Association for Behavior Analysis International

Antipsychotic medications are commonly used to address destructive behaviors in people with developmental disabilities. Contingent skin shock is less commonly employed. Here, the risks and the benefits of antipsychotic medication and contingent skin shock are enumerated and compared. First, the major untoward effects of antipsychotic medications and contingent skin shock are summarized. Second, an efficacy analysis was conducted consisting of the following components: a brief description of the conclusions of a 1991 review of antipsychotic medications; a complete analysis of the effect of first generation and second generation antipsychotics on the irritability subscale of the Aberrant Behavior Checklist; a complete analysis of first generation and second generation antipsychotics on the Clinical Global Impression Improvement Scale; a complete analysis of the effect of first generation antipsychotics, second generation antipsychotics, and contingent skin shock on destructive behavior frequency. The results of the analysis suggest that contingent skin shock is by far the most effective procedure and has the most favorable side effect profile.

The side effects of first generation antipsychotic medication include acute extrapyramidal syndromes, chronic extrapyramidal syndromes, neuroleptic malignant syndrome, weight gain, sexual dysfunction, seizure, prolactin level elevation, and sudden cardiac death, among other side effects. These effects are described and summarized. To describe the efficacy of first generation antipsychotics in treating destructive behaviors the conclusions of a 1991 review by Thompson, Hackenberg, and Schaal (1991) are first summarized. Second, because only six relevant studies since 1990 were found, each is briefly reviewed. Finally, Aberrant Behavior Checklist Irritability Subscale, Clinical Global Impression Improvement, and frequency data derived from the Thompson, Hackenberg, and Schaal (1991) review and six subsequent studies since are described. The results suggest that generally, first generation antipsychotic medications have limited efficacy with respect to the three dependent variables reviewed.

The side effects of second generation antipsychotic medication include acute extrapyramidal syndromes, chronic extrapyramidal syndromes, neuroleptic malignant syndrome, weight gain, sexual dysfunction, seizure, prolactin level elevation, and sudden cardiac death, among other side effects. These effects are described and summarized. To describe the efficacy of second generation antipsychotics in treating destructive behaviors, a literature search was conducted. Studies were included for analysis if second generation antipsychotic medications were used to treat the destructive behaviors of people with developmental disabilities and any of the following dependent variables were used: Aberrant Behavior Checklist Irritability Subscale, Clinical Global Impression Improvement, problem behavior frequency. For those studies with a placebo control, the mean change in ABC-I was 12.3 for those given a drug compared to 5.75 for those given placebo. The CGI-I data show that approximately 54% of participants given a drug were rated as much or very much improved compared to approximately 16% of those given placebo. The analysis of frequency data suggest that second generation antipsychotic medication was effective in reducing destructive behavior frequency by 90% in 34 of 136 destructive behaviors.

The negative side effects of contingent skin shock include emotional behavior, avoidance responses, and anxiety among other negative side effects. However, positive side effects are most often reported. These effects are described and summarized. To describe the efficacy of contingent skin shock in treating destructive behaviors, a literature review was conducted. Studies were included for analysis if contingent skin shock was used to treat the destructive behaviors of people with developmental disabilities and problem behavior frequency was the dependent variable in the study. 117 different behaviors or groups of behaviors exhibited by 114 different participants are summarized. The results show that 110 of 117 behaviors were reduced by 90% or more.