In the life of a behavior analysts, hearing about medications is a double-edged sword. On one hand, there are many children that would benefit from medication to help address certain symptoms of their diagnosis; but on the other hand, there is little research on the effectiveness of many of the medications being prescribed. The lack of evidence is more than I’ll try to address in this post (though maybe I’ll brave that topic later). Rather, I want to consider the potential benefits of the use of medications and help understand how to make INFORMED decisions that are best for the individual.
First and foremost, ask questions to ensure you know exactly what the proposed medication is expected to do, both good and bad. Many of the medications being prescribed to help address challenging behaviors were actually designed for other purposes and are prescribed “off label” to hopefully address these needs. What are some questions you can ask?
- What (exact) behavior should I expect to see improve while on this medication?
- How will the medication help that improvement happen? (This will help understand the primary purpose of the medication [e.g., lower blood pressure] and how calmer behavior might be a secondary result.)
- What are the key behavioral side effects of the medication?
- What are the key medical side effects of the medication?
- How quickly should I expect to see changes?
Having answers to these questions will help you understand what to expect, if the medication will likely address what you see as a serious concern, and whether or not the pros outweigh the cons.
After you have all of the information, begin collecting data (before making your decision) on the behavior the medication is intended to address. Even if the pros (on paper) outweigh the cons, that is only true if the potential positives actually happen. And the only way to know if the behavior is improving is to know how much it occurs before the medication v. how much it occurs while on the medication. How can the behavior be quantified?
- Count how many times the behavior happens each day
- Time how long the behavior lasts
- Keep a rating scale of how intense the behavior is each day (e.g., physically harmful v. annoying but not dangerous, etc.)
Now that you can see how much the target behavior is occurring, go ahead and make your decision. If you decide to move forward with the medication, keep tracking the data. Make a note on the day the medication began and watch what happens to the data. Remember before when I recommended asking how quickly you should expect to see changes? This is where that comes in. If the doctor said you should expect effects to kick in within a couple days, you should see changes in your data quickly. If they said it will take 2 to 3 weeks, you know you need to let the medication take it’s time before you make judgements about the effectiveness.
When it is time to follow up with your doctor about the medication, take the data with you. Help your doctor make informed recommendations with really concrete evidence of the effects (or lack thereof) the medication is having. Doctors and families want the same thing: healthy, happy kids who are able to function well in their environments. The more objectively you can describe the effects to your doctor, the better they’ll be able to make recommendations about altering dosages, continuing/discontinuing medications, etc; and they will appreciate the additional information you’ll be able to share with them if you record data.
There is one more recommendation that doesn’t quite fit into the step-by-step process I’ve tried to lay out here, but it’s a BIGGIE! Whenever you are making changes to treatment (whether they be medication-related or not), try to make one change at a time and record in your data when they happen. For example, if you are considering adding a medication and increasing ABA therapy from 4 hours a week to 12 hours a week, decide which change you’ll make first and leave the other alone for a couple of weeks. If the behavior changes in the desired way, maybe the other change isn’t needed. If you don’t see the necessary change, then consider the other option.
If you change multiple things at once, there is no way to know which change actually did something beneficial. This is dangerous because you could end up continuing something with serious negative side effects because you think it’s helping when it was really the other change that was supporting the positive changes. The other negative about doing too much at once is more “practical” in nature: if you are doing things that aren’t necessary or effective, your resources are spread unnecessarily thin as opposed to focusing them all in the direction of the effective treatment(s).
Things to remember:
- Ask lots of questions on the front end
- Take data before making any decisions
- Make your decision (based on your data) and keep tracking it
- Share the data with your doctor moving forward
- Make one change at a time
Hopefully this has been helpful, not only as it relates to medications, but in making any decisions regarding treatment options.