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Current Developmental Disorders Reports

, Volume 6, Issue 4, pp 195–201 | Cite as

Psychotropic Medication in Intellectual and Developmental Disabilities: Patterns of Use and Recommendations for Monitoring Effects

  • Maria G. ValdovinosEmail author
Intellectual Disabilities (M Feldman and R Condillac, Section Editors)
  • 19 Downloads
Part of the following topical collections:
  1. Topical Collection on Intellectual Disability

Abstract

Purpose of Review

The purpose of this paper is to provide a brief review of the patterns of psychotropic medication use in individuals with intellectual and developmental disabilities (IDD) and recommendations for monitoring the effects of these medications.

Recent Findings

Challenging behavior (e.g., aggression, self-injury, property destruction) in individuals with IDD is often observed, and both behavioral and pharmacological interventions have been evaluated for their effectiveness in treating these behaviors. Although behavioral interventions have been shown to be effective at decreasing challenging behavior, psychotropic medications are frequently used to treat challenging behavior despite a lack of clinical indication (i.e., psychiatric diagnosis).

Summary

Limited evidence exists supporting the effectiveness of psychotropic medication to address challenging behavior. Given the demonstrated effectiveness of behavioral interventions, a comprehensive approach to supporting those with IDD and challenging behavior should include behavioral assessment and intervention, and continuous monitoring of and data collection on challenging behavior.

Keywords

Psychotropic medication Intellectual and developmental disabilities Challenging behavior 

