Demonstrating an Analyses of Clinical Data Evaluating Psychotropic Medication Reductions and the ACHIEVE! Program in Adolescents with Severe Problem Behavior
Tweak the behavior plan before the pill: real clinic charts show bigger behavior drops when ABA changes come first.
01Research in Context
What this study did
Cox and team pulled old charts from 22 teens with severe problem behavior. All kids had intellectual or developmental disabilities. Each teen was in the ACHIEVE! outpatient program.
The authors looked at two kinds of changes: behavior-plan tweaks and psych-medicine changes. They scored which change came first and how big the behavior drop was.
What they found
Behavior-plan edits cut problem behavior more than medicine edits in most cases. The advantage showed up no matter who made the first move.
Yet the winner was not the same for every kid. A few teens responded better to dose cuts or new meds. The data say: watch the individual, not just the label.
How this fits with other research
Siegel (2018) also tracked big behavior drops, but in an inpatient autism unit. Both papers used case-series charts and saw large reductions, so the pattern holds across settings.
Tiger et al. (2021) fine-tuned assessments for automatically maintained behavior. Cox et al. widen the lens, showing that once you pick the right lever—behavior plan or med—the payoff can be even larger.
Hoffmann et al. (2018) treated precursors and kept severe behavior near zero. Cox adds real-world evidence that changing the plan, not just the pill, often drives the biggest change.
Why it matters
If a teen’s behavior spikes, try a functional tweak first—new reinforcer, shorter demand, or visual cue—before you chase the psychiatrist. Chart the result for two weeks. Only then consider a med change. This order matches what worked most often in the data and keeps you focused on behavior principles your training already gives you.
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02At a glance
03Original abstract
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. The online version contains supplementary material available at 10.1007/s40614-020-00279-3.
Perspectives on Behavior Science, 2022 · doi:10.1007/s40614-020-00279-3