Function-Based Analysis of Psychotrophic Effects on Problem Behavior in IDD

描述（由申请人提供）：精神药物用于治疗智力和发育障碍（IDD）患者的问题行为（例如，攻击和自残）。在过去，这些药物被用于化学抑制患有IDD和问题行为的个体，这种做法导致联邦政府参与监督药物使用。尽管IDD人群中精神药物的使用发生了变化，但很大比例的人群服用精神药物，大多数人服用一种以上的药物（即多种药物）。这种做法令人担忧，因为IDD患者更容易出现不良副作用（ASE）。此外，由于沟通困难，他们不太可能报告这些ase。虽然精神药物是用来治疗破坏性行为的，但有充分的证据表明，行为也可以通过解决影响行为的环境变量来治疗。研究还表明，精神药物可以对破坏行为产生不同的影响，影响行为发生的环境。然而，这些研究都集中在单一药物治疗上，而事实上；多药是治疗的现实。目前，我们尚不清楚多药治疗和多药治疗方案的变化是否以及如何影响行为与维持行为的偶然性之间的关系。关于ase在调解这种关系中所起的作用，人们所知的就更少了。需要进行进一步的研究，以扩大对多药方案及其改变对问题行为和强化偶然事件的影响的了解。此外，研究需要确定asa在影响这些行为和偶然事件中扮演什么角色（如果有的话）。从这项研究中获得的信息可以极大地促进对IDD患者最有效的行为和药物治疗。这一系列研究将增强我们对多种药物使用如何影响IDD患者问题行为的理解，特别是这些药物如何调节行为与发生行为的环境之间的关系。本研究的目的是调查多种药物的使用如何系统地影响IDD患者的问题行为。在整个研究过程中，将进行直接观察以监测行为，并在改变多药方案时进行类似功能分析（AFA）。鉴于先前的研究结果，我们预计药物的变化将导致AFAs结果的变化。这项研究的结果将证实，除了监测问题行为的频率和强度外，继续监测行为功能的重要性和必要性，以确定最有效的治疗方法。到目前为止，初步的研究结果表明，在精神药物改变后，确实可以观察到行为上的变化。主要研究者在临床和应用研究方面都有丰富的经验，可以进行AFAs来评估药物效果。此外，主要研究者与参与者将被招募的社区有联系，并且有足够的学生对进行这类研究感兴趣。联合国人口与发展中心的使命。拟议的研究在几个层面上与NICHD的使命非常吻合。首先，具体目标的完成应该对促进临床理解精神药物治疗方案的变化和潜在的药物ase如何影响IDD患者的破坏性行为产生重要的见解。第二，本研究旨在培养本科生从事科学研究的能力，以保障全体人民的健康、生产力、独立性和福祉。

DESCRIPTION (provided by applicant): Psychotropic medications are prescribed to treat problem behavior (e.g., aggression and self-injury) of persons with intellectual and developmental disabilities (IDD). In the past, these medications were used to chemically restrain individuals with IDD and problem behavior, and this practice resulted in federal involvement to monitor medication use. Despite the changes that have been made in the use of psychotropic medications in the IDD population, a large percentage of the population is prescribed psychotropic medication with a majority of the individuals taking more than one medication (i.e., polypharmacy). This practice is concerning because individuals with IDD have been found to be more susceptible to experiencing adverse side effects (ASE). Furthermore, given difficulties with communication, they are less likely to report these ASEs. Although psychotropic medications are prescribed to treat disruptive behavior, there is ample evidence that demonstrates how behavior can also be treated by addressing environmental variables impacting behavior. Research has also demonstrated that psychotropic medication can exert differential effects on disruptive behavior impacting the circumstances in which behavior occurs. However, these studies have focused on single drug treatments, when in fact; polypharmacy is the reality of treatment. At present, it is unknown if, and if so how, polypharmacy and changes in polypharmacy regimens affect the relationship between behavior and the contingencies maintaining them. Even less is known regarding the role ASEs play in mediating this relationship. Further research needs to be conducted to extend what is known about the impact that polypharmacy regimens and their alterations have on problem behavior and reinforcement contingencies. Furthermore, research needs to determine what role, if any, ASEs play in impacting these behaviors and contingencies. The information yielded from this research could greatly contribute to the most efficacious behavioral and medicinal treatment for individuals with IDD. This line of research will enhance our understanding of how polypharmacy use impacts problem behavior of individuals with IDD, specifically how these medications may mediate the relationship between behavior and the environment in which it occurs. The purpose of the proposed study will be to investigate how polypharmacy use systematically affects problem behavior of persons with IDD. Direct observations will be conducted to monitor behavior throughout the study and analogue functional analyses (AFA) will be conducted when changes are made to polypharmacy regimens. Given previous research findings, we anticipate that changes in medication will produce changes in the results of AFAs. The findings of this research will confirm the importance and need for continued monitoring of behavior function, in addition to monitoring frequency and intensity, of problem behavior in order to determine the most efficacious treatment. Thus far, preliminary research results suggest that after psychotropic medication alterations are made, changes are indeed observed in behavior. The principle investigator has extensive experience, in both clinical and applied research settings, conducting AFAs to evaluate medication effects. Additionally, the principle investigator has ties to the community from which participants would be recruited and has ample students interested in conducting this type of research. Mission of NICHD. The proposed study fits well with NICHD's mission on several levels. First, completion of the specific aims should result in important insights for advancing clinical understanding of how changes in psychotropic medication regimens and potential medication ASEs can affect disruptive behaviors of individuals with IDD. Second, the proposed study is constructed to train undergraduate students to conduct scientific research to ensure the health, productivity, independence, and well-being of all people. PUBLIC HEALTH RELEVANCE: The relevance of this research to public health is that it will empirically validate a more robust method (i.e., continuous monitoring of behavior function) for determining the treatment effectiveness of psychotropic medication for problem behaviors such as aggression and self-injurious behavior in individuals with intellectual disabilities (ID). These behaviors often serve as a barrier for individuals with ID to living in community (versus institutional) settings. Furthermore, the number and combination of medications used to treat these behaviors can produce adverse side effects that can compromise one's quality of life. Based on the findings of this research, the likelihood that psychotropic medication will be used with greater efficacy and in combination with more appropriate behavioral interventions may increase. Furthermore, the outcomes of this research may provide psychiatrists with a new way of monitoring medication effectiveness and ultimately impact how medication is prescribed.