Psychotropic medication use in adults with intellectual disability in Queensland, Australia, from 1999 to 2015: a cohort study.
Half of Australian adults with ID now take psychotropics, and challenging behavior is the top reason—so behavior analysts must coordinate with prescribers.
01Research in Context
What this study did
The team tracked every adult with intellectual disability who used Queensland disability services from 1999 to 2015. They looked at pharmacy records to see who filled psychotropic prescriptions.
No one was asked to start or stop meds. The study simply counted how many people got the drugs and why.
What they found
Psychotropic use rose from 43% to 54% over the 16 years. Challenging behavior was the strongest red flag: it quadrupled the odds of receiving the drugs.
In plain words, half of the adults you serve are likely on these meds, and behavior is the main driver.
How this fits with other research
Ono (1998) saw the opposite link in Japanese facilities: residents already on antipsychotics showed more challenging behavior. The difference is timing. The Japanese study looked at people after they were medicated; M et al. looked at what got them prescribed in the first place.
Bromley et al. (1998) found the same climb in kids: antipsychotic use kept rising over 12 years for children with ID and autism. M et al. show the trend keeps going once those kids become adults.
Silverman et al. (1994) gave some comfort: when adults with ID take antipsychotics at guideline doses, movement side-effects are no worse than in unmedicated peers. So the higher use seen by M et al. does not automatically mean harm if doses stay modest.
Why it matters
Expect most adult clients to arrive on psychotropics. Always request the med list and recent behavior data. Pair your behavior plan with the prescribing doctor so you can show when meds can be reduced. Document behavior in simple graphs; doctors need your data to justify tapering.
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02At a glance
03Original abstract
BACKGROUND: Longitudinal data on medication use in adults with intellectual disability (ID) are scarce. We describe the longitudinal use of and factors associated with psychotropic medication prescribing in adults with ID living in the Australian community. METHODS: Longitudinal data were obtained from adults with ID in the community in Queensland, Australia, between 1999 and 2015. Participant characteristics and medication use information were extracted from baseline questionnaires and health check booklets. Logistic regression was used to investigate the associations between participant characteristics and psychotropic medication use, commencement or cessation. RESULTS: Longitudinal data were available for 138 participants on 697 reviews. The proportion of participants prescribed psychotropic medications increased from 43% to 54% between 1999 and 2015. The rates of commencement and cessation of psychotropic medications between consecutive time periods ranged from 9% to 18% and 7% to 15%, respectively. Challenging behaviour was associated with psychotropic medication use (adjusted odds ratio = 4.1; 95% confidence interval: 2.1-7.9). Presence of challenging behaviour, either consistent or newly identified, was positively associated with ongoing use or commencement of psychotropic medications. CONCLUSIONS: Psychotropic medications are commonly prescribed to adults with ID. Challenging behaviour is positively associated with ongoing use and commencement.
Journal of intellectual disability research : JIDR, 2020 · doi:10.1111/jir.12685