Cox Alison D, Pritchard Duncan, Penney Heather, Eiri Llio, Dyer Tim J
Department of Applied Disability Studies, Brock University, St. Catharines, Ontario Canada.
Aran Hall School, Dolgellau, UK.
Perspect Behav Sci. 2021 Feb 12;45(1):125-151. doi: 10.1007/s40614-020-00279-3. eCollection 2022 Mar.
Researchers report increasing trends in psychotropic medication use to treat problem behavior in individuals with intellectual and developmental disability, despite some controversy regarding its application and treatment efficacy. A substantial evidence base exists supporting behavioral intervention efficacy, however research evaluating separate and combined intervention (i.e., concurrent application of behavioral and psychopharmacological interventions) effects remains scarce. This article demonstrates how a series of analyses on clinical data collected during treatment (i.e., four case studies) may be used to retrospectively explore separate and combined intervention effects on severe problem behavior. First, we calculated individual effect sizes and corresponding confidence intervals. The results indicated larger problem behavior decreases may have coincided more often with behavioral intervention adjustments compared to medication adjustments. Second, a conditional rates analysis indicated surges in problem behavior did not reliably coincide with medication reductions. Spearman correlation analyses indicated a negative relationship between behavioral intervention phase progress and weekly episodes of problem behavior compared to a positive relationship between total medication dosage and weekly episodes of problem behavior. However, a nonparametric partial correlation analyses indicated individualized, complex relationships may exist among total medication dosage, behavioral intervention, and weekly episodes of problem behavior. We discuss potential clinical implications and encourage behavioral researchers and practitioners to consider applying creative analytic strategies to evaluate separate and combined intervention effects on problem behavior to further explore this extremely understudied topic.
The online version contains supplementary material available at 10.1007/s40614-020-00279-3.
研究人员报告称，尽管在使用精神药物治疗智力和发育障碍个体的问题行为方面存在一些争议，但其使用呈上升趋势。有大量证据支持行为干预的有效性，然而，评估单独干预和联合干预（即同时应用行为和心理药物干预）效果的研究仍然很少。本文展示了如何对治疗期间收集的临床数据（即四个案例研究）进行一系列分析，以回顾性地探索单独干预和联合干预对严重问题行为的影响。首先，我们计算了个体效应量和相应的置信区间。结果表明，与药物调整相比，问题行为的更大减少可能更常与行为干预调整同时出现。其次，条件率分析表明，问题行为的激增与药物减少并不可靠地同时出现。斯皮尔曼相关性分析表明，行为干预阶段进展与每周问题行为发作次数之间呈负相关，而总药物剂量与每周问题行为发作次数之间呈正相关。然而，非参数偏相关性分析表明，总药物剂量、行为干预和每周问题行为发作次数之间可能存在个体化的复杂关系。我们讨论了潜在的临床意义，并鼓励行为研究人员和从业者考虑应用创造性的分析策略来评估单独干预和联合干预对问题行为的影响，以进一步探索这个研究极少的主题。
在线版本包含可在10.1007/s40614-020-00279-3获取的补充材料。
