Challenging behaviour, the application of restrictive measures and psychotropic drug prescription in people with intellectual disabilities.
Drugs plus restraints are used together yet behaviour stays severe, so add behaviour analysis instead of hoping meds will replace restrictions.
01Research in Context
What this study did
Jonker et al. (2024) looked at adults with intellectual disability who show severe challenging behaviour. They checked three things at once: how bad the behaviour was, whether the person took psychotropic drugs, and whether staff used restrictive measures like physical holds or locked doors. The design was cross-sectional, meaning one snapshot in time, so no one received an intervention.
What they found
The worst behaviour scores showed up in the group getting BOTH medication and restrictive practices. Having one did not replace the other; they piled together. Because the study only looked at one point in time, we cannot say which came first or whether either approach helped.
How this fits with other research
Griffith et al. (2012) meta-analysis of 598 people found behavioural interventions can cut challenging behaviour a lot. Josien’s snapshot shows drugs plus restrictions still leave behaviour severe, hinting that behaviour analytic treatment may be missing.
Scheifes et al. (2016) reported 84 % of adults on psychotropic meds suffered adverse events that hurt quality of life. Josien adds: not only do side-effects happen, but the drugs are paired with physical restrictions and still do not calm behaviour.
de Kuijper et al. (2010) saw that one in three Dutch residents with ID received antipsychotics, mostly for behaviour not psychosis. Josien updates the story: high prescribing continues and now comes bundled with restrictive measures, yet behaviour stays severe.
Why it matters
If you work with adults who have ID and severe behaviour, do not assume medication will reduce the need for physical restraints or locked doors. The data show the two are used together yet behaviour remains extreme. Schedule a medication review with the psychiatrist, then run or refer for a functional behaviour assessment and skill-building plan. Replacing or cutting drugs without behaviour support is risky, but adding solid behaviour analysis may finally lower both behaviour and the need for chemical or physical controls.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one client on both meds and restraints, open a joint review with the team, and start a functional assessment to build a skill-replacement plan.
02At a glance
03Original abstract
BACKGROUND: Prescribing of psychotropic drugs (PDs) and applying restrictive measures are both frequently used in managing challenging behaviour of people with intellectual disabilities (ID), which is not always according to guidelines or good clinical practice. AIMS: This study aimed to investigate the potential triangular relationship between challenging behaviour, the application of restrictive measures and PD prescription. METHODS AND PROCEDURES: In this cross-sectional study, data on challenging behaviour, PD prescription and restrictive measures were collected. We defined and compared four mutually exclusive groups of participants. OUTCOMES AND RESULTS: Challenging behaviour in the group in whom one or more PD were prescribed as a restrictive measures (PDRM) was more severe than in the other three groups. More severe challenging behaviour, a higher number of antipsychotics, antidepressants and anxiolytics/hypnotics prescriptions, a lower dosage, and more application of domotics as restrictive measure was shown in the PDRM compared to the group in whom PDs were prescribed according to guidelines (PDNRM). CONCLUSIONS AND IMPLICATIONS: We did not find indications for a triangular relationship of challenging behaviour, the application of restrictive measures and PD prescriptions. Future longitudinal research is needed to better understand this complex relationship and should investigate the indication and the effect of treatment. WHAT THIS PAPER ADDS?: This study is a first exploration of the potential triangular relationship between symptoms of challenging behaviour, psychotropic drug (PD) prescription, and the application of restrictive measures. Prescribing PDs and applying restrictive measures are two interventions which are commonly used to manage challenging behaviour in people with intellectual disabilities. Both have been subject of research separately in recent years. However, it is conceivable that the PD prescription in treatments for challenging behaviour could be a substitute for another form of a restrictive measure, for example a physical or mechanical restraint. For this purpose, we defined and compared four mutually exclusive groups of participants. We found no indication for this triangular relationship. On the other hand, we found the highest severity of challenging behaviour in the group who used PDs as restrictive measure next to other restrictive measures. Our results may suggest that both prescribing PDs and applying non-pharmacological restrictive measures are used simultaneously in managing challenging behaviour, are not sufficiently implemented or effective.
Research in developmental disabilities, 2024 · doi:10.1016/j.ridd.2024.104824