The use of anti-psychotic drugs with adults with learning disabilities and challenging behaviour.
Antipsychotic use in adults with ID tracks living place more than clinical need — and newer trials show many can safely come off.
01Research in Context
What this study did
The team mailed short forms to every learning-disability service in North-West England. They asked how many adults had challenging behavior and how many took antipsychotics.
Forms came back from 25 districts. The survey counted pills, not people. It showed where drugs were used, not why.
What they found
Nearly half of the adults with challenging behavior were on antipsychotics. Prescribing rates swung from 20% to 80% between districts. Living in a hospital or hostel raised the odds more than any diagnosis.
How this fits with other research
de Kuijper et al. (2014) later proved many of those same adults can taper off the drugs safely. Their 14-week taper cut challenging behavior with no extra risk.
Rieth et al. (2022) repeated the survey idea and found the new driver is lack of daily choice, not geography. The map changed, but pills still follow place, not need.
Edwards et al. (2007) asked psychiatrists and learned most already believe the drugs are over-used. The worry Lerman et al. (1995) uncovered was already shared by prescribers.
Why it matters
If you write behavior plans for adults with ID, check the med list first. Ask when the last drug review happened. Push for gradual tapers and more daily choices. Geography and setting should not decide who gets sedation — the behavior plan should.
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02At a glance
03Original abstract
The use of anti-psychotic medication with an adult population of people with learning disabilities and challenging behaviours was investigated as part of an epidemiological study covering seven district health authorities and corresponding local authorities in North West England. The study found a high rate of prescription of anti-psychotic drugs (48.1%). Chlorpromazine was the most frequently prescribed drug, followed by Thioridazine and Haloperidol. Three variables, psychiatric diagnosis, where the person was resident (hospital disturbed ward, hospital non-disturbed ward, hostel or family home) and district of origin were found to be significant determinants of prescriptions when all other variables were controlled. Of the variables reflecting individual characteristics those significantly related to prescription suggested that the socially disruptive effects of challenging behaviour were determining prescription. The results are discussed in the context of differing prescription practices across residence and district in the context of the management of socially disruptive behaviour.
Journal of intellectual disability research : JIDR, 1995 · doi:10.1111/j.1365-2788.1995.tb00518.x