever happens again, I won't let him get passed a certain point without trying medication. I can't define that point, but I'll know it when it happens.
I also feel that a lot of his various therapies have worked together to reduce his anxieties. For instance, occupational and Sensory Integration Disorder (SID) therapy helped his visual motor skills, helped him write without pain, reduced his sensitivity to clothing and the environment in general, etc., etc. It's not such a continuous struggle to perform to expectations because of underlying problems, and he doesn't have to concentrate so hard on the actual mechanics allowing him to focus on getting a task done.
As more supports and therapies came on-line, things got better overall.