Notes

Compliance with Ethical Standards

Conflict of Interest

Maria Valdovinos declares that she has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Deb S, Unwin G. Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature. Curr Opin Psychiatry. 2007;20:461–6.  https://doi.org/10.1097/YCO.0b013e3282ab9952.CrossRefPubMedGoogle Scholar
  2. 2.
    Glover G, Bernard S, Brandford D, Holland A, Strydom A. Use of medication for challenging behavior in people with intellectual disability. Br J Psychiatry. 2014;205:6–7.  https://doi.org/10.1192/bjp.bp.113.141267.CrossRefPubMedGoogle Scholar
  3. 3.
    Tsiouris JA. Pharmacotherapy for aggressive behaviours in persons with intellectual disabilities: treatment or mistreatment? J Intellect Disabil Res. 2010;54:1–16.  https://doi.org/10.1111/j.1365-2788.2009.01232.x.CrossRefPubMedGoogle Scholar
  4. 4.
    Tyrer P, Hassiotis A. Drug treatments in people with intellectual disability and challenging behaviour: time to rethink? BMJ Clin Res. 2014;348:g4323.  https://doi.org/10.1136/bmj.g4323.CrossRefGoogle Scholar
  5. 5.
    Dove D, Warren Z, McPheeters ML, Taylor JL, Sathe NA, Veenstra-VanderWeele J. Medications for adolescents and young adults with autism spectrum disorders: a systematic review. Pediatr. 2012;130:717–26.  https://doi.org/10.1542/peds.2012-0683.CrossRefGoogle Scholar
  6. 6.
    Stortz JN, Lake JK, Cobigo V, Ouellette-Kuntz HM, Lunsky Y. Lessons learned from our elders: how to study polypharmacy in populations with intellectual and developmental disabilities. Intellect Dev Disabil. 2014;52:60–77.  https://doi.org/10.1352/1934-9556-52.1.60.CrossRefPubMedGoogle Scholar
  7. 7.
    Lee CS, Williamson LR, Martin SE, DeMarco M, Majczak M, Martini J, et al. Adverse events in very young children prescribed psychotropic medications: preliminary findings from an acute clinical sample. J Child Adolesc Psychopharmacol. 2015;25.  https://doi.org/10.1089/cap.2015.0034.CrossRefGoogle Scholar
  8. 8.
    Vijayakumar N, Op de Macks Z, Shirtcliff EA, Pfeifer JH. Puberty and the human brain: insights into adolescent development. Neurosci Biobehav Rev. 2018;92:417–36.  https://doi.org/10.1016/j.neubiorev.2018.06.004.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    O’Dwyer M, McCallion P, McCarron M, Henman M. Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: a neglected area of research. Ther Adv Drug Saf. 2018;9:535–57.  https://doi.org/10.1177/2042098618782785.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Dworschak W, Ratz C, Wagner M. Prevalence and putative risk markers of challenging behavior in students with intellectual disabilities. Res Dev Disabil. 2016;58:94–103.  https://doi.org/10.1016/j.ridd.2016.08.006.CrossRefPubMedGoogle Scholar
  11. 11.
    Richards C, Oliver C, Nelson L, Moss J. Self-injurious behaviour in individuals with autism spectrum disorder and intellectual disability. J Intellect Disabil Res. 2012;56:476–89.  https://doi.org/10.1111/j.1365-2788.2012.01537.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Kreider AR, Matone M, Bellonci C, dos Reis S, Feudtner C, Huang YS, et al. Growth in the concurrent use of antipsychotics with other psychotropic medications in Medicaid-enrolled children. J Am Acad Child Adolesc Psychiatry. 2014;53:960–970.e2.  https://doi.org/10.1016/j.jaac.2014.05.010.CrossRefPubMedGoogle Scholar
  13. 13.
    Scheifes A, de Jong D, Stolker JJ, Nijman HL, Egberts TC, Heerdink ER. Prevalence and characteristics of psychotropic drug use in institutionalized children and adolescents with mild intellectual disability. Res Dev Disabil. 2013;34:3159–67.CrossRefGoogle Scholar
  14. 14.
    McQuire C, Hassiotis A, Harrison B, Pilling S. Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis. BMC Psychiatry. 2015;15:303–13.  https://doi.org/10.1186/s12888-015-0688-2.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Rasmussen L, Pratt N, Roughead E, Moffat A. Prevalence of psychotropic medicine use in Australian children with autism spectrum disorder: a drug utilization study based on children enrolled in the longitudinal study of Australian children. J Autism Dev Disord. 2019;49:227–35.  https://doi.org/10.1007/s10803-018-3718-3.CrossRefPubMedGoogle Scholar
  16. 16.
    Jobski K, Höfer J, Hoffmann F, Bachmann C. Use of psychotropic drugs in patients with autism spectrum disorders: a systematic review. Acta Psychiatr Scand. 2017;35:8–28.  https://doi.org/10.1111/acps.12644.CrossRefGoogle Scholar
  17. 17.
    Moyal WN, Lord C, Walkup JT. Quality of life in children and adolescents with autism spectrum disorders: what is known about the effects of pharmacotherapy? Paediatr Drugs. 2014;6:123–8.  https://doi.org/10.1007/s40272-013-0050-4.CrossRefGoogle Scholar
