Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


50th Annual Convention; Philadelphia, PA; 2024

Event Details

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Symposium #238
CE Offered: BACB
Exploring the Effects of Medication on Challenging and Adaptive Behavior Within the Field of Applied Behavior Analysis
Sunday, May 26, 2024
10:00 AM–11:50 AM
Marriott Downtown, Level 4, Franklin Hall 9-10
Area: CBM/DDA; Domain: Applied Research
Chair: Matthew O'Brien (The University of Iowa Stead Family Children's Hospital; The University of Iowa)
Discussant: Lisa Alberts (Lasalle University)
CE Instructor: Lisa Alberts, Ph.D.

Individuals who exhibit challenging behavior are commonly prescribed psychotropic medications with the hope of reduced challenging behavior with minimal adverse effects. The effects are often measured indirectly through rating scales and interviews with caregivers, which are prone to response biases and may fail to detect subtle behavior changes. Behavior analysts are uniquely trained in direct measurement methods and are well-suited to assess the effects of medication on challenging and adaptive behavior. The four presentations in this symposium highlight the role of behavior analysis in the assessment of medication effects for individuals who exhibit challenging behavior. The first presentation provides outcome data from a randomized clinical trial of cannabidiol on irritability and aggression in children with autism. In the second presentation, large-scale data are presented on the effects of medication and medication withdrawal on challenging behavior at a large service provider. The third presentation provides data on the collateral effects of stimulant medication on social behavior for children with ADHD from a pilot clinical trial. The final talk will present the results of a systematic literature review covering psychotropic medication use for challenging behavior in individuals with intellectual disabilities. Lisa Alberts, DNP, will provide a discussion of these talks.

Instruction Level: Intermediate
Keyword(s): behavior assessment, challenging behavior, neurodevelopmental disabilities, psychotropic medication
Target Audience:

Basic understanding of psychotropic medications

Learning Objectives: 1. Attendees will be able to develop single case designs to measure the effects of medication on behavior. 2. Attendees will be able to describe the collateral effects of psychotropic medications. 3. Attendees will be able to identify the benefits and challenges of direct measurement of medication effects on behavior.

The Effect of Cannabidiol on Symptoms of Irritability and Aggression in Children With Autism Spectrum Disorder

PATRICK ROMANI (University of Colorado, Anschutz Medical Campus), Nanastasia Welnick (Neuroscience Institute Research Team; Children’s Hospital Colorado), Rebecca Rochowiak (Neuroscience Institute Research Team; Children’s Hospital Colorado), Angelique Koerner (Children’s Hospital Colorado/ University of Colorado Denver), Nicole Tartaglia (Department of Pediatrics; University of Colorado School of Medicine)

Youth diagnosed with autism spectrum disorder exhibit challenging and aggressive behaviors at a higher rate than their neurotypical peers. Preliminary data suggests that cannabidiol (CBD) may reduce problem behaviors among autistic children. The purpose of the current study was to evaluate the efficacy of CBD as treatment for problem behaviors. We will present data from 31 children enrolled in a double-blinded modified cross-over study with 3 arms, including 2 traditional placebo-controlled cross-over arms (12 weeks per treatment/3 week wash-out), plus a third arm where participants receive CBD for the entire 27 weeks. Randomized participants were titrated to a dose of 10mg/kg/day of CBD or placebo (provided by Jazz Pharmaceuticals). The research team conducted a functional analysis of problem behavior prior to the participant receiving CBD/placebo and two more times when participants received CBD or placebo at 10mg/kg/day. The research team will be unblinded to study conditions in December 2023. We will present individual and aggregated data on the rate of and the latency to problem behavior occurrence when participants took CBD or placebo. Results from the current study will be essential towards providing recommendations to caregivers and practitioners using CBD as a treatment for problem behaviors.

