|Examining the Effects of Medication on Behavioral Assessment and Treatment|
|Sunday, May 29, 2016|
|10:00 AM–11:50 AM |
|Grand Ballroom CD North, Hyatt Regency, Gold East|
|Area: DDA/BPN; Domain: Applied Research|
|Chair: Griffin Rooker (Kennedy Krieger Institute)|
|Discussant: M. Christopher Newland (Auburn University)|
|CE Instructor: Griffin Rooker, Ph.D.|
Individuals with intellectual and developmental disabilities (IDD) are at a greater risk for having psychiatric conditions than their typically developing peers (Emerson, 2003). Furthermore, individuals with IDD who engage in severe problem behaviors (aggression, self-injury, etc.) are three times more likely be diagnosed with a psychiatric condition and provided medication as one aspect of clinical care than those who do not engage in severe problem behavior (Rojohn, Matson, Naglieric, and Mayville, 2004). The four studies presented here examined the effects and side effects of medication during the assessment and treatment of severe problem behavior. Hardesty et al. and Valdovinos et al. both examined the effects and side effects of medication on severe problem behavior during assessment in two different populations and using two different methods (collected case series and prospective analogues). Similarly, Maley and Bourret and Retzlaff et al. both examined the effects of medication during treatment for different target behavior and using two different methods (collected case series and applied treatment). Results of these studies suggest several interesting findings that are directly applicable to clinical care and new prospects for future research. In addition, Dr. Chris Newland will lend his expertise in behavioral pharmacology by serving as discussant.
|Keyword(s): Assessment, Medication, Problem Behavior, Treatment|
The Impact of Medication on Functional Analyses Outcomes: Findings From 12 Inpatient Cases
|SAMANTHA HARDESTY (Kennedy Krieger Institute), Griffin Rooker (Kennedy Krieger Institute), Jennifer R. Zarcone (Kennedy Krieger Institute), Lynn G. Bowman (Kennedy Krieger Institute and Johns Hopkins University School of Medicine)|
Numerous studies have demonstrated drug specific (i.e., risperidone) effects on FA outcomes (i.e., Crosland et al 2003; Zarcone et al 2004); however, no descriptive studies examined how medication modifications may impact the clarity (i.e., differentiation) or results (i.e., masked functions) of subsequent FAs. The purpose of this study was to examine the extent to which psychotropic medication changes altered FA outcomes on an inpatient unit. A review of electronic medical charts was conducted between the years 1995-2014. In total, 12 FA cases (out of 81total) had sufficient evidence (i.e., multiple FAs, detailed medication changes) for further review. Participants were aged 7 to 21 years and were diagnosed with IDD. In each case, 2-4 FAs were conducted. Attending psychiatrists directed medication changes with the guidance of the interdisciplinary team, and those who collected data for FAs remained blind to changes. To determine differentiation, criteria were established similarly to Hagopian et al. (1997), and a quotient score was generated. In half of the cases, alterations to medication (dosage and/or type) led to different conclusions, while the other half did not. In 10 of the 12 cases quotient scores were improved following medication changes. Implications for practicing clinicians will be offered.
Using Functional Analysis to Evaluate the Adverse Side Effects of Psychotropic Medication on Challenging Behavior
|Maria G. Valdovinos (Drake University), ELIZABETH SCHIEBER (University of Florida), Lisa Beard (Drake University), Meara McMahon (University of Maryland, Baltimore County)|
Psychotropic medications are often prescribed and used in conjunction with behavioral interventions to reduce challenging behavior in individuals with intellectual disabilities (ID). Functional analyses (FAs) are conducted to determine the conditions under which challenging behaviors are likely to occur and subsequent impact that psychotropic medications may have on challenging behavior function. Under-assessed, however, is the impact psychotropic medication side effects have on challenging behavior. The presence of adverse side effects (ASEs) are difficult to identify given the communication impairments those with ID may often possess. The present study used FA methodology to assess the impact of psychotropic medication adverse side effects on challenging behavior of five individuals diagnosed with IDD. Conditions were selected for assessment based on individual’s initial medication regimen. FAs were conducted when a participant began the study and two weeks after a change in psychotropic medication regimen. Results indicated different rates of challenging behavior during ASE conditions across medication changes for all participants, higher rates implying a more severe experience of specific side effects. These data demonstrate that this method of evaluation may provide feedback for informative decisions about psychotropic medication regimens that could improve quality of life for individuals with ID.
Telehealth Treatment of Sleep-Related Trichotillomania and Trichophagia Using Improved Sleep Hygiene and Melatonin
|BILLIE RETZLAFF (Munroe-Meyer Institute, University of Nebraska Medical Center), Katie Lichtblau (Munroe-Meyer Institute, University of Nebraska Medical Center), Patrick Romani (University of Colorado School of Medicine and Children's Hospital Colorado), Brian D. Greer (Munroe-Meyer Institute, University of Nebraska Medical Center), Wayne W. Fisher (Munroe-Meyer Institute, University of Nebraska Medical Center), Allie Bragdon (Childhood Autism Services, Inc.)|
We used a telehealth model to treat one young girls sleep-related trichotillomania and trichophagia using a night-vision webcam placed in the girls bedroom. Data collectors recorded intervals with trichotillomania and trichophagia remotely from a university-based program using video footage of preceding nights, and the girls mother carried out all of the procedures in their home. We implemented a biobehavioral treatment package consisting of sleep-hygiene recommendations (e.g., a structured bedtime and wake time) in combination with the titrated use of melatonin, which decreased the girls trichotillomania and trichophagia and improved her sleep pattern, as depicted by both nightly and hourly analyses, and results maintained at a onemonth follow up. We discuss the use of behavior-analytic research strategies and tactics to evaluate treatments not commonly implemented by behavior analysts.
The Effect of Psychotropic Medication on Severe Problem Behavior in Individuals With Autism
|AVA MALEY (The New England Center for Children ), Jason C. Bourret (New England Center for Children)|
Psychotropic medications are often prescribed to individuals diagnosed with various mental illnesses. Physicians also prescribe psychotropic medication such as anti-psychotics, anti-depressants and psychostimulants to individuals diagnosed with autism spectrum disorder (ASD) to treat behavior problems. In this study, we sampled archival data on problem behavior for individuals previously or currently prescribed one or more psychotropic medications. Data were analyzed in terms of the probability of psychotropic medications of various categories producing decreases in problem behavior and the amount of change observed. In addition, dose response curves were plotted to examine dose-dependent effects. The findings are discussed in terms of implications for behavior analysts working with individuals who may be prescribed various forms of psychotropic medication.