Problem behavior and psychiatric impairment within a developmentally disabled population. III: Psychotropic medication.

Malott (1988) looked at every person in one state’s developmental-disability system. That was 35,000 adults and youths.

The team asked: who takes psych meds, how many, and where do they live? They used surveys and file reviews.

Med use climbs with age. It also climbs with behavior severity and with how locked the home is.

People who also have a psychiatric label get the most pills. The survey gave the first big map of this pattern.

Marcell et al. (1988) looked at the same decade and saw the opposite problem. Only 3% of research papers even said if subjects were on meds. Malott (1988) filled that gap by actually counting the pills.

Yamashiro et al. (2019) and Ellingsen et al. (2014) later repeated the count. They found the same climb in adults with ASD and in kids on Medicaid. The trend has not gone away; it has grown.

Soto et al. (2024) took the next step. They showed that adding an emotional-development assessment in hospital cut antipsychotic load. The old map of high use is now a road map for reduction.

You now know that age, setting restrictiveness, and dual diagnosis are red flags for over-medication. Use this list when you review cases. Pair each med with a behavior plan and ask the team: is this pill still needed? You can start the taper talk with data from 1988 that still holds true today.