A behavioral diagnostic paradigm for integrating behavior-analytic and psychopharmacological interventions for people with a dual diagnosis.
Use a four-box behavioral diagnostic filter to decide when behavior plans can replace or shrink psychotropic meds for clients with dual diagnoses.
01Research in Context
What this study did
The authors built a step-by-step checklist. It tells clinicians when to use behavior plans first and when to add or keep psychotropic meds.
The paper is conceptual. No new data were collected. The team drew from decades of behavioral case work with people who have both developmental and psychiatric diagnoses.
What they found
The checklist sorts each problem behavior into one of four boxes. The box decides if you start with behavior tools, meds, or both.
The goal is simple: replace or reduce drugs whenever behavior analysis can do the job safely.
How this fits with other research
van der Geest et al. (2002) later tested the idea. They mentored three treatment teams and saw low-integration sites jump to high integration in weeks. The gains held at six months.
Baranek et al. (2005) echo the call. Their review says stereotypy in autism needs the same two-field marriage, giving the checklist extra face validity.
Falcomata et al. (2012) show the need. They found most staff feel lost when clients have dual diagnoses. The 1997 paradigm gives those staff a map.
Why it matters
You now have a one-page filter to bring to psychiatry rounds. Run the client’s target behavior through the four boxes. If it lands in the ‘behavior-only’ square, you can write a behavior plan and propose a med taper. The team gets a shared language and the client gets fewer side effects.
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02At a glance
03Original abstract
Aberrant behaviors exhibited by people with developmental disabilities have been well documented. Often, psychotropic medications, especially neuroleptics, have been used to control behaviors such as self-injury, physical aggression, property destruction, and hyperactivity. Serious side effects of these medications have occurred, resulting in litigation and regulation of their use by courts, surveyors, and accrediting bodies. Rules and regulations have been developed requiring that behaviors/symptoms necessitating that medication usage be clearly delineated, that behavior programs be developed and implemented to reduce need, and that the interdisciplinary team approach be used to monitor effectiveness of interventions. Currently, little guidance exists on how behavioral and psychopharmacological interventions should be applied or combined. This paper presents a paradigm for integrating behavior-analytic and psychopharmacological treatment interventions in the treatment of persons with developmental disabilities that meets applicable standards. Our model is consistent with the least restrictive, yet effective treatment philosophy. Implications for research and treatment are presented.
Research in developmental disabilities, 1997 · doi:10.1016/s0891-4222(97)00003-6