Demonstrating an Analyses of Clinical Data Evaluating Psychotropic Medication Reductions and the ACHIEVE! Program in Adolescents with Severe Problem Behavior

Perspect Behav Sci. 2021 Feb 12;45(1):125-151. doi: 10.1007/s40614-020-00279-3. eCollection 2022 Mar.


Researchers report increasing trends in psychotropic medication use to treat problem behavior in individuals with intellectual and developmental disability, despite some controversy regarding its application and treatment efficacy. A substantial evidence base exists supporting behavioral intervention efficacy, however research evaluating separate and combined intervention (i.e., concurrent application of behavioral and psychopharmacological interventions) effects remains scarce. This article demonstrates how a series of analyses on clinical data collected during treatment (i.e., four case studies) may be used to retrospectively explore separate and combined intervention effects on severe problem behavior. First, we calculated individual effect sizes and corresponding confidence intervals. The results indicated larger problem behavior decreases may have coincided more often with behavioral intervention adjustments compared to medication adjustments. Second, a conditional rates analysis indicated surges in problem behavior did not reliably coincide with medication reductions. Spearman correlation analyses indicated a negative relationship between behavioral intervention phase progress and weekly episodes of problem behavior compared to a positive relationship between total medication dosage and weekly episodes of problem behavior. However, a nonparametric partial correlation analyses indicated individualized, complex relationships may exist among total medication dosage, behavioral intervention, and weekly episodes of problem behavior. We discuss potential clinical implications and encourage behavioral researchers and practitioners to consider applying creative analytic strategies to evaluate separate and combined intervention effects on problem behavior to further explore this extremely understudied topic.

Supplementary information: The online version contains supplementary material available at 10.1007/s40614-020-00279-3.

Keywords: Adolescents with intellectual and developmental disability; Polypharmacy; Psychopharmacological interventions; Severe problem behavior; The ACHIEVE! program.