This blog is the fourth and final in four of 'Thursday's Theory' which addresses the relationship between Applied Behaviour Analysis and Psychiatry. With a rapidly increasing reliance on medication in the Global North (generally the western world), rapidly increasing mental health struggles, increasing crime, increasing behaviour problems, increase in developmental delays, autism, social struggles, anxiety, OCD, NVLD, language delay.... The list goes on.... Society has seen an increasing reliance on psychiatric services. This means that over the last few years behaviour analysts and psychiatrists have been working together more often.
The first week's Thursday's Theory discussed: Behaviour analysis and psychiatric services and Psychotropic medication; this was followed by the discussion of ABA and mental health, and what the research says.
This was followed by week three: ABA and psychopharmacology: conflict or complimentary and answering the question we are always asked, "is medication bad?".
This week we will answer how Behaviour Analysis can help and l list lots of research references for you.
So....What can behaviour analysts do to help?
It is important to remember that we all bring different things to the table, each of us having different vantage points whether we are a Parent, Doctor, Psychiatrist, Teacher or Behaviour Analyst. In reality, a doctor gets a snapshot of the behaviour or receives a point of view from a parent or other professional. As a behaviour analyst, we should be taking continual data and continual observations. This is why continuity in therapy or services is so very important. A doctor will therefore have to make a rapid decision and treatment choice based on this few minute time period. A rash, for example, can be assessed quickly but not so much aggression or depression. A behaviour analyst will, hopefully, be able to see behaviour (its presence or absence) in context and over a substantial period of time.
Your behaviour analyst should be able to provide information to other professionals and parents by:
- Clearly defining target behaviors
- Collecting data and graphing it
- Analysing (environmental) functions (vs endogenous causes)
- Educating team members about ABA.
In an ideal world we can help the psychiatrist, patient and his or her family by:
- Coordinating with the prescribing physician
- Identifying & clearly defining behaviours targeted by the medication
- Provide the physician with information
- Presenting Single subject design: graphs
- Change only 1 variable at a time. This is so important as, if you change more than one at a time, you will have no idea what is causing the change in behaviour.
Most psychiatrists are called upon due to a specific behaviour which isn't an appropriate behaviour to be seen in a child or teenager of that age, or due to the lack of a behaviour that is typically seen. Due to this, there are some things that we often do to help a psychiatrist determine the required medication and then to track improvement in behaviour is to:
- Track sleep patterns
- Provide activity level data
- Provide weight data
- Provide data regarding social isolation
Interestingly, Tsiouris et al(2003) found that core conventional symptoms of depression were strongly associated with each other, but challenging behaviuors were not associated with depression as had been previously thought (Sturmey et al 2010). The symptoms previously associated were aggression, anger, self-injurious behaviour.
We basically just need to let the data do the talking.... Measuring observable data and having clients measure internal behaviour (eg thoughts and feelings) and then then us graphing it is so powerful and is 100% truthful.
Behaviour Analysts are also used to help report side effects. Research shows that if people know what the side effects are, they are more likely to report them. This is important with secondary effects as well as side effects. Knowing side and secondary effects allow us to observe and take frequency and intensity data on these for the Psychiatrists. This prevents new medications being layered on top of old, as opposed to replacing a former medication, which is a common problem. Obviously not every individual will experience adverse side effects!
Examples of side effects are:
- Anticholinergic effects , which means you will get very dry and thirsty (this is a side effect of antihistamine) - -
- Akathesia, which is the feeling that you have to move. Ironically drugs are often prescribed for people who have behavioural and hyperactive disorders. In some cases doses keep increasing to reduce the behaviour, however the increased akathesia is actually a side effect!
- Tardive Dyskinesia which is Tics, Rolling tongue, abnormal movement; Increased risk over time
- Neuroleptic Malignant Syndrome which looks like Flu; Fever with Rigidity; Possibly fatal
- Weight Gain. This is especially important to know when treating eating disorders.
- Heart problems
Secondary effects are those that effect behaviours other than the target behaviour, eg. Attention span and changes in the value of specific stimuli as evocative or consequating variables, ie the way that the person interacts with the world. For example, in some situations medication is prescribed to reduce head banging behaviour it actually increases it. This is because in some situations the function is self stimulation, ie the individual likes the feeling for some reason or another. So inhibiting the neurotransmitters/neurones/pain receptors dulls the sensation thus leading to an increase in the behaviour.
Zarcone (2008) says that "the Individual will benefit most when the members of a collaborative or inter-disciplinary team combine their expertise and consider all the possible interventions and outcomes". It is important for us to remember this. The behaviour analyst is the team member who is best prepared to demonstrate a direct link between the behavior and the environment. This will reduce the likelihood that psychotropic medications will be incorrectly used to address operant processes.
Those are just some more thoughts on psychiatry and ABA. I would love to hear your feedback.
Below is a long list of references for you. Happy reading!
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The majority of this information has come directly from the CEUS presented through Florida Institute of Technology by Tom Freeman or has been inspired by him. The references were all collated and guided by him. We are so grateful for his work in this area and love learning from him.