Positive Behavioral Outcomes Following Medication Reductions
KELLIE P. GOLDBERG (Bancroft), Arielle Di Stefano (Bancroft), Miranda Slotkin (Bancroft), Amanda Schechtman (Bancroft, Rider University), Tracy L. Kettering (Bancroft)
Abstract: Psychotropic medications are commonly prescribed as a treatment for challenging behavior. Individuals with autism and other developmental and intellectual disabilities with behavioral challenges are often prescribed off-label psychotropic medications and polypharmacy is a common occurrence (Bowring et al., 2017, Laermans et al. 2023). In a review of published studies evaluating pharmacologic interventions for challenging behavior, Matson and Neal (2008) concluded that psychotropic medications may be less effective in managing challenging behavior when accounting for studies that included objective measurements for the target behavior. In this presentation, we will summarize large scale data on medication use across children and adults receiving services at a large non-profit behavioral service provider. We will provide example data from clients who were observed to have reductions of challenging behavior that corresponded with the reduction or removal of psychotropic medications. In some cases, the complete suppression of challenging behavior was observed following medication removal. We will also share data from clients who were observed to have increases in challenging behavior corresponding to the addition of or an increased dose of psychotropic medication.

The Effects of Stimulant Medication on the Social Behavior of Children With Attention-Deficit/Hyperactivity Disorder (ADHD)

ELIZABETH FREIBURGER (University of Iowa ), Carolyn Zhou (The University of Iowa), Alexander Pauls (The University of Iowa), Matthew O'Brien (The University of Iowa Stead Family Children's Hospital; The University of Iowa)

ADHD is the most common neurodevelopmental disorder and is characterized by inattentiveness, hyperactivity, and impulsivity. To address the symptoms of ADHD, nearly two-thirds of children with ADHD take psychotropic medication, with the majority demonstrating improvements. Although there is an abundance of research demonstrating the efficacy of stimulant medication for ADHD symptoms, including disruptive behavior, less is known about the collateral effects of stimulant medication, such as its impact on positive social behaviors. The purpose of this study was to evaluate the effects of stimulant medication on various social behaviors of five children diagnosed with ADHD who were enrolled in a larger pilot clinical trial. Free play sessions from functional analyses were coded for physical and vocal behavior associated with more or less social interaction (e.g., vocal initiation, solitary play, physical orientation) on and off stimulant medication in reversal designs. The results suggests that stimulant medication slightly suppressed participants’ social behaviors, with some idiosyncratic findings. The implication is that there may be a tradeoff of improvements in ADHD symptoms with reduced positive social behaviors. Implications for clinic and future research will be discussed.


Psychotropic Medication Use for Challenging Behaviors in Individuals With Intellectual Disabilities: An Update

CHRISTOPHER J. PERRIN (Bancroft), Tracy L. Kettering (Bancroft), Patrick Romani (University of Colorado, Anschutz Medical Campus), Elizabeth Freiburger (University of Iowa ), Alexander Pauls (The University of Iowa), Matthew O'Brien (The University of Iowa Stead Family Children's Hospital; The University of Iowa)

Challenging behavior (CB) in individuals with intellectual disabilities (ID) is common. Recent studies found the prevalence of CB in school age children with ID ranges from 48% to 60% and is approximately 18% in adults with ID (Bowring et al., 2019; Simó-Pinatella et al., 2019). Within this population, psychotropic medication as an intervention for CB is high, with many individuals experiencing both high doses of medication as well as polypharmacy (Bowring et al., 2017). In a 2009 paper, Matson and Neil reviewed the evidence supporting the use of psychotropic medication as an intervention for CB emitted by individuals with ID. They described the evidence as “minimal”, noting a discrepancy in findings between studies that incorporated object measures of behavior versus those that relied on rating scales and other indirect measures. Given these findings, the authors called for additional high-quality studies. The purpose of this review was to evaluate the evidence for use of psychotropic medication in the treatment of CB for individuals with ID. In addition to those studies included in the original review, we conducted a search of PsychInfo and PubMed databases and reference sections to identify studies published between 2008 and 2023. For included studies, we evaluated the extent to which each study met (a) criteria for establishing scientific confidence (Sprague & Werry, 1971), (b) the use of polypharmacy, (c) specification of target behaviors, (d) the use of objective measurements of CB, and (e) the use of behavioral interventions. This talk will discuss the findings of this review and considerations for behavior analysts when working with clients prescribed psychotropic medication.




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