Peter,
Sorry for overlooking this message.
The 4 pillars in my experience are fundamental and should not be skipped. But, I realize that each pillar may not be solely effective for every child, but in combination are often very helpful. Remember too that the 4 pillars are something that is always there in the background as other interventions are implemented. For example, if you have a patient with moderate to severe diabetes, it is critical that person make lifestyle changes, e.g., exercise, diet, to improve their help. They may need medication for a period of time, but that does not mean they should give up on the diet and exercise. The same can be said of the 4 pillars in that they are fundamental always to continue to pursue while other things are done over time.
Dr. Woeller