  18. 18.
    Ray WA, Stein M, Murray KT, Fuchs C, Patrick SW, Daughterty J, et al. Association of antipsychotic treatment with risk of unexpected death among children and youths. JAMA Psychiatry. 2019;76:162–71.  https://doi.org/10.1001/jamapsychiatry.2018.3421.CrossRefPubMedGoogle Scholar
  19. 19.
    Valdovinos MG, Schroeder SR, Kim G. Prevalence and correlates of psychotropic medication use among adults with developmental disabilities: 1970 – 2000. Int Rev Res Ment Retard. 2003;26:175–220.CrossRefGoogle Scholar
  20. 20.
    Sheehan R, Hassiotis A, Walters K, Osborn D, Strydom A, Horsfall L. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ. 2015;351:h4326.  https://doi.org/10.1136/bmj.h4326.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bowring DL, Totsika V, Hastings RP, Toogood S, Griffith GM. Challenging behaviours in adults with an intellectual disability: a total population study and exploration of risk indices. Br J Clin Psychol. 2017;56:16–32.  https://doi.org/10.1111/bjc.12118.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Tsiouris JA, Kim SY, Brown WT, Pettinger J, Cohen IL. Prevalence of psychotropic drug use in adults with intellectual disability: positive and negative findings from a large scale study. J Autism Dev Disord. 2013;43:719–31.  https://doi.org/10.1007/s10803-012-1617-6.CrossRefPubMedGoogle Scholar
  23. 23.
    Häβler F, Thome J, Reis O. Polypharmacy in the treatment of subjects with intellectual disability. J Neural Transm. 2015;122:S93–S100.  https://doi.org/10.1007/s00702-014-1219-x.CrossRefPubMedGoogle Scholar
  24. 24.
    Lunsky Y, Modi M. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disabilities. Psychiatr Serv. 2017;69:242–6.  https://doi.org/10.1176/appi.ps.201700032.CrossRefPubMedGoogle Scholar
  25. 25.
    Lowe K, Allen D, Jones E, Brophy S. Moore1 K, James W. Challenging behaviours: prevalence and topographies. J Intellect Disabil Res. 2007;51:625–36.  https://doi.org/10.1111/j.1365-2788.2006.00948.x.CrossRefPubMedGoogle Scholar
  26. 26.
    • Perry BI, Kwok HF, Mendis J, Purandare K, Wijeratne A, et al. Problem behaviours and psychotropic medication use in intellectual disability: a multinational cross-sectional survey. J Intellect Disabil Res. 2018;62:140–9.  https://doi.org/10.1111/jir.12471Identified a pattern of psychotropic medication prescription to address challenging behavior, rather than psychopathology, and factors that may attribute to this pattern. CrossRefPubMedGoogle Scholar
  27. 27.
    Totsika V, Toogood S, Hastings RP, Lewis S. Persistence of challenging behaviour in adults with intellectual disability over a period of 11 years. J Intellect Dev Disabil Res. 2008;52:446–57.  https://doi.org/10.1111/j.1365-2788.2008.01046.x.CrossRefGoogle Scholar
  28. 28.
    O’Dwyer C, McCallion P, Henman M, McCarron M, O’Leary E, Burke E, et al. Prevalence and patterns of antipsychotic use and their associations with mental health and problem behaviours among older adults with intellectual disabilities. J Appl Res Intellect Disabil. 2019;32:981–93.  https://doi.org/10.1111/jar.12591.CrossRefPubMedGoogle Scholar
  29. 29.
    Paton C, Flynn A, Shingleton-Smith A, McIntyre S, Bhaumik S, Rasmussen J, et al. Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. J Intellect Disabil Res. 2011;55:665–74.  https://doi.org/10.1111/j.1365-2788.2011.01421.x.CrossRefGoogle Scholar
  30. 30.
    Gomes T, Khuu W, Tadrous M, Vigod S, Cobigo B, Lunsky Y. Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study. BMJ Open. 2019;30:e028125.  https://doi.org/10.1136/bmjopen-2018-028125.CrossRefGoogle Scholar
  31. 31.
    Deb S, Unwin G, Deb T. Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour. J Intellect Disabil Res. 2015;59:11–25.  https://doi.org/10.1111/jir.12119.CrossRefPubMedGoogle Scholar
  32. 32.
    de Kuijper G, Hoekstra PJ. Physicicans’ reasons not to discontinue long-term used off-label antipsychotic drugs in people with intellectual disability. J Intellect Disabil Res. 2017;61:899–908.  https://doi.org/10.1111/jir.12385.CrossRefPubMedGoogle Scholar
  33. 33.
    Scheifes A, Walraven S, Stolker JJ, Nijman HL, Egberts TC, Heerdink ER. Adverse events and the relation with quality of life in adults with intellectual disability and challenging behavior using psychotropic drugs. Res Dev Intellect Disabil. 2016;49-50:13–21.  https://doi.org/10.1016/j.ridd.2015.11.017.CrossRefGoogle Scholar
  34. 34.
    Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, et al. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry. 2009;48:1110–9.  https://doi.org/10.1097/CHI.0b013e3181b76658.CrossRefPubMedGoogle Scholar
