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Strategies for Maximizing Psychotropic Drug Treatments for People with Autism and Other Developmental Disabilities: A Primer for Teachers and Parents. Marc Weeden , Ph.D , BCBA-D Juniper Gardens Children’s Project University of Kansas. Overview. History/Prevalence Off-Label Prescribing

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marc weeden ph d bcba d juniper gardens children s project university of kansas

Strategies for Maximizing Psychotropic Drug Treatments for People with Autism and Other Developmental Disabilities: A Primer for Teachers and Parents

Marc Weeden, Ph.D, BCBA-D

Juniper Gardens Children’s Project

University of Kansas

overview
Overview
  • History/Prevalence
  • Off-Label Prescribing
  • Behavior Analysis
  • Identify Target Behavior (s)
  • Record and Graph Relevant Data
  • Interpret Data
  • Communicate Data to Appropriate Parties
history prevalence
History/Prevalence
  • Psychotropic drugs – medications prescribed with the intent of improving an individual’s mood, cognition, or overt behavior
  • 1950’s – Thorazine
  • Approximately 40-50% people with autism receive at least one psychotropic medication (e.g., Green et al., 2006; Goin-Kochel, Myers, & Mackintosh, 2007)
risperidone risperdal
Risperidone (Risperdal)
  • A wide variety of psychotropic drugs are prescribed for people with autism and other developmental disabilities
  • Antipsychotics are the most prescribed (Poling et al., 2004)
  • Approved by the FDA in 2006 for treating “irritability” in people with autism between the ages of 5 and 17
  • Only drug that is FDA-approved as a psychotropic medication for people with autism
off label prescribing
Off-Label Prescribing
  • Any other drug that is prescribed to improve the behavior of people with autism, the use is “off-label”
  • The drug is prescribed for a purpose other than that for which it is specifically FDA-approved
  • Accepted medical practice if there is reasonable scientific evidence that a given drug is effective for a particular application
a word of warning
A Word of Warning
  • Drugs do not selectively reduce problem behavior
  • Appropriate behavior may be reduced, too
  • Drugs may interact with other non-pharmacological interventions
behavior analysis
Behavior Analysis
  • Scientific study of behavior
  • B.F. Skinner 1938
  • Behavior is the subject of study
  • Behavior can be observed, described, and recorded
  • Data, Data, Data
applied behavior analysis
Applied Behavior Analysis
  • Discipline concerned with analyzing and modifying human behavior
  • Procedures based on basic principles of behavior are used by professionals and/or paraprofessionals to change behavior in socially significant ways (Miltenberger, 2004)
characteristics of aba
Characteristics of ABA
  • Behavior is the subject of study
  • Labels are de-emphasized
  • Behaviors of interest are clearly defined
  • Variables that control behavior are identified and modified
  • Behavior change is measured over time
  • Hypothetical underlying causes of behavior are avoided
applications of aba
Applications of ABA
  • Organizational Behavior Management
  • Health
  • Safety
  • Developmental Disabilities
  • Behavioral Pediatrics
  • Drug Addiction
  • Recycling
  • Education
  • Behavioral Pharmacology
how to identify target behavior s
How to Identify Target Behavior (s)
  • Behavioral Excess
    • Behavior to be decreased in frequency, duration, or intensity
      • Example: Smoking
  • Behavioral Deficit
    • Desirable behavior to be increased in frequency, duration, or intensity
      • Example: Exercising, Studying
defining the target behavior s
Defining the Target Behavior (s)
  • Definitions must be specific and related to actions
  • Example from Major League Baseball: Unsportsmanlike behavior
  • Cursing, throwing the bat, kicking the dirt
defining the target behavior s13
Defining the Target Behavior (s)
  • Internal states (sad, angry, frustrated) are avoided
  • Internal states can’t be observed or measured by others
defining the target behavior s14
Defining the Target Behavior (s)
  • Labels (“a bad sport”) are not used because they do not describe an individual’s actions
  • Definitions can vary from person to person
  • Precise definitions help to ensure data accuracy
defining the target behavior s15
Defining the Target Behavior (s)
  • Labels are sometimes used to explain behavior
  • Example from Miltenberger (2004):
    • A person is observed to repeat syllables or words when they speak (labeled a “stutterer”)
    • To say the person repeats syllables or words because he/she is a stutterer is incorrect, as the label (stutterer) is not the cause of the behavior (repeating words or syllables when they speak)
  • Same thing can be applied to individuals with autism
how to record and graph relevant data
How to Record and Graph Relevant Data
  • Record data at a time the behavior is likely to occur
  • Observation sessions should be approximately the same length (e.g., all sessions are 20 min)
  • Natural settings (e.g., classroom) are more likely to yield representative data than contrived settings (e.g., clinic)
  • In contrived settings, however, outside sources of influence can be eliminated
how to record and graph relevant data17
How to Record and Graph Relevant Data
  • Dimension of behavior – some quantifiable aspect of a behavior of interest
    • Frequency – number of times a behavior occurs in the observational period
    • Duration – how long a behavior takes to occur from beginning to end
how to record and graph relevant data18
How to Record and Graph Relevant Data
  • Baseline – record the behavior prior to implementing the intervention
  • Allows for comparison and gives a clearer picture as to the effectiveness of the medication (is the behavior already decreasing due to a teacher intervention before the meds are given?)
  • Not always possible, as in the case of self-injurious behavior
how to interpret data
How to Interpret Data
  • Risperidone intervention
  • Example 1: Talk outs is the behavior of interest
  • Defined: Speaking at an audible level while teacher is providing instruction to the entire class
  • Use frequency as method of recording
  • Data recorded during math class each by paraprofessional
how to interpret data21
How to Interpret Data
  • You can say that the intervention was successful if all other sources of variability can be ruled out (e.g., other intervention started at the same time)
  • Be aware of side-effects (e.g., sedation)
how to interpret data22
How to Interpret Data
  • Methylphenidate (Ritalin)
  • Example 2: On-Task is the behavior of interest
  • Defined: Participating in an assigned task (e.g., completing math problems)
  • 20 minute observation period
  • Duration
  • Recording with a stop watch how long child is on-task
how to communicate results
How to Communicate Results
  • Make the graph easy to understand
  • Meet as often as possible with the circle of support (e.g, parents, teachers, paraprofessionals)
  • Let the data guide treatment decisions
  • The MD will be able to better adjust or discontinue medication usage with accurate data
risperidone side effects
Risperidone Side Effects
  • Dry Mouth
  • Increased Appetite
  • Weight Gain
  • Sedation
  • Constipation
  • Blood Pressure Changes
  • Dizzyness
  • Headache
  • Tremors
risperidone side effects26
Risperidone Side Effects
  • Make a plan to evaluate side effects
  • For example, closely monitor the weight of the person taking the drug (e.g., once per week)
  • Are they asking for more to drink and is this causing problems?
  • Might be difficult for an individual with autism to report adverse effects
summary
Summary
  • Define target behavior precisely
  • Select an appropriate system of measurement
  • Communicate results
  • Make a plan to evaluate side effects
  • Let the data guide treatment decisions
concluding comment
Concluding Comment
  • Psychotropic drugs are neither good nor bad
  • Medications can be helpful, harmful, or inconsequential
  • Good psychopharmacology, like any good intervention, is individualized and data based
  • The task will rarely be easy, but it will always be worthwhile
contact info
Contact info
  • mweeden@ku.edu