Association for Behavior Analysis International

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.

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.

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.