Psychotropic medications use and side effects of individuals with intellectual and developmental disabilities.
Heavy psychotropic polypharmacy and CNS toxicity are common in adult IDD crises—always screen for side effects before treating the behavior.
01Research in Context
What this study did
Patton et al. (2020) looked at the adults with IDD who entered a crisis residential program.
Staff used the MEDS scale to count psychotropic drugs and spot CNS side effects like tremors, slurred speech, and sedation.
The team wanted to see if heavy medication loads were adding to the behavioral crisis.
What they found
Each person took an average of 3.6 psychotropic drugs; 85 % were on two or more.
More than half showed clear CNS side effects: drooling, stiff gait, or extreme drowsiness.
High drug load and side effects often mimicked “problem behavior,” so crises may be iatrogenic.
How this fits with other research
Klein et al. (2024) tracked youth with IDD in British Columbia and found the same pattern: one in three received two or more drug classes within a year.
Together the two studies span adolescence to adulthood and show polypharmacy starts early and persists.
Nøttestad et al. (2003) saw that moving people from institutions to community homes did not cut neuroleptic use; Patton et al. (2020) now show the practice is still entrenched in 2020 crisis units.
Dolezal et al. (2010) systematic review warned that evidence for antipsychotics like clozapine in ID is weak; Patton et al. (2020) provide the real-world fallout—people stuck on risky combinations.
Why it matters
If your client enters crisis already sedated or shaky, the behavior may be drug-driven, not a skill deficit. Run the MEDS screen, share results with the prescriber, and ask if a taper or switch is possible. Your data can protect the client from further chemical restraint and speed true stabilization.
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02At a glance
03Original abstract
BACKGROUND: Many people with intellectual and developmental disabilities (IDD) are treated with psychotropic medications, and polypharmacy is common. Although few studies address psychotropic side effects in the population, people with IDD have been found more likely to experience side effects than others who do not have IDD. Because many individuals with IDD may not report side effects reliably, there is risk that side effects may be missed. METHODS: Psychotropic use and side effects of 71 adults with IDD admitted for a 30-day crisis stay to a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) Resource Center were reviewed. START is a specialised behavioural health outreach, training and crisis programme for individuals with IDD. During crisis stays, centre nurses administer the Matson Evaluation of Drug Side Effects screen, a psychometrically established psychotropic medication side effects screen developed for use with people with IDD. Data reviewed were de-identified data used to inform day-to-day practices and assess outcomes for individuals START served. RESULTS: The average age was 28 years, and 56% of the sample was male. All individuals were taking at least one psychotropic, while 79% were taking three or more. The average number of psychotropics used was 3.94. Antipsychotics were the most commonly prescribed medications taken by 85% of the sample; 49% of whom were not reported to have psychosis. Although the overall number of psychotropics did not correlate with Matson Evaluation of Drug Side Effects scores, the average scale scores for all participants was high in contrast to prior studies of people with IDD not taking psychotropics, with central nervous system side effects being the most commonly reported. CONCLUSION: In the present study, data for individuals experiencing a crisis were reviewed and indicated high rates of psychotropic polypharmacy and side effects rates higher than previously reported for people with IDD not taking psychotropics. Prospective study in larger samples is needed to determine if missed or under-appreciated psychotropic side effects may play a role in behavioural health challenges of some people with IDD.
Journal of intellectual disability research : JIDR, 2020 · doi:10.1111/jir.12777