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-DJuniper Gardens Children’s Project

University of Kansas

OverviewHistory/PrevalenceOff-Label PrescribingBehavior AnalysisIdentify Target Behavior (s)Record and Graph Relevant DataInterpret DataCommunicate Data to Appropriate Parties

History/PrevalencePsychotropic drugs – medications prescribed

with the intent of improving an individual’s mood, cognition, or overt behavior

1950’s – ThorazineApproximately 40-50% people with autism

receive at least one psychotropic medication (e.g., Green et al., 2006; Goin-Kochel, Myers, & Mackintosh, 2007)

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 PrescribingAny 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 WarningDrugs do not selectively reduce problem

behavior

Appropriate behavior may be reduced, too

Drugs may interact with other non-pharmacological interventions

Behavior AnalysisScientific study of behavior B.F. Skinner 1938Behavior is the subject of study Behavior can be observed, described, and

recorded Data, Data, Data

Applied Behavior AnalysisDiscipline 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 ABABehavior is the subject of studyLabels are de-emphasizedBehaviors of interest are clearly definedVariables that control behavior are identified

and modified Behavior change is measured over time Hypothetical underlying causes of behavior

are avoided

Applications of ABAOrganizational Behavior ManagementHealthSafetyDevelopmental DisabilitiesBehavioral PediatricsDrug AddictionRecyclingEducationBehavioral Pharmacology

How to Identify Target Behavior (s)Behavioral Excess

Behavior to be decreased in frequency, duration, or intensity Example: Smoking

Behavioral DeficitDesirable behavior to be increased in

frequency, duration, or intensity Example: Exercising, Studying

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 (s)Internal states (sad, angry, frustrated) are

avoided

Internal states can’t be observed or measured by others

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 (s)Labels are sometimes used to explain behaviorExample 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 Record data at a time the behavior is likely to

occurObservation 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 DataDimension of behavior – some quantifiable

aspect of a behavior of interestFrequency – number of times a behavior occurs

in the observational periodDuration – how long a behavior takes to occur

from beginning to end

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 DataRisperidone interventionExample 1: Talk outs is the behavior of

interestDefined: Speaking at an audible level while

teacher is providing instruction to the entire class

Use frequency as method of recordingData recorded during math class each by

paraprofessional

0

5

10

15

20

25

30

35

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Days

Fre

qu

ency

of

Tal

k O

uts

Before Intervention Intervention

How to Interpret DataYou 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 DataMethylphenidate (Ritalin)Example 2: On-Task is the behavior of

interestDefined: Participating in an assigned task

(e.g., completing math problems)20 minute observation periodDurationRecording with a stop watch how long child

is on-task

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10

% o

f T

ime

On

Tas

k

sessions

How to Communicate ResultsMake 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 decisionsThe MD will be able to better adjust or

discontinue medication usage with accurate data

Risperidone Side EffectsDry MouthIncreased Appetite Weight GainSedationConstipationBlood Pressure ChangesDizzynessHeadacheTremors

Risperidone Side EffectsMake 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

SummaryDefine target behavior preciselySelect an appropriate system of

measurementCommunicate resultsMake a plan to evaluate side effectsLet the data guide treatment decisions

Concluding CommentPsychotropic drugs are neither good nor badMedications can be helpful, harmful, or

inconsequentialGood psychopharmacology, like any good

intervention, is individualized and data basedThe task will rarely be easy, but it will always

be worthwhile

Contact infomweeden@ku.edu