Transcript Slide 1
Marc Weeden, Ph.D, BCBA-D
Juniper Gardens Children’s Project
University of Kansas
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
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)
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
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
Drugs do not selectively reduce problem behavior
Appropriate behavior may be reduced, too
Drugs may interact with other non-pharmacological
interventions
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
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
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
Organizational Behavior Management
Health
Safety
Developmental Disabilities
Behavioral Pediatrics
Drug Addiction
Recycling
Education
Behavioral Pharmacology
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)
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 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
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 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 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
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
Frequency of Talk Outs
35
Before Intervention
Intervention
30
25
20
15
10
5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Days
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 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
100
90
% of Time On Task
80
70
60
50
40
30
20
10
0
1
2
3
4
5
6
sessions
7
8
9
10
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
Dry Mouth
Increased Appetite
Weight Gain
Sedation
Constipation
Blood Pressure Changes
Dizzyness
Headache
Tremors
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
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
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
[email protected]