1. 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

2. Overview History/Prevalence Off-Label Prescribing Behavior Analysis
Identify Target Behavior (s)
Record and Graph Relevant Data
Interpret Data
Communicate Data to Appropriate Parties

3. 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)

4. 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

5. 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

6. 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

7. 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
Behavior is the subject of study (this includes thoughts, feelings, etc.)

8. 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)
Emphasize teaching appropriate behavior in addition to decreasing problem behavior

9. 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
ABA not used to change ADHD, for example,…Used to change behavior exhibited by an individual diagnosed with ADHD
Labels are not causes of behavior, as they are not physical events.

10. Applications of ABA Organizational Behavior Management Health Safety
Developmental Disabilities
Behavioral Pediatrics
Drug Addiction
Recycling
Education
Behavioral Pharmacology
Safety (Pilots, warehouse workers)

11. 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

12. 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

13. Defining the Target Behavior (s)
Internal states (sad, angry, frustrated) are avoided
Internal states can’t be observed or measured by others

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

21. 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)

22. 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

24. 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

25. Risperidone Side Effects
Dry Mouth
Increased Appetite
Weight Gain
Sedation
Constipation
Blood Pressure Changes
Dizzyness
Headache
Tremors

26. 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

27. 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

28. 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

29. Contact info