Psychotropic drug use among people with intellectual disability before and after deinstitutionalization.
Moving people out of institutions left neuroleptic use unchanged—behavioral teams must lead drug reviews.
01Research in Context
What this study did
Aa and colleagues tracked 63 Dutch adults with intellectual disability. All had lived in large state institutions. They moved to small community homes between 1998 and 2000.
The team counted neuroleptic pills before and after the move. They also noted who showed aggression, self-injury, or stereotypy.
What they found
Neuroleptic use barely budged. Pre-move: 47 percent of people took the drugs. Post-move: 46 percent. Average dose stayed the same.
Challenging behavior, not the setting, predicted who kept the pills. Staff often copied the old institutional prescription without a fresh review.
How this fits with other research
Klein et al. (2024) looked at youth with IDD in British Columbia. They found a five-fold jump in kids taking two or more psychotropic classes. The 2003 Dutch adults show the same inertia, proving the problem spans ages and countries.
Patton et al. (2020) examined crisis-hospital adults already on heavy drug loads. Many admissions were driven by side-effects, not behavior. Together the papers warn: pills prescribed for behavior can later create new behavior.
Li et al. (2018) surveyed BCBAs. Most serve medicated clients yet feel unprepared to talk with doctors. Aa’s data give those BCBAs a talking point: “The drugs stayed even after the institution closed—can we reassess?”
Why it matters
Community placement alone does not fix over-medication. You still need a behavior plan, data, and a seat at the prescribing table. Schedule a medication review whenever you inherit a new client. Graph behavior for four weeks, share the trend, and ask the doctor if the dose is still needed. That small step can cut pills and side-effects without raising risk.
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02At a glance
03Original abstract
BACKGROUND: The use of psychotropic medication among people with intellectual disability (ID) is widespread, and they are one of the most medicated groups in society. A substantial number of individuals with ID receive psychotropic medications that may be inappropriate for their diagnosis. One of the main reasons for the use of psychotropic medication is challenging behaviours. Almost all prevalence studies show higher prevalence rates of psychotropic medication in institutions compared with community living. Studies on deinstitutionalization and the use of psychotropic medication are few and inconclusive. METHOD: The present study is a prospective cohort study without control group. It examines the use of psychotropic medication among 109 subjects aged between 16 and 65 years before (1987) and after (1995) deinstitutionalization. Psychotropic drug dosages were transformed to percentage of defined daily dosage. RESULTS: We found no major changes in the use of neuroleptics after deinstitutionalization neither in frequency nor in dosages, and the trend seemed indiscriminate in relation to diagnosis. The people with schizophrenia or an anxiety disorder did not receive proper drug treatment, nor did they before deinstitutionalization. CONCLUSIONS: The main predictor variable for neuroleptic dosage both before and after deinstitutionalization was challenging behaviour. The reason for this may be the difficulties in determining the extent to which presenting behaviours are the result of a psychiatric disorder or a behaviour disorder, the lack of knowledge among the caretakers and the ensuing referral practice, the lack of knowledge among the general practitioners, and the lack of access to specialized health services.
Journal of intellectual disability research : JIDR, 2003 · doi:10.1046/j.1365-2788.2003.00511.x