Board Certified Behavior Analysts and Psychotropic Medications: Slipshod Training, Inconsistent Involvement, and Reason for Hope
Most BCBAs lack med training and prescriber contact—fix it with a four-step script.
01Research in Context
What this study did
Li and her team sent an online survey to 402 board-certified behavior analysts. They asked how often the BCBAs served clients who take psychotropic meds, what training they had, and how much they work with prescribers.
Most respondents worked with kids with autism. The survey took about 10 minutes and was sent out in 2017.
What they found
Eight in ten BCBAs said at least half of their clients take psychotropic drugs. Yet only one in four felt their grad school trained them well on these meds.
Even worse, 60 % rarely or never talk with the prescribing doctor. Most learn about med changes from parents after the fact.
How this fits with other research
Newhouse-Oisten et al. (2017) came first and gave a four-step roadmap for BCBA–prescriber talks. Li et al. (2018) show most BCBAs still are not at the table, so the roadmap sits unused.
Colombo et al. (2021) asked about severe-problem-behavior training and found the same gap: half of BCBAs get zero support. The medication gap is part of a wider training hole.
LaFrance et al. (2019) explain why BCBAs are left out: teams do not know our scope. Li’s data prove the cost of that confusion—clients lose behavioral input when meds start or stop.
Why it matters
If you work with clients on risperidone, SSRIs, or ADHD meds, you are flying blind without prescriber contact. Use the Newhouse-Oisten four-step script this week: share baseline data, list possible behavioral shifts, ask for a team review, and document everything. One email can move you from sideline to team member and protect your client from med-behavior mismatches.
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02At a glance
03Original abstract
People with autism spectrum disorder often receive psychotropic medications and two drugs, risperidone and aripiprazole, are approved for treating “irritability” in this population. A number of authors have suggested that behavior analysts can contribute to the prudent use of such drugs, but little is known regarding Board Certified Behavior Analysts’ involvement in practices relevant to the use of psychotropic drugs. We e-mailed Board Certified Behavior Analysts an anonymous web-based survey regarding such practices. A majority of respondents work with individuals with autism spectrum disorder who take at least one psychotropic medication but respondents’ training relevant to psychotropic medications is inconsistent. Many report that their training is inadequate, they do not regularly work as part of interdisciplinary teams concerned with medication, and behavior-analytic interventions are not typically evaluated before drugs are prescribed. Nonetheless, the majority of respondents reported that medications sometimes produce beneficial effects. Those involved in training behavior analysts should consider the competencies needed for graduates to work effectively as members of teams concerned with the optimal use of medications and how to foster and assess those competencies. Behavior analysts should also work to develop and implement strategies that foster collaboration with psychiatrists and other physicians. • Psychotropic drugs are often prescribed for people with autism, and both risperidone and aripiprazole are approved for reducing “irritability,” which comprises self-injury, aggression, tantrums, and other challenging responses. • Respondents are not consistently involved in monitoring the effects of psychotropic drugs, which are often administered prior to evaluating an alternative, less restrictive, intervention. • Respondents are not trained consistently with respect to matters relevant to psychotropic drugs, and many apparently are not trained adequately. • People involved in training behavior analysts should consider the competencies needed for graduates to work effectively as members of teams concerned with the optimal use of medications and how to foster and assess those competencies. • Behavior analysts should also work to develop and implement strategies that foster collaboration with psychiatrists and other physicians.
Behavior Analysis in Practice, 2018 · doi:10.1007/s40617-018-0237-9