Association for Behavior Analysis International

Many adults with intellectual disabilities receiving community-based residential and day habilitation services are diagnosed with comorbid psychiatric disorders. Treatment planning for these individuals includes the use of applied behavior analysis in combination with psychiatric medication. The first study in this symposium found that of the 102 participants with intellectual disabilities, 70.6% were diagnosed with a comorbid psychiatric disorder and 67.6% were prescribed at least 1 psychiatric medication. The second study found that treatment compliance with medication was improved with the addition of a long acting injectable antipsychotic medication. Prior to its addition, the participant was compliant with treatment only 84% of the time. With the addition of the injectable medication, treatment compliance averaged 100%. When certain medications are prescribed it may be necessary for the individual being treated to receive medical monitoring. The third study found that by using systematically increasing approximations to a doctor's visit with a blood draw via role plays reinforced by the administration of a $1.00 token that was later redeemed for money the participant was successful for 100% of the steps with actual blood draws and this behavior has maintained for 6 consecutive months.

Many adults receiving community based residential and day habilitation services are prescribed psychotropic medications for the management of both psychiatric and behavioral issues. The following study is a descriptive report of the prescribing patterns for 102 adults receiving community based residential and day habilitation services. Of the 102 adults all are diagnosed with intellectual disabilities and 70.6% with a comorbid Axis I psychiatric disorder. The average age of the individuals reviewed was 47.8 years with a range of 23 to 83 years and gender being 38.2% female and 61.8% male. Of the individuals reviewed, 67.6% were prescribed at least one psychiatric medication and many were prescribed more than one, including different classes of medication. Patterns of prescribing were varied and the prescribers consisted of community-based psychiatrists, behavioral neurologists, and a consulting psychiatrist who is part of a multidisciplinary treatment team. Three master's level clinicians collected data for the study and IOA was 100%.

Medication treatment non-compliance is a long-standing issue for individuals with a diagnosed psychiatric disorder including those with intellectual disabilities. This treatment non-compliance interferes with the individual's stability making it difficult to manage their behavior on an outpatient basis. The current study is a review of medication non-compliance of a 57-year-old female diagnosed with a late onset Schizoaffective Disorder and Intellectual Disabilities in the moderate range. Exacerbation of her mental illness manifests as paranoia, which interferes with medication treatment compliance. Prior to addition of a long acting injectable antipsychotic medication she was compliant with medication treatment 84% of the time with a monthly range of 23% to 100%. With the addition of the injectable medication treatment compliance averaged 100% with a monthly range of 99% to 100%. The addition of the injectable medication makes it more likely the individual is compliant with taking prescribed medication. Interobserver agreement data was collected and was 100%.

Doctor refusal and needle avoidance are common problems for people with and without disabilities. Certain medications must be accompanied by routine blood draws to ensure the overall safety of the person. The absence of this blood work could delay or prevent appropriate medications from being administered. The current study evaluated the effects of a systematic desensitization treatment package for doctor refusal and needle avoidance for a 21-year old woman with Schizoaffective Disorder and an Intellectual Disability. The woman was exposed to systematically increasing approximations to a doctor's visit with a blood draw via role plays. Successful exposure resulted in the administration of a $1.00 token that was later redeemed for money. During baseline, the woman was successful for 0% of steps across three opportunities and during treatment she was successful for 95% of steps across 44 sessions. After treatment, the woman was successful for 100% of the steps with actual blood draws and this behavior has maintained for 6 consecutive months. Interobserver Agreement (IOA) data were taken across 22.7% of sessions and were 100%.