|Psychotropic Drug Use in Children: Prescribing and Deprescribing|
|Monday, May 25, 2020|
|10:00 AM–10:50 AM |
|Marriott Marquis, Level M2, Marquis Ballroom 5|
|Area: BPN/CBM; Domain: Translational|
|Chair: M. Christopher Newland (Auburn University)|
|CE Instructor: M. Christopher Newland, Ph.D.|
Children receive psychotropic medications for many reasons, including the management of hyperactivity or attention deficits and the reduction of aggressive or destructive behavior. These problems are frequently amenable to behavioral interventions. Many children seen by applied behavior analysts are on psychotropic medications. Ideally, the behavior analyst can work closely with prescribers to balance behavioral and pharmacological interventions, to the child’s benefit, and terminate medications when they are no longer warranted. Often, however, psychotropics are overused and collaborations with prescribers are difficult to forge. In this symposium, we address psychotropic medication use for behavioral problems from three perspectives. Annette Griffith will discuss the ethical and practical considerations for behavior analysts who work with clients on psychotropic medication. Jennifer Zarcone will discuss the emergence of state and national policy surrounding the use of psychotropic medication. Chris Newland will examine the practice of “deprescribing,” namely, how long a prescription lasts once it is initiated. Together, these speakers will provide an in-depth view of psychotropic drug use in children that will be of value to the practitioner who works with individual clients as well as to the researcher interested in coupling behavioral and pharmacological interventions rationally.
|Instruction Level: Intermediate|
|Keyword(s): Clinical psychopharmacology, Deprescribing, Medication policy, Psychotropic medication|
|Target Audience: |
The target audience is applied researchers and practitioners who are interested in the relative contribution of behavioral and pharmacological approaches to managing clinical syndromes. Practitioners will learn practical guidelines when working with clients on medication, their ethical obligations, and the role of state policy guidelines. Applied researchers will learn about different kinds of psychotropic medications and how they might be used. All will learn about how long prescriptions can be active once they are initiated.
|Learning Objectives: Learn practical guidelines and ethical obligations when working with clients taking psychotropic medication. Learn about the policies of governmental agencies regarding the use of psychotropic medication. Learn about deprescribing practices with different classes of psychotropic medications.|
|Psychotropic Medication Management: Ethical and Practical Considerations for Behavior Analysts|
|ANNETTE GRIFFITH (The Chicago School of Professional Psychology), Chrystal Jansz Rieken (The Chicago School of Professional Psychology)|
|Abstract: In the management of psychotropic medications, behavior analysts can contribute a unique set of skills to assist in the definition and measurement of target behavior and adverse effects. Specifically, they can develop systems to ensure data are relevant and informative, and they can present that data to physicians in clear and easy-to-interpret displays; this allows for behavioral responses to medications to be more easily identified (Zarcone, Griffith, & Jansz Reiken, 2019). Understanding behavioral effects of psychotropic treatments may reduce the likelihood that clients continue with ineffective or harmful medications and may increase the likelihood that they benefit from the medications they do take. Considering that the majority of behavior analysts, at some point in their careers, will work with individuals likely to be prescribed psychotropic medications (Association of Professional Behavior Analysts; 2014; Li & Poling, 2018), it follows that there is a need to discuss the role and possible contributions of the behavior analyst when working with such clients and their treatment teams. The current presentation will review the ethical and practical considerations required for effective interdisciplinary collaboration, with specific attention on the importance of practicing within our bounds of competence.|
Prescription Practices: The Impact of National and State Policies
|JENNIFER R. ZARCONE (The May Institute), Sarah Weddle (May Institute )|
There are many factors that influence policy at the state and national level when medication is prescribed for children and other vulnerable individuals. For these individuals, medications are often prescribed “off label” once approved by the FDA, before dosing and side effects profiles have been developed. Many professional groups have practice parameters that guide providers in their prescription practices as they relate to specific diagnoses and conditions (e.g., The Work Group on Quality Issues, American Academy of Child and Adolescent Psychiatry, 1997). Many states have begun to enact policies and regulations around prescription practices that result from legal issues. For example, Massachusetts has a policy for adults who are unable to consent to treatment called the Rogers Guardianship. The guardian can authorize “extraordinary” medical treatment for the adult, usually related to the use of antipsychotic medication. While the policy has the best of intentions, there are many factors that limit how effectively it is implemented. In this review, state and national policies related to prescription practices will be reviewed and the positive and negative impact of these policies will be discussed.
|Psychotropic Medications: When Does a Prescription End?|
|M. CHRISTOPHER NEWLAND (Auburn University), John T. Rapp (Auburn University)|
|Abstract: A clear set of criteria for initiating and terminating drug use exists for many drugs, but for psychotropic medications the criteria for “deprescribing” is poorly defined, even in children. The scientific literature surrounding deprescribing is spotty, new, and largely qualitative. Using a database of about 10,000 children in the Alabama Foster Care system, we examined the determinants of prescription duration for drugs from different classes, including non-psychotropics. The median duration of a prescription was over one year longer for some psychotropics than nonpsychotropics and was especially long for drugs used to treat ADHD (stimulants and noradrenergic agonists) and problem behavior (second-generation antipsychotics). The median prescription duration differed across age group but even young children were prescribed some psychotropics for more than a year. Prescription duration tended to be longer for males and longer for children in urban settings, though these were also relatively weak influences. The ability to quantify prescription duration can help guide policy and raises the need to articulate criteria for terminating the use of powerful psychotropic medications.|