Marc Weeden, Ph.D, BCBA-D
Juniper Gardens Children’s Project
University of Kansas
Overview
 History/Prevalence
 Off-Label Prescribing
 Behavior Analysis
 Identify Target Behavior (s)
 Record and Graph Relevant Data
 Interpret Data
 Communicate Data to Appropriate Parties
History/Prevalence
 Psychotropic drugs – medications prescribed with the
intent of improving an individual’s mood, cognition,
or overt behavior
 1950’s – Thorazine
 Approximately 40-50% people with autism receive at
least one psychotropic medication (e.g., Green et al.,
2006; Goin-Kochel, Myers, & Mackintosh, 2007)
Risperidone (Risperdal)
 A wide variety of psychotropic drugs are prescribed for
people with autism and other developmental disabilities
 Antipsychotics are the most prescribed (Poling et al., 2004)
 Approved by the FDA in 2006 for treating “irritability” in
people with autism between the ages of 5 and 17
 Only drug that is FDA-approved as a psychotropic
medication for people with autism
Off-Label Prescribing
 Any other drug that is prescribed to improve the
behavior of people with autism, the use is “off-label”
 The drug is prescribed for a purpose other than that
for which it is specifically FDA-approved
 Accepted medical practice if there is reasonable
scientific evidence that a given drug is effective for a
particular application
A Word of Warning
 Drugs do not selectively reduce problem behavior
 Appropriate behavior may be reduced, too
 Drugs may interact with other non-pharmacological
interventions
Behavior Analysis
 Scientific study of behavior
 B.F. Skinner 1938
 Behavior is the subject of study
 Behavior can be observed, described, and recorded
 Data, Data, Data
Applied Behavior Analysis
 Discipline concerned with analyzing and modifying
human behavior
 Procedures based on basic principles of behavior are
used by professionals and/or paraprofessionals to
change behavior in socially significant ways
(Miltenberger, 2004)
Characteristics of ABA
 Behavior is the subject of study
 Labels are de-emphasized
 Behaviors of interest are clearly defined
 Variables that control behavior are identified and
modified
 Behavior change is measured over time
 Hypothetical underlying causes of behavior are
avoided
Applications of ABA
 Organizational Behavior Management
 Health
 Safety
 Developmental Disabilities
 Behavioral Pediatrics
 Drug Addiction
 Recycling
 Education
 Behavioral Pharmacology
How to Identify Target Behavior (s)
 Behavioral Excess
 Behavior to be decreased in frequency, duration, or
intensity

Example: Smoking
 Behavioral Deficit
 Desirable behavior to be increased in frequency,
duration, or intensity

Example: Exercising, Studying
Defining the Target Behavior (s)
 Definitions must be specific and related to actions
 Example from Major League Baseball:
Unsportsmanlike behavior
 Cursing, throwing the bat, kicking the dirt
Defining the Target Behavior (s)
 Internal states (sad, angry, frustrated) are avoided
 Internal states can’t be observed or measured by others
Defining the Target Behavior (s)
 Labels (“a bad sport”) are not used because they do not
describe an individual’s actions
 Definitions can vary from person to person
 Precise definitions help to ensure data accuracy
Defining the Target Behavior (s)
 Labels are sometimes used to explain behavior
 Example from Miltenberger (2004):
 A person is observed to repeat syllables or words when
they speak (labeled a “stutterer”)
 To say the person repeats syllables or words because
he/she is a stutterer is incorrect, as the label (stutterer)
is not the cause of the behavior (repeating words or
syllables when they speak)
 Same thing can be applied to individuals with autism
How to Record and Graph Relevant Data
 Record data at a time the behavior is likely to occur
 Observation sessions should be approximately the
same length (e.g., all sessions are 20 min)
 Natural settings (e.g., classroom) are more likely to
yield representative data than contrived settings (e.g.,
clinic)
 In contrived settings, however, outside sources of
influence can be eliminated
How to Record and Graph Relevant Data
 Dimension of behavior – some quantifiable aspect of a
behavior of interest
 Frequency – number of times a behavior occurs in the
observational period
 Duration – how long a behavior takes to occur from
beginning to end
How to Record and Graph Relevant Data
 Baseline – record the behavior prior to implementing
the intervention
 Allows for comparison and gives a clearer picture as to
the effectiveness of the medication (is the behavior
already decreasing due to a teacher intervention before
the meds are given?)
 Not always possible, as in the case of self-injurious
behavior
How to Interpret Data
 Risperidone intervention
 Example 1: Talk outs is the behavior of interest
 Defined: Speaking at an audible level while teacher is
providing instruction to the entire class
 Use frequency as method of recording
 Data recorded during math class each by
paraprofessional
Frequency of Talk Outs
35
Before Intervention
Intervention
30
25
20
15
10
5
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Days
How to Interpret Data
 You can say that the intervention was successful if all
other sources of variability can be ruled out (e.g., other
intervention started at the same time)
 Be aware of side-effects (e.g., sedation)
How to Interpret Data
 Methylphenidate (Ritalin)
 Example 2: On-Task is the behavior of interest
 Defined: Participating in an assigned task (e.g.,
completing math problems)
 20 minute observation period
 Duration
 Recording with a stop watch how long child is on-task
100
90
% of Time On Task
80
70
60
50
40
30
20
10
0
1
2
3
4
5
6
sessions
7
8
9
10
How to Communicate Results
 Make the graph easy to understand
 Meet as often as possible with the circle of support
(e.g, parents, teachers, paraprofessionals)
 Let the data guide treatment decisions
 The MD will be able to better adjust or discontinue
medication usage with accurate data
Risperidone Side Effects
 Dry Mouth
 Increased Appetite
 Weight Gain
 Sedation
 Constipation
 Blood Pressure Changes
 Dizzyness
 Headache
 Tremors
Risperidone Side Effects
 Make a plan to evaluate side effects
 For example, closely monitor the weight of the person
taking the drug (e.g., once per week)
 Are they asking for more to drink and is this causing
problems?
 Might be difficult for an individual with autism to
report adverse effects
Summary
 Define target behavior precisely
 Select an appropriate system of measurement
 Communicate results
 Make a plan to evaluate side effects
 Let the data guide treatment decisions
Concluding Comment
 Psychotropic drugs are neither good nor bad
 Medications can be helpful, harmful, or
inconsequential
 Good psychopharmacology, like any good
intervention, is individualized and data based
 The task will rarely be easy, but it will always be
worthwhile
Contact info
 mweeden@ku.edu