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| Psychotropic Medication Management, Tapering, and Discontinuation |
| Sunday, May 25, 2025 |
| 9:00 AM–10:50 AM |
| Convention Center, Street Level, 159 AB |
| Area: BPN/DDA; Domain: Applied Research |
| Chair: Nicholas Lowther (Judge Rotenberg Educational Center) |
| Discussant: Nathan Blenkush (Judge Rotenberg Educational Center) |
| Abstract: Psychotropic medications are often used in tandem with applied behavior analysis to treat the problem behavior of children with emotional and behavioral challenges in schools as well as those of individuals with intellectual and developmental disabilities. Although the Food and Drug Administration approved risperidone and aripiprazole to treat “irritability” associated with autism spectrum disorder, the drugs can have adverse effects such as weight changes, metabolic changes, sedation, acute dystonia, akathisia, tardive dyskinesia, parkinsonian features, and neuroleptic malignant syndrome. Many other off-label drugs are prescribed to manage problem behaviors. In fact, there may be no clear association between psychotropic medication use and psychiatric diagnosis. There is evidence to support the notion that discontinuation of psychotropic medications prescribed to those with intellectual and developmental disabilities can occur without increases in problem behavior. We will explore medication management, tapering, and discontinuation through dose change effect sizes, conditional rates, visual analysis of problem behavior data, and the clinical decision-making process in behavioral psychopharmacology. |
| Instruction Level: Advanced |
| Keyword(s): medication, pharmaceutical, pharmacology, psychotropic |
| Target Audience: Audience members with experience in treating problem behavior alongside psychotropic medication treatment. Attendees should have a general understanding of psychotropic medications effects and their influence on behavioral treatment. |
Learning Objectives: 1. Discuss the benefits of collaborating with stakeholders and psychiatric professionals.
2. Discuss the potential benefits and risks associated with psychotropic medication tapering and discontinuation.
3. Discuss the general behavioral effects of psychotropic medication tapering and discontinuation. |
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| The Good and Bad of Medication Management: Case Studies Demonstrating the Importance of Provider and Caregiver Collaboration |
| HILLARY GENOVESE (Bierman Autism Centers), Chrissy Barosky (Bierman Autism Centers) |
| Abstract: Psychotropic medications are often used in tandem with applied behavior analysis a recent study suggested that approximately 74% of those diagnosed with autism have a comorbid diagnosis. Due to the high rate of comorbid disorders, it is critical that providers that treat each unique diagnosis work together to better serve the individual, especially when it comes to diagnoses that require treatment with multiple medication types. This presentation will review two case studies that demonstrate the correlational effects of collaboration on medication management (clobazam, lamotrigine, methylphenidate, & dextroamphetamine) on interfering behavior in two clients with autism and comorbid diagnoses of attention deficit hyperactivity disorder and a seizure disorder. The results of the analysis demonstrated that rapid changes in medication without collaboration coincided with increased rates of interfering behavior while collaboration and data review led to decreases in interfering behavior in the clinical setting. The importance of collaboration with medical providers and behavior analysts, review of the data, and medication stabilization will be reviewed in the context of behavioral treatment. |
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| Aripiprazole (Abilify) Tapering and Discontinuation Amidst Comprehensive Behavioral Treatment |
| ANAHITA MASOUM (Judge Rotenberg Educational Center), John O'Neill (Judge Rotenberg Educational Center) |
| Abstract: Aripiprazole (Abilify) is an antipsychotic medication approved by the Food and Drug Administration for the treatment of "irritability" associated with autism spectrum disorder and is often prescribed for off-label use in the treatment of problem behavior. Behavior analysts have discussed the clear potential value of behavioral analytic methods in clinical psychopharmacology but they are not generally accepted as contributing substantial evidence by the Food and Drug Administration. This is unfortunate because applied behavior analyst's focus on individualized treatment and data monitoring could be utilized to improve outcomes. Unfortunately, there is a severe shortage of adequate training and interdisciplinary collaboration on psychotropic medication decisions in applied behavior analysis. Regardless, psychotropic medications are variables of interest in clinical practice as they may mediate, moderate, or otherwise confound the effects of behavioral treatment. We analyzed 12 clinical cases that involved various psychiatric diagnoses and aripiprazole monopharmacy by way of dose reduction effect sizes and conditional rates of severe problem behavior. Data support previous findings in that medication reductions did not reliably coincide with increased rates of problem behavior and suggest that aripiprazole can be safely tapered and discontinued amidst comprehensive behavioral treatment. |
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| Risperidone (Risperdal) Tapering and Discontinuation Amidst Comprehensive Behavioral Treatment |
| JOHN O'NEILL (Judge Rotenberg Educational Center), Anahita Masoum (Judge Rotenberg Educational Center) |
| Abstract: Risperidone (Risperdal) is an antipsychotic medication approved by the Food and Drug Administration for the treatment of "irritability" associated with autism spectrum disorder and is often prescribed for off-label use in the treatment of problem behavior. While guidelines for conducting research in applied behavioral pharmacology are available, there is little research on the independent and interactive effects of psychotropic medications and behavioral interventions on problem behavior. There is some evidence to suggest that behavioral function might be affected by medications, that behavioral intervention adjustments may have larger effects on rate of problem behavior than medication adjustments, and that medication reductions may not reliably coincide with increased rates of problem behavior. We analyzed 20 clinical cases that involved various psychiatric diagnoses and risperidone monopharmacy by way of dose reduction effect sizes and conditional rates of severe problem behavior. Data support previous findings in that medication reductions did not reliably coincide with increased rates of problem behavior and suggest that risperidone can be safely tapered and discontinued amidst comprehensive behavioral treatment. |
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| Olanzapine (Zyprexa) and Quetiapine (Seroquel) Tapering and Discontinuation Amidst Comprehensive Behavioral Treatment |
| DAWN O'NEILL (Judge Rotenberg Center; CBSI), Anahita Masoum (Judge Rotenberg Educational Center), John O'Neill (Judge Rotenberg Educational Center) |
| Abstract: Psychotropic drugs such as antipsychotics that are prescribed to treat symptoms psychiatric diagnoses can have adverse effects such as weight changes, metabolic changes, sedation, acute dystonia, akathisia, tardive dyskinesia, parkinsonian features, and neuroleptic malignant syndrome. For this reason, systematic medication tapering should be considered when comprehensive behavioral treatment is in place and the potential benefits outweigh the risks. Olanzapine (Zyprexa) and quetiapine (Seroquel) are antipsychotic medications approved by the Food and Drug Administration for the treatment of symptoms associated with psychiatric diagnoses and are often prescribed for off-label use in the treatment of problem behavior. We analyzed 22 clinical cases that involved various psychiatric diagnoses and olanzapine or quetiapine monopharmacy by way of dose reduction effect sizes and conditional rates of severe problem behavior. Data support previous findings in that medication reductions did not reliably coincide with increased rates of problem behavior and suggest that olanzapine and quetiapine can be safely tapered and discontinued amidst comprehensive behavioral treatment. |
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