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Gepubliceerd in: Journal of Child and Family Studies 4/2014

01-05-2014 | Original Paper

Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Auteurs: Jonathan C. Huefner, Annette K. Griffith, Gail L. Smith, Dennis G. Vollmer, Laurel K. Leslie

Gepubliceerd in: Journal of Child and Family Studies | Uitgave 4/2014

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Abstract

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.
Literatuur
go back to reference Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? Child Abuse and Neglect, 30, 409–424. PubMedCrossRef Chamberlain, P., Price, J. M., Reid, J. B., Landsverk, J., Fisher, P. A., & Stoolmiller, M. (2006). Who disrupts from placement in foster and kinship care? Child Abuse and Neglect, 30, 409–424. PubMedCrossRef
go back to reference Chamberlain, P., & Reid, J. B. (1987). Parent observation and report of child symptoms. Behavioral Assessment, 9, 97–109. Chamberlain, P., & Reid, J. B. (1987). Parent observation and report of child symptoms. Behavioral Assessment, 9, 97–109.
go back to reference Chouinard, G. (2004). New nomenclature for drug-induced movement disorders including tardive dyskinesia. Journal of Clinical Psychiatry, 65, 9–15. PubMed Chouinard, G. (2004). New nomenclature for drug-induced movement disorders including tardive dyskinesia. Journal of Clinical Psychiatry, 65, 9–15. PubMed
go back to reference Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
go back to reference Connor, D. F., Ozbayrak, K. R., Harrison, R. J., & Melloni, R. H. J. (1998). Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology, 8, 27–38. doi: 10.​1016/​S0031-9384(96)00373-3. PubMedCrossRef Connor, D. F., Ozbayrak, K. R., Harrison, R. J., & Melloni, R. H. J. (1998). Prevalence and patterns of psychotropic and anticonvulsant medication use in children and adolescents referred to residential treatment. Journal of Child and Adolescent Psychopharmacology, 8, 27–38. doi: 10.​1016/​S0031-9384(96)00373-3. PubMedCrossRef
go back to reference Connor, D. F., Ozbayrak, K. R., Kusiak, K. A., Caponi, A. B., & Melloni, R. H. (1997). Combined pharmacotherapy in children and adolescents in a residential treatment center. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 248–254. doi: 10.​1097/​00004583-199702000-00016. PubMedCrossRef Connor, D. F., Ozbayrak, K. R., Kusiak, K. A., Caponi, A. B., & Melloni, R. H. (1997). Combined pharmacotherapy in children and adolescents in a residential treatment center. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 248–254. doi: 10.​1097/​00004583-199702000-00016. PubMedCrossRef
go back to reference Criste, T. R. (1989). Needs analysis at Western New York Children’s Psychiatric Center (Internal report). Boys Town, NE: Father Flanagan’s Boys’ Home. Criste, T. R. (1989). Needs analysis at Western New York Children’s Psychiatric Center (Internal report). Boys Town, NE: Father Flanagan’s Boys’ Home.
go back to reference Daly, D. L., Schmidt, M. D., Spellman, D. F., Criste, T. R., Dinges, K., & Teare, J. F. (1998). The Boys Town Residential Treatment Center: Treatment implementation and preliminary outcomes. Child & Youth Care Forum, 27, 267–279. Daly, D. L., Schmidt, M. D., Spellman, D. F., Criste, T. R., Dinges, K., & Teare, J. F. (1998). The Boys Town Residential Treatment Center: Treatment implementation and preliminary outcomes. Child & Youth Care Forum, 27, 267–279.
go back to reference dosReis, S., Zito, J. M., Safer, D. J., Gardner, J. F., Puccia, K. B., & Owens, P. L. (2005). Multiple psychotropic medication use for youths: A two-state comparison. Journal of Child and Adolescent Psychopharmacology, 15, 68–77. PubMedCrossRef dosReis, S., Zito, J. M., Safer, D. J., Gardner, J. F., Puccia, K. B., & Owens, P. L. (2005). Multiple psychotropic medication use for youths: A two-state comparison. Journal of Child and Adolescent Psychopharmacology, 15, 68–77. PubMedCrossRef