  35. 35.
    Research Units on Pediatric Psychopharmacology Autism Network (RUPP). Risperidone in children with autism and serious behavioral problems. N Engl J Med. 2002;347:314–21.  https://doi.org/10.1056/NEJMoa013171.CrossRefGoogle Scholar
  36. 36.
    Unwin GL, Deb S. Efficacy of atypical antipsychotic medication in the management of behaviour problems in children with intellectual disabilities and borderline intelligence: a systematic review. Res Dev Disabil. 2011;32:2121–33.  https://doi.org/10.1002/14651858.CD000377.pub2.CrossRefPubMedGoogle Scholar
  37. 37.
    Sohanpal SK, Deb S, Thomas C, Soni R, Lenôtre L, Unwin G. The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2007;51:750–65.  https://doi.org/10.1111/j.1365-2788.2006.00935.x.CrossRefPubMedGoogle Scholar
  38. 38.
    Handen BL, Aman MG, Arnold LE, Hyman SL, Tumuluru RV, Lecavalier L, et al. Atomoxetine, parent training, and their combination in children with autism spectrum disorder and attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2015;54:905–15.  https://doi.org/10.1016/j.jaac.2015.08.013.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Rundberg-Rivera EV, Townsend LD, Schneider J, Farmer CA, Molina B, Findling RL, et al. Participant satisfaction in a study of stimulant, parent training, and risperidone in children with severe physical aggression. J Child Adolesc Psychopharmacol. 2015;25:225–33.  https://doi.org/10.1089/cap.2014.0097.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ruddick L, Davies L, Bacarese-Hamilton M, Oliver C. Self-injurious, aggressive and destructive behaviour in children with severe intellectual disability: prevalence and service need and service receipt in the UK. Res Dev Disabil. 2015;45-46:307–15.  https://doi.org/10.1016/j.ridd.2015.07.019.CrossRefPubMedGoogle Scholar
  41. 41.
    Aman MG, McDougle CJ, Scahill L, Handen B, Arnold LE, Johnson C, et al. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. Am Acad Child Adolesc Psychiatry. 2009;48:1143–54.  https://doi.org/10.1097/CHI.0b013e3181bfd669.CrossRefGoogle Scholar
  42. 42.
    Valdovinos MG, Henninger-McMahon M, Schieber E, Beard L, Conley B, Haas A. Assessing the impact of psychotropic medication changes on challenging behavior of individuals with intellectual disabilities. Int J Dev Disabil. 2016;62:200–11.  https://doi.org/10.1080/20473869.2016.1177301.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Schaal DW, Hackenberg T. Toward a functional analysis of drug treatment for behavior problems of people with developmental disabilities. Am J Ment Retard. 1994;99:123–40.PubMedGoogle Scholar
  44. 44.
    Valdovinos MG, Kennedy CH. Behavior analytic conceptualization of psychotropic medication side effects. Behav Anal. 2004;27:231–8.  https://doi.org/10.1007/bf03393182.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Michael J. Distinguishing between discriminative and motivational functions of stimuli. J Exp Anal Behav. 1982;37:149–55.CrossRefGoogle Scholar
  46. 46.
    Couppis MH, Kennedy CH. The rewarding effect of aggression is reduced by nucleus accumbens dopamine receptor antagonism in mice. Psychopharmacol. 2008;197:449–56.  https://doi.org/10.1007/s00213-007-1054-y.CrossRefGoogle Scholar
  47. 47.
    Iwata BA, Dorsey MF, Slifer KJ, Bauman KE, Richman GS. Toward a functional analysis of self-injury. J Appl Behav Anal. 1994;27:197–209.CrossRefGoogle Scholar
  48. 48.
    Valdovinos MG, Nelson SM, Kuhle J, Dierks AM. Using analogue functional analysis to measure variations in problem behavior rate and function after psychotropic medication changes: a clinical demonstration. J Ment Health Res Intellect Disabil. 2009;2:279–93.  https://doi.org/10.1080/19315860903104807.CrossRefGoogle Scholar
  49. 49.
    Zarcone JR, Lindauer SL, Morse PS, Crosland KA, Valdovinos MG, McKerchar TL, et al. Effects of risperidone on destructive behavior of persons with developmental disabilities: III. Functional analysis. Am J Ment Retard. 2004;109:310–21.  https://doi.org/10.1352/0895-8017(2004)109%3C310:EORODB%3E2.0.CO;2.CrossRefPubMedGoogle Scholar
  50. 50.
    Cox AD, Virues-Ortega J. Interactions between behavior function and psychotropic medication. J Appl Behav Anal. 2016;49:85–104.  https://doi.org/10.1002/jaba.247.CrossRefPubMedGoogle Scholar
  51. 51.
    Carlson G, Pokrzywinski J, Uran K, Valdovinos MG. The use of reinforcer assessments in evaluating psychotropic medication effects. J Dev Phys Disabil. 2012;24:515–28.  https://doi.org/10.1007/s10882-012-9282-4.CrossRefGoogle Scholar
  52. 52.
