Board Certified Behavior Analysts and Psychotropic Medications: Slipshod Training, Inconsistent Involvement, and Reason for Hope

Abstract

People with autism spectrum disorder often receive psychotropic medications and two drugs, risperidone and aripiprazole, are approved for treating "irritability" in this population. A number of authors have suggested that behavior analysts can contribute to the prudent use of such drugs, but little is known regarding Board Certified Behavior Analysts' involvement in practices relevant to the use of psychotropic drugs. We e-mailed Board Certified Behavior Analysts an anonymous web-based survey regarding such practices. A majority of respondents work with individuals with autism spectrum disorder who take at least one psychotropic medication but respondents' training relevant to psychotropic medications is inconsistent. Many report that their training is inadequate, they do not regularly work as part of interdisciplinary teams concerned with medication, and behavior-analytic interventions are not typically evaluated before drugs are prescribed. Nonetheless, the majority of respondents reported that medications sometimes produce beneficial effects. Those involved in training behavior analysts should consider the competencies needed for graduates to work effectively as members of teams concerned with the optimal use of medications and how to foster and assess those competencies. Behavior analysts should also work to develop and implement strategies that foster collaboration with psychiatrists and other physicians. • Psychotropic drugs are often prescribed for people with autism, and both risperidone and aripiprazole are approved for reducing "irritability," which comprises self-injury, aggression, tantrums, and other challenging responses. • Respondents are not consistently involved in monitoring the effects of psychotropic drugs, which are often administered prior to evaluating an alternative, less restrictive, intervention. • Respondents are not trained consistently with respect to matters relevant to psychotropic drugs, and many apparently are not trained adequately. • People involved in training behavior analysts should consider the competencies needed for graduates to work effectively as members of teams concerned with the optimal use of medications and how to foster and assess those competencies. • Behavior analysts should also work to develop and implement strategies that foster collaboration with psychiatrists and other physicians.

Psychotropic Medication Monitoring in a Human Services Organization for Children with Autism Spectrum Disorder: Description and Evaluation of Interdisciplinary Team Review

“…It should be noted that pharmacological treatment is conducted frequently with this population but decisions about medication are often based on clinical judgement without objective outcome measures (Poling et al, 2017 ; Spencer et al, 2013 ). Further, the combined effects from behavioral-pharmacological intervention can be difficult to assess without controlled analysis (Li & Poling, 2018 ; Matson & Dempsey, 2008 ). Establishing a system of data-informed and coordinated decision making about psychotropic medications is built on the expertise of multiple disciplines and defining standards of care for children and their families.…”

“…These results suggest that some prescription practices may be guided by reasonable criteria but more objective methods should be considered. For example, Li and Poling ( 2018 ) posited that applied behavior analysis (ABA) principles and methods “are often appropriate for the everyday evaluation of psychotropic medications” (p. 3). Further, behavior measurement and evaluation should be integrated within interdisciplinary teams responsible for the care and treatment of children with ASD in human services settings (Brodhead, 2015 ) especially in the context of medication management (Newhouse-Oisten et al, 2017 ).…”

A Call for Discussion About Scope of Competence in Behavior Analysis

“…For example, the behavior analyst may report having sufficient competence and generally high confidence but find that the highly controlled experimental conditions differ significantly from the classroom in which services are provided. Similarly, the behavior analyst may realize the current consumer would have been excluded from relevant studies because of a comorbidity or potential side effects from psychotropic medications (Li & Poling, 2018), bringing into question the extent to which the evidence applies in the current case (Slocum et al, 2014). Under these conditions, the answer to Question 4 may be medium or low because the significant adaptations from the research conditions to the real-world application may require additional consultation or professional development.…”

Medication training for behavior analysts.

“…This means BCBAs are highly likely to be supporting clients taking psychotropic medications. In fact, in a recent survey study 40% of BCBA respondents reported that over half of the clients on their caseload were taking psychotropic medications (Li & Poling, 2018). Unfortunately, approximately 70% of BCBAs reported they either rarely or never work directly with prescribing professionals.…”