- Concern about high dose
- Polypharmacy 
- Need for staff training/awareness
- Physical problem may be causing behavior
- CB is prescribed for mental problem, when it is actually physical
- PRN
  - Open to abuse
- Wanted clear guidance to insure appropriate use
- Side effects and their impact on QOL
- Need for Regular medication reviews
- Importance of Shared Decision making
- Involving the person and their family in medication decisions
- Difference in staff attitude
- A balanced approach is needed
- Weighing benefit vs harm


Support Staff's Opinions on the Causes of CB

 - Often the first people to ask the prescriber for medication for CB
- They may be overly optimistic about the effects that it will have on the individual
  - Can be anxious and obstructive at the prescriber’s attempts to withdraw the medication
- Proper training and education is important for psychotropic medications to be effective and successful

Cedarville University

CB are displayed by up to 60% of the adult IDD population. Example behaviors include physical aggression toward others including self (self-injurious) and property, and verbal aggression. 

CB may be difficult to manage as it can cause stress to the individual, their families, and those around them. It can also lead to restrictive practices as well as loss of community based placements. This can lead to hospitalization and a limited access to long term care facilities.


Challenging Behaviors (CB)

Deb, S., Limbu, B., Unwin, G. L., & Weaver, T. (2023). The Use of Medication for Challenging Behaviors in People with Intellectual Disabilities: The Direct Care Providers’ Perspective. Journal of Mental Health Research in Intellectual Disabilities, 16(3), 253-274. https://doi.org/10.1080/19315864.2023.2192691

The Use of Medication for Challenging Behaviors in People with Intellectual Disabilities: The Direct Care Providers’ Perspective

- There are national guidelines in place recommending the use of nonpharmacological interventions 
  - Behavioral support plans
  -  Cognitive behavioral therapy
  -  Anger management
  - Mindful-based meditation 
Done BEFORE the consideration of psychotropic medications. 


Recommended Nonpharmacological Treatments for Challenging behaviors

It is Multifactorial and Includes 
- Physical Pain
- Psychological
- Depression
- Psychological trauma
- Stress
- Social
- Environmental
- Inappropriate care environment 


Causes of CB

Role of Direct Support Staff and Challenging Behaviors

- Impacts both the child's and family's quality of life
- May lead to more expensive and restrictive care
- Rejection by peers and caretakers
- Decreased social interactions
- Reduced Access to educational services
- Exclusion from community settings
- Exposure to restraints 
- Potential to experience serious side effects of psychotropic medications

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