    Larue RH, Northup J, Baumeister AA, Hawkins MF, Seale L, Williams T, et al. An evaluation of stimulant medication on the reinforcing effects of play. J Appl Behav Anal. 2008;41:143–7.  https://doi.org/10.1901/jaba.2008.41-143.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Northup J, Fusilier I, Swanson V, Roane H, Borrero J. An evaluation of methylphenidate as a potential establishing operation for some common classroom reinforcers. J Appl Behav Anal. 1997;30:615–25.  https://doi.org/10.1901/jaba.1997.30-615.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Northup J, Fusilier I, Swanson V, Huete J, Bruce T, Freeland J, et al. Further analysis of the separate and interactive effects of methylphenidate and common classroom contingencies. J Appl Behav Anal. 1999;32:35–50.  https://doi.org/10.1901/jaba.1999.32.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    O’Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6:e010505.  https://doi.org/10.1136/bmjopen-2015-010505.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    • Valdovinos MG, Schieber E, Henninger-McMahon M, Beard L, Wilkinson A, Carpenter J. Adverse side effects of psychotropic medication and challenging behavior: pilot work assessing impact. J Dev Phys Disabil. 2017;29:969–82.  https://doi.org/10.1007/s10882-017-9570-0Proposes a method to evaluate the potential relationship between adverse side effects and challenging behavior. CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Zarcone JR, Napolitano DA, Valdovinos MG. Measurement of problem behaviour during medication evaluations. J Intellect Disabil Res. 2008;52:1015–28.  https://doi.org/10.1111/j.1365-2788.2008.01109.x.CrossRefPubMedGoogle Scholar
  58. 58.
    Valdovinos MG, Weyand D. Blood glucose levels and problem behavior. Res Dev Disabil. 2006;27:227–31.  https://doi.org/10.1016/j.ridd.2005.02.002.CrossRefPubMedGoogle Scholar
  59. 59.
    Sheehan R, Hassiotis A. Reduction or discontinuation of antipsychotics for challenging behaviour in adults with intellectual disability: a systematic review. Lancet Psychiatry. 2017;4:238–56.  https://doi.org/10.1016/S2215-0366(16)30191-2.CrossRefPubMedGoogle Scholar
  60. 60.
    Tsakanikos E, Costelli H, Holt G, Sturmey P, Bouras N. Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism. J Autism Dev Disord. 2007;35:1080–5.  https://doi.org/10.1007/s10803-006-0248-1.CrossRefGoogle Scholar
  61. 61.
    •• de Kuijper G, van der Putten AAJ. Knowledge and expectations of direct support professionals toward effects of psychotropic drug use in people with intellectual disabilities. J Appl Res Intellect Disabil. 2017;30:1–9S.  https://doi.org/10.1111/jar.12357Found that direct support professionals’ knowledge and expectations of how psychotropic medications impact behavior of individuals with IDD are not realistic; they provide some recommendations for training. CrossRefPubMedGoogle Scholar
  62. 62.
    Oliver MNI, Skillman GD. Optimizing direct-care paraprofessionals’ adherence to behavioral support programs. NADD Bull. 2012;5(1).Google Scholar
  63. 63.
    Sandall S, Schwartz I, Lacroix B. Interventionists’ perspectives about data collection in integrated early childhood classrooms. J Early Interv. 2004;26:161–74.  https://doi.org/10.1177/105381510402600301.CrossRefGoogle Scholar
  64. 64.
    • Li A, Poling A. Board certified behavior analysts and psychotropic medications: slipshod training, inconsistent involvement, and reason for hope. Behav Anal Pract. 2018;11:350–7.  https://doi.org/10.1007/s40617-018-0237-9Identified gaps in behavior analysts’ training regarding psychotropic medication and recommend areas to develop competence. CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    •• Molina-Ruiz RM, Martín-Carballeda J, Asensio-Moreno I, Montañés-Rada F. A guide to pharmacological treatment of patients with intellectual disability in psychiatry. Int J Psychiatry Med. 2017;52:176–89.  https://doi.org/10.1177/0091217417720896Conducted a brief review of the effectiveness of treatment with psychotropic medication and provide recommendations for psychotropic medication use. CrossRefPubMedGoogle Scholar
  66. 66.
    O’Reilly MF. Functional analysis of episodic self-injury correlated with recurrent otitis media. J Appl Behav Anal. 1997;30:165–7.  https://doi.org/10.1901/jaba.1997.30-165.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Carr EG, Smith CE, Giacin TA, Whelan BM, Pancari J. Menstrual discomfort as a biological setting event for severe problem behavior: assessment and intervention. Am J Ment Retard. 2003;108:117–33.  https://doi.org/10.1352/0895-8017(2003)108<0117:MDAABS>2.0.CO;2.CrossRefPubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Psychology DepartmentDrake UniversityDes MoinesUSA

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