|Behavior Analytic Approaches to Understanding the Effects of Psychotropic Medication on Challenging Behavior|
|Sunday, May 28, 2023|
|8:00 AM–9:50 AM |
|Hyatt Regency, Capitol Ballroom 5-7|
|Area: CBM/DDA; Domain: Applied Research|
|Chair: Matthew O'Brien (The University of Iowa; University of Iowa Stead Family Children's Hospital)|
|Discussant: M. Christopher Newland (Auburn University)|
|CE Instructor: M. Christopher Newland, Ph.D.|
Psychotropic medications are commonly prescribed for individuals who exhibit severe and challenging behavior, but their effects on challenging behaviors are seldom evaluated with empirical data at the individual level and usually assessed with indirect methods (e.g., rating scales and interviews) at the group level. Although behavior analysts rarely receive training concerning medication and rarely take part in monitoring the effects of psychotropic medications, given their focus on data collection and behavioral monitoring, behavior analysts are well-suited to study the effects of psychotropic medications on challenging behavior. This symposium brings together four studies interested in the relationship between psychotropic medication and challenging behavior. Across these studies, individual (studies 1 and 2) and group (studies 3 and 4) analyses are conducted to demonstrate how the initiation of medication and/or changes in medication effect the behavior of individuals with intellectual and neurodevelopmental disabilities from childhood to adulthood. These studies highlight the interaction of psychotropic medications and environmental context on the occurrence of challenging behavior and subsequently the importance of collecting data and monitoring medication for individuals with challenging behavior. Dr. Christopher Newland will provide a discussion on these talks.
|Instruction Level: Intermediate|
|Keyword(s): challenging behavior, functional analysis, neurodevelopmental disabilities, psychotropic medication|
|Target Audience: |
Audience should have a basic understanding of psychopharmacology and behavioral assessment and treatment.
|Learning Objectives: At the conclusion of this symposium, participants will be able to (1) describe some of the positive effects of psychotropic medications on challenging behavior; (2) identify strategies for monitoring the effects of psychotropic medications; and (3) state ways in which psychotropic medications and the environment interact to impact challenging behavior.|
The Combined Effects of Antipsychotic Medications and Competing Stimuli on Psychotic Symptoms Exhibited by a Patient With Schizophrenia
|SHANNA BAIKIE (Children's Hospital Colorado), Patrick Romani (University of Colorado, Anschutz Medical Campus)|
This presentation will describe results from a multidisciplinary model for treating youth diagnosed with psychotic disorders. We will highlight results from a 17-year-old patient diagnosed with autism spectrum disorder and schizophrenia admitted to a psychiatric inpatient unit. Behavior analysts coordinated closely with psychiatrists to evaluate the function of responding to internal stimuli and corresponding behavioral treatment approaches following different dosages of antipsychotic medications. A functional analysis of responding to internal stimuli showed maintenance by automatic reinforcement. Within a reversal design, we evaluated the effect of response-independent delivery of competing stimuli as Zyprexa and Clozapine titrated to therapeutic doses. During medication-only conditions, psychotic symptoms occurred during approximately 200 s of a 300-s session. The addition of the competing stimuli along with Zyprexa decreased levels of responding to internal stimuli. Unfortunately, this behavior continued to be impairing and occurred variably during sessions. The addition of Clozapine plus competing stimuli produced the best treatment outcome with zero or near-zero levels of responses to internal stimuli occurring with this treatment package in place. In addition to discussing the role of behavioral strategies when evaluating medication-behavior relations, we will also discuss ways to engage with a multidisciplinary team when treating serious psychopathology.
The Effects of Stimulant Medication on Disruptive Behavior and Choice in Children With Attention-Deficit/Hyperactivity Disorder (ADHD)
|ALEX PAULS (University of Iowa), Matthew O'Brien (The University of Iowa; University of Iowa Stead Family Children's Hospital), Elizabeth Freiburger (University of Iowa ), Brendon Nylen (University of Iowa)|
Many children and adolescents diagnosed with ADHD also display disruptive behavior, such as aggression and destruction (Strine et al., 2006) and even though stimulant medication is a first line treatment for ADHD symptoms, it has not been indicated to treat disruptive behaviors. Several large studies have suggested that stimulant medication may reduce disruptive behavior (e.g., Pringsheim et al., 2015) and single case studies have shown that stimulant medication may differentially effect disruptive behavior across functions (e.g., Torelli et al., 2019). Additionally, LaRue et al. (2008) demonstrated differential effects on social behavior and choice making for children taking stimulant medications. The purpose of this study is to evaluate the effects of stimulant medication on (a) disruptive behavior, (b) social behaviors, and (c) delay discounting for children and adolescents diagnosed with ADHD. Using a reversal design, functional analyses, preference assessments, and a test of delay discounting were conducted on and off medication. The results will be discussed in terms of implications for behavioral intervention planning for children and adolescents who display disruptive behavior and take stimulant medication.
|Psychotropic Medication Usage Among Patients in an Intensive Day Treatment Clinic for Severe Behavior|
|ANNA MARIE-KILZER CATES (University of Iowa ), Matthew O'Brien (The University of Iowa; The University of Iowa Stead Family Children's Hospital), Alex Pauls (The University of Iowa)|
|Abstract: Behavioral intervention is often recommended as a first line treatment for severe and challenging behavior (SCB) among individuals with intellectual and other neurodevelopmental disabilities. However, a large proportion of individuals with SCB are also prescribed psychotropic medications to address their SCB, many of which have never received behavioral intervention. Unfortunately, most research on psychotropic medication and SCB has been focused on the adult population. In this study, we summarize the prevalence and patterns of psychotropic medication usage among children and adolescents referred to an intensive day treatment clinic for (SCB) over a 10-year period. We assess the relationship between patient demographics and medication usage, with a particular focus on access to behavioral intervention services. Finally, we compare behavioral profiles between patients taking psychotropic medications and those who are not. The results are discussed in terms of current guidelines on best practice for prescribing psychotropic medication for children and adolescents with SCB.|
Conditional Probabilities of Challenging Behavior in Individuals With Intellectual Disabilities During Psychotropic Medication Changes
|CLAIRE ELIZABETH EPPERSON (Drake University ), Faith Hollihan-Moy (Drake University), Meg Dredge (Drake University), Carissa Johnson (Drake University), Maddie Jones (Drake University), Maria G. Valdovinos (Drake University)|
Challenging behavior is common for individuals with intellectual disabilities, and psychotropic medications are prescribed as treatment (Cox, et al., 2022; Matson & Neal, 2009). However, little is known about the influence that psychotropic medication has on the presentation of challenging behavior and environmental events that occasion it (Cox & Virues-Ortega, 2021; Falligant & Bednar, 2021). The current study examines conditional, and background, probabilities of challenging behavior across psychotropic medication changes. Weekly one-hour observation sessions were conducted (and video recorded) for seven participants (range of 25-90 observations conducted with each). The observations were coded for antecedents (e.g., demands, restricted access, no attention), challenging behavior (e.g., problem vocalizations, physical aggression, self-injurious behavior), and consequences (e.g., attention, access to items, escape from demand). We used a parametric design to evaluate changes in probabilities following psychotropic medication alterations. Preliminary results revealed that the presentation of demands and delivery of attention (physical and verbal) were associated with higher conditional probability values than other variables coded. Following psychotropic medication changes, slight changes in these values were observed. These calculated probabilities give insight into the potential interaction between environmental events, challenging behavior, and changes in psychotropic medication regimen.