go back to reference Duffy, F. F., Narrow, W. E., Rae, D. S., West, J. C., Zarin, D. A., Rubio-Stipec, M., et al. (2005). Concomitant pharmacotherapy among youths treated in routine psychiatric practice. Journal of Child and Adolescent Psychopharmacology, 15, 12–25. doi: 10.​1089/​cap.​2005.​15.​12. PubMedCrossRef Duffy, F. F., Narrow, W. E., Rae, D. S., West, J. C., Zarin, D. A., Rubio-Stipec, M., et al. (2005). Concomitant pharmacotherapy among youths treated in routine psychiatric practice. Journal of Child and Adolescent Psychopharmacology, 15, 12–25. doi: 10.​1089/​cap.​2005.​15.​12. PubMedCrossRef
go back to reference Foltz, R. (2006). The mistreatment of mood disorders in youth. Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry, 8, 147–155. CrossRef Foltz, R. (2006). The mistreatment of mood disorders in youth. Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry, 8, 147–155. CrossRef
go back to reference Fontanella, C. A., Bridge, J. A., & Campo, J. V. (2009). Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. The Annals of Pharmacotherapy, 43, 1939–1947. doi: 10.​1345/​aph.​1M326. PubMedCrossRef Fontanella, C. A., Bridge, J. A., & Campo, J. V. (2009). Psychotropic medication changes, polypharmacy, and the risk of early readmission in suicidal adolescent inpatients. The Annals of Pharmacotherapy, 43, 1939–1947. doi: 10.​1345/​aph.​1M326. PubMedCrossRef
go back to reference Foxx, R. M. (1998). A comprehensive treatment program for inpatient adolescents. Behavioral Interventions, 13, 67–77. CrossRef Foxx, R. M. (1998). A comprehensive treatment program for inpatient adolescents. Behavioral Interventions, 13, 67–77. CrossRef
go back to reference Griffith, A. K., Huscroft-D’Angelo, J., Epstein, M. H., Singh, N. N., Huefner, J. C., & Pick, R. (2010). Psychotropic medication use for youth in residential treatment: A comparison between youth with monopharmacy versus polypharmacy. Journal of Child and Family Studies, 19, 795–802. doi: 10.​1007/​s10826-010-9372-9. CrossRef Griffith, A. K., Huscroft-D’Angelo, J., Epstein, M. H., Singh, N. N., Huefner, J. C., & Pick, R. (2010). Psychotropic medication use for youth in residential treatment: A comparison between youth with monopharmacy versus polypharmacy. Journal of Child and Family Studies, 19, 795–802. doi: 10.​1007/​s10826-010-9372-9. CrossRef
go back to reference Griffith, A. K., Ingram, S. D., Barth, R. P., Trout, A. L., Duppong Hurley, K., Thompson, R. W., et al. (2009). The family characteristics of youth entering a residential care program. Residential Treatment for Children & Youth, 26, 135–150. doi: 10.​1080/​0886571090291428​3. CrossRef Griffith, A. K., Ingram, S. D., Barth, R. P., Trout, A. L., Duppong Hurley, K., Thompson, R. W., et al. (2009). The family characteristics of youth entering a residential care program. Residential Treatment for Children & Youth, 26, 135–150. doi: 10.​1080/​0886571090291428​3. CrossRef
go back to reference Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2002). Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder. Pediatrics, 109, 733–739. PubMedCrossRef Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2002). Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder. Pediatrics, 109, 733–739. PubMedCrossRef
go back to reference Kubiszyn, T. (2005). Introduction to the special issue: The Division 16 Task Force on Psychopharmacology, Learning and Behavior. School Psychology Quarterly, 20, 115–117. CrossRef Kubiszyn, T. (2005). Introduction to the special issue: The Division 16 Task Force on Psychopharmacology, Learning and Behavior. School Psychology Quarterly, 20, 115–117. CrossRef
go back to reference Larzelere, R. E., Chmelka, M. B., Schmidt, M. D., & Jones, M. (2002). The Treatment Progress Checklist: Psychometric development of a daily symptom checklist. In C. Newman, C. J. Liberton, K. Kutash, & R. M. Friedman (Eds.), Proceedings of the 14th Annual Florida Mental Health Institute Conference (pp. 359–362). Tampa, FL: University of South Florida. Larzelere, R. E., Chmelka, M. B., Schmidt, M. D., & Jones, M. (2002). The Treatment Progress Checklist: Psychometric development of a daily symptom checklist. In C. Newman, C. J. Liberton, K. Kutash, & R. M. Friedman (Eds.), Proceedings of the 14th Annual Florida Mental Health Institute Conference (pp. 359–362). Tampa, FL: University of South Florida.
