Treatment plans for autistic individuals are uniquely tailored with the person in mind and under the premise that every autistic person is impacted differently and may benefit from individualized treatments or interventions. Nevertheless, there exists a growing consensus that among the various treatments for autism, Applied Behavior Analysis (ABA) integrated with psychotropic medications is more effective at targeting physical aggression, self-injurious behaviors and property destruction in autistic individuals, especially for those individuals with dual diagnosis such as Autism and Bipolar Disorder, Not Otherwise Specified or Impulse Control Disorder, NOS.
Applied Behavior Analysis (
Applied behavior analysis (
Functional Behavioral Analysis, which falls under the purview of Applied Behavior Analysis, is useful in identifying antecedents and consequences that are associatedwith increased frequency of behaviors. One of the most widely used descriptive analysis is the A-B-C procedure (Antecedent-Behavior-Consequence) (Bijou, et al., 1968). The underlying hypothesis of this procedure is that, over time, a careful recording of the “ABCs” of a target behavior will permit the identification of a specific antecedent and/or subsequent (function or cause of behaviors) to the target behavior that predict high and low frequency of the behavior.
Determining the source of control of a behavior (cause) is critical to determine the appropriate intervention. One of the challenges of behavior analysts is to identify the function or cause of a maladaptive behavior (e.g. self-injurious behavior, physical aggression outburst or property destruction) and to control a complex environmental context or contingency relationships due to the fact that some maladaptive behaviors may have been controlled by multiple variables (Smith, Iwata, Vollmer, & Zarcone, 1993).
It is extensively investigated that Applied Behavior Analysis or interventions based on the function (cause) of a behavior have proven to be very effective in changing and controlling challenging behaviors in autistic individuals. However, the problem becomes more complex when the challenging behaviors are multi-factorial and determined by learned behaviors and /or brain physiology or chemistry dysfunction. In these cases, Applied Behavior Analysis integrated with psychotropic medications has proven beneficial for many autistic individuals.
Maladaptive behaviors may be maintained by any number of variables such as a medical condition, idiosyncratic condition or lack of verbal communication in non-verbal individuals and / or neurological or psychiatric disorders. If the function is deemed, by the person’s interaction with the environment, such as to escape from or avoid a noisy room or attention-seeking, it would be understandable to develop an intervention accordingly. However, if an autistic individual engages in self-injurious behavior as a result of a sinus infection, dental problem, pain or a bodily discomfort, using a behavioral intervention or psychotropic medications intervention to address the problematic behavior, would be ineffective and unethical.
In a research that took a sample of Medicaid enrolled individuals with autism, 56% used at least 1 psychotropic medication, 20% of whom were prescribed 3 medications concurrently.Neuroleptic medications were the most common psychotropicclass (31%), followed by antidepressants (25%) and stimulants(22%) (Mandell, et al. 2008); 11.5% anti-epileptic drugs and 12.5% antihypertensive drugs (e.g. alpha or beta blockers) (Aman, et al. 2004).
In summary, Applied Behavior Analysis and psychotropic medications (e.g. Risperdal, Haldol) are empirically validated treatments for reducing problem behaviors in individuals with autism. Additionally,