Pharmacological management of challenging behavior of individuals with intellectual disability.
An Australian snapshot shows 873 people with ID were on behavioral antipsychotics without RCT backing—check your own caseload for the same pattern.
01Research in Context
What this study did
Burack et al. (2004) counted how many Australians with intellectual disability were taking antipsychotics for behavior. They used a 2000 government registry that listed 873 people.
The team looked at age, sex, and drug type. Older males were the most likely to receive these medicines for restraint.
What they found
Nearly 900 people with ID were on behavioral antipsychotics in one year. The number shocked policy makers.
The drugs were used mainly to manage aggression or self-injury, not for psychosis.
How this fits with other research
Webb et al. (1999) had already searched for RCTs on the same topic. They found only three trials and no proof that the drugs help or harm. Burack et al. (2004) now show the drugs were still widely used without that proof.
Branford (1996) showed 31 of 123 clients could safely stop antipsychotics if they were on low doses and had mild behaviors. The 2004 audit implies most clients never got that chance.
Tassé et al. (2013) later found that half of older adults with ID have prescription errors, with polypharmacy as the top risk. Their data extend the 2004 warning into a new safety issue: wrong or duplicate scripts.
Why it matters
You may meet clients who entered services years ago on high-dose antipsychotics. This paper urges you to audit every file. Ask: Is the drug for behavior or psychosis? Can we taper? Pair the audit with the withdrawal clues from Branford (1996): low dose, no severe aggression, stable epilepsy. One clean chart review this week could cut polypharmacy and side-effect risk.
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02At a glance
03Original abstract
In many Westernized countries, including Australia, concerns about the use of psychotropic drugs to manage the challenging behavior of individuals with intellectual disability have resulted in the development of legislative and procedural controls. Although these constraints may limit indiscriminate use, employing medication remains a common practice. This study examined information about 873 individuals (566 males, 307 females) who were the subjects of reports to the Intellectual Disability Review Panel in March 2000 concerning the use of chemical restraint. A high proportion of people with intellectual disability were reported to have received drugs for purposes of behavioral restraint. The range of drugs was extensive, although those from the antipsychotic class were the most frequently reported. Many individuals concurrently received more than one type of drug or more than one drug from the same drug class. More males than females and more older than younger individuals were administered medication. A relationship between gender and age was apparent, with younger males but older females dominating. The use of drugs to mange the behavior of people with intellectual disability may at times be warranted. However, it is important that the extent and type of drug use, as well as the characteristics of those who are medicated, be subject to ongoing scrutiny.
Research in developmental disabilities, 2004 · doi:10.1016/j.ridd.2004.03.001