|Psychotropic Medication and Polypharmacy in People With Intellectual and Other Developmental Disabilities Who Present Problem Behavior
|Saturday, May 23, 2020
|3:00 PM–4:50 PM
|Walter E. Washington Convention Center, Level 1, Salon G
|Area: DDA/BPN; Domain: Applied Research
|Chair: Duncan Pritchard (Aran Hall School)
|Discussant: Jennifer R. Zarcone (The May Institute)
|CE Instructor: Jennifer R. Zarcone, Ph.D.
Psychotropic medication and polypharmacy is common in people with intellectual and other developmental disabilities (IDD) who present problem behavior, despite minimal evidence for the effectiveness of multi-drug use and the risk of adverse side-effects. Behavior analysts are well placed to advocate for the use of behavioral interventions and the withdrawal of psychotropic medication. However, interdisciplinary polypharmacy management remains problematic, especially in community settings where behavior analysts are perhaps under-represented and may sometimes lack the knowledge, strategies, and indeed status, to be able to collaborate with other professionals effectively. This symposium will review and discuss a range of initiatives and practices that may help behavior analysts develop the knowledge and skills they need to enable them to support their clients more effectively when treating problem behavior alongside polypharmacy withdrawal.
|Instruction Level: Intermediate
|Keyword(s): Interdisciplinary Management, Medication Effects, Polypharmacy, Problem Behavior
This symposium is aimed at behavior analysts who are supporting individuals with intellectual and other disabilities who are currently, or are at risk of being, prescribed one or more types of psychotropic medication because of their problem behavior.
Reducing Polypharmacy in Adolescent Males With Intellectual and Other Developmental Disabilities Who Present Problem Behavior
|HEATHER PENNEY (Aran Hall School), Tim J. Dyer (Aran Hall School), Alison Cox (Brock University), Duncan Pritchard (Aran Hall School)
Despite numerous campaigns (e.g., Stopping Over-Medication of People with a Learning Disability; STOMP, UK) to reduce the use of psychotropic medication in people with intellectual and other developmental disorders (IDD), psychotropic medication is frequently used to treat behavior disorders in adolescents with IDD. Usually it is parent/carer reports of problem behaviour to community-based prescribers that leads to the introduction of psychotropic medication and subsequent polypharmacy. Sometimes, if the problem behaviour is so severe that it becomes unsafe for the adolescent to remain in the family home or attend a day school, the young person is placed in a residential treatment program. Often, after behavioural interventions are implemented and the frequency and intensity of the problem behavior are reducing, it is possible to withdraw the medication. However, both the parents and prescribing professional can be reluctant to withdraw psychotropic medication, especially if the young person has multiple diagnoses (e.g. conduct disorder, anxiety disorder, attention-deficit hyperactivity disorder, sleep disorder, etc.). It is therefore imperative that a collaborative approach is taken if behaviour analysts are to have any influence over the type and level of medication prescribed (2.09a, 2.03b, 4.07b, 4.09; BACB, 2014). We will demonstrate a method of visual presentation of problem behaviour and medication changes that have enhanced collaboration and thus helped bring about the successful withdrawal of polypharmacy in some young people attending our program.
|A Systematic Review of Direct Measures to Evaluate Psychotropic Medication Effects in Children and Adolescents
|JESSICA TORELLI (Vanderbilt University), Blair Lloyd (Vanderbilt University), Marney Squires Pollack (Vanderbilt University)
|Abstract: Children with disabilities commonly engage in problem behavior, and physicians increasingly prescribe psychotropic medications to address these behavioral concerns. In current practice and research, medication effects are commonly evaluated based on caregiver reports and rating scales. Direct measures of behavior have potential to provide complementary information to these indirect measures. Relative to indirect measures, direct measures provide a sensitive, objective measure of behavior in relevant environmental contexts and allow frequent progress monitoring. We systematically reviewed studies using direct measures of behavior to evaluate effects of one or more non-stimulant medication for children ages 2-17. We identified 49 studies that met inclusion criteria. We summarized descriptive study characteristics, including participant characteristics, drug classes, behaviors measured, assessment procedures, and study designs. We also coded study quality and evaluated outcomes for studies that met a minimum quality threshold. Most studies evaluated first-generation (typical) antipsychotics for children with intellectual and developmental disabilities, using unstructured direct observations. There were significant deficits in study quality; among 10 studies that met a minimum quality threshold, we found limited evidence of medication effects as measured by direct assessments. We identify avenues for future research to inform the reliability and validity of direct measures to evaluate psychotropic medication effects.
Maximising Treatment Outcomes for Adults With Severe Challenging Behavior Residing in a Specialist Facility
|ALISON COX (Brock University)
Individuals who engage in dangerous behavior towards others, or themselves, have historically been under-treated and under-researched (Foxx, 2000, p.1). Unfortunately, this trend has not changed in that challenging behavior literature featuring adult participants has been steadily declining since 2008. Adults who engage in severe, pervasive challenging behavior interact frequently with emergency service personnel, are the most expensive to support and often end up in inappropriate placement (e.g., incarceration, hospital settings). The current study adds to the scarce literature base by describing a comprehensive behavioral intervention featuring differential reinforcement, safe-extinction, token economy and response cost. Most clients experienced psychotropic medication reduction while they participated in the residences three program phases: behavioral stabilization, skill acquisition and generalisation and maintenance. We describe how to safely, effectively and ethically implement the intervention components of each programming phase, as well as hypothesize how each programming component may have contributed to maximizing treatment outcomes for each of the five client.
|Considerations and Strategies for Practitioners Regarding Interdisciplinary Polypharmacy Management
|ANITA LI (Western Michigan University)
|Abstract: Polypharmacy is the administration of multiple pharmacological agents to target specific behaviors or conditions. The prevalence of challenging behaviors exhibited by individuals with intellectual disabilities also increases the risk of polypharmacy. Behavior analytic practitioners working with older individuals, individuals with challenging behavior, or individuals in residential settings are more likely to encounter cases involving polypharmacy and medication management. The continued practice of polypharmacy may result in drug adverse effects, posing long-term risks for clients and potentially impacting outcomes and implementation of ABA therapy. A recent survey of practitioners indicated a lack of knowledge and strategies were barriers to interdisciplinary collaboration. Therefore, this paper will provide an overview of polypharmacy management initiatives and practices, literature support on establishing guidelines, and perspectives from the medical community to empower practitioners with strategies and data to be considered in their practice.