Factors associated with use of medication for behavioral challenges in adults with intellectual and developmental disability.
Adults with IDD get behavior meds more often when they live in restrictive, low-choice settings—boosting autonomy may safely cut medication need.
01Research in Context
What this study did
Rieth et al. (2022) sent a survey to adults with intellectual or developmental disabilities who also show challenging behavior. They asked where each person lived, how many daily choices the person could make, and whether the person took behavior meds.
The team then used statistics to see if living place or choice level predicted medication use.
What they found
Adults with fewer everyday choices and those living in group homes were more likely to be on behavior medications. The link held even after controlling for other factors.
How this fits with other research
Lerman et al. (1995) saw the same pattern almost thirty years ago: adults with learning disabilities in certain residences were prescribed antipsychotics at high rates, often for convenience rather than clear clinical need.
de Kuijper et al. (2014) extends the story. Their randomized trial showed that carefully reducing those same medications actually improved behavior, proving that high use is not inevitable.
Matson et al. (2009) and Torelli et al. (2023) add the flip side: when adults gain more choice—through person-centred plans or smaller community homes—they report higher control and better well-being. Together these papers show that restricted settings drive both medication use and poor outcomes, while choice-rich settings support less medication and better lives.
Why it matters
If you serve adults with IDD, check how many real choices they have each day—what to eat, wear, or do. Advocate for more autonomy and smaller or community-based homes. Each extra choice may lower the need for behavior meds and align with the positive taper results shown by de Kuijper et al. (2014).
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02At a glance
03Original abstract
BACKGROUND/AIMS: Persons with intellectual or developmental disabilities and who exhibit challenging behaviors are often prescribed medication to control behavior. Little is known about the environmental factors that may be associated with taking these medications. METHODS AND OUTCOMES: This study examined the association between individual and intermediate or environmental factors and the documented use of medication for clients with intellectual or developmental disabilities (IDD) who exhibit challenging behavior, using the 2014-15 National Core Indicators Adult Consumer Survey dataset. RESULTS AND CONCLUSIONS: Individual-level variables associated with a higher likelihood of taking medication for persons with IDD exhibiting challenging behaviors included being of younger age, male gender, having moderate or severe intellectual disability, being ambulatory, communicating verbally, having a behavioral plan, requiring support for behavioral challenges, and having a history of mental illness. Environment-level variables included infrequently eating out and having less everyday choice. This study found that restrictions in opportunities to make choices in their life was associated with a greater likelihood of being on a medication for persons with IDD who exhibit challenging behavior. Living in group home settings also increased the likelihood of medication use. A limitation of the study is a lack of information on why medications were prescribed and whether they were intended to treat the challenging behavior. IMPLICATIONS: This work has important implications for health providers, as addressing malleable social factors may provide an avenue for reducing challenging behaviors without the need for medication.
Research in developmental disabilities, 2022 · doi:10.1016/j.ridd.2022.104182