go back to reference LeFever, G. B., Arcona, A. P., & Antonuccio, D. O. (2003). ADHD among American schoolchildren evidence of overdiagnosis and overuse of medication. The Scientific Review of Mental Health Practice, 2, 49–60. LeFever, G. B., Arcona, A. P., & Antonuccio, D. O. (2003). ADHD among American schoolchildren evidence of overdiagnosis and overuse of medication. The Scientific Review of Mental Health Practice, 2, 49–60.
go back to reference Lekhwani, M., Nair, C., Nikhinson, I., & Ambrosini, P. J. (2004). Psychotropic prescription practices in child psychiatric inpatients 9 years old and younger. Journal of Child and Adolescent Psychopharmacology, 14, 95–103. PubMedCrossRef Lekhwani, M., Nair, C., Nikhinson, I., & Ambrosini, P. J. (2004). Psychotropic prescription practices in child psychiatric inpatients 9 years old and younger. Journal of Child and Adolescent Psychopharmacology, 14, 95–103. PubMedCrossRef
go back to reference Leo, J. (2006). The truth about academic medicine: Children on psychotropic drugs and the illusion of science. In S. Timimi & B. Maitra (Eds.), Critical voices in child and adolescent mental health (pp. 107–127). London: Free Association Books. Leo, J. (2006). The truth about academic medicine: Children on psychotropic drugs and the illusion of science. In S. Timimi & B. Maitra (Eds.), Critical voices in child and adolescent mental health (pp. 107–127). London: Free Association Books.
go back to reference Lerer, B. (2002). Pharmacogenetics of psychotropic drugs. Cambridge, UK: Cambridge University Press. CrossRef Lerer, B. (2002). Pharmacogenetics of psychotropic drugs. Cambridge, UK: Cambridge University Press. CrossRef
go back to reference Najjar, F., Welch, C., Grapentine, W. L., Sachs, H., Siniscalchi, J., & Price, L. H. (2004). Trends in psychotropic drug use in a child psychiatric hospital from 1991–1998. Journal of Child and Adolescent Psychopharmacology, 14, 87–93. doi: 10.​1089/​1044546047738405​26. PubMedCrossRef Najjar, F., Welch, C., Grapentine, W. L., Sachs, H., Siniscalchi, J., & Price, L. H. (2004). Trends in psychotropic drug use in a child psychiatric hospital from 1991–1998. Journal of Child and Adolescent Psychopharmacology, 14, 87–93. doi: 10.​1089/​1044546047738405​26. PubMedCrossRef
go back to reference Pappadopulos, E., MacIntyre, J. C., Crismon, M. L., Findling, R. L., Malone, R. P., Derivan, A., et al. (2003). Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 145–161. doi: 10.​1097/​00004583-200302000-00008. PubMedCrossRef Pappadopulos, E., MacIntyre, J. C., Crismon, M. L., Findling, R. L., Malone, R. P., Derivan, A., et al. (2003). Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY). Part II. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 145–161. doi: 10.​1097/​00004583-200302000-00008. PubMedCrossRef
go back to reference Pappadopulos, E., Woolston, S., Chait, A., Perkins, M., Connor, D. F., & Jensen, P. S. (2006). Pharmacotherapy of aggression in children and adolescents: Efficacy and effect size. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15, 27–39. PubMedCentralPubMed Pappadopulos, E., Woolston, S., Chait, A., Perkins, M., Connor, D. F., & Jensen, P. S. (2006). Pharmacotherapy of aggression in children and adolescents: Efficacy and effect size. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15, 27–39. PubMedCentralPubMed
go back to reference Pathak, S., Arszman, S. P., Danielyan, A., Johns, E. S., Smirnov, A., & Kowatch, R. A. (2004). Psychotropic utilization and psychiatric presentation of hospitalized very young children. Journal of Child and Adolescent Psychopharmacology, 14, 433–442. doi: 10.​1089/​cap.​2004.​14.​433. PubMedCrossRef Pathak, S., Arszman, S. P., Danielyan, A., Johns, E. S., Smirnov, A., & Kowatch, R. A. (2004). Psychotropic utilization and psychiatric presentation of hospitalized very young children. Journal of Child and Adolescent Psychopharmacology, 14, 433–442. doi: 10.​1089/​cap.​2004.​14.​433. PubMedCrossRef
go back to reference Pavkov, T. W., & Walrath, C. M. (2008). Clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance. Journal of Child and Family Studies, 17, 839–852. doi: 10.​1007/​s10826-008-9193-2. CrossRef Pavkov, T. W., & Walrath, C. M. (2008). Clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance. Journal of Child and Family Studies, 17, 839–852. doi: 10.​1007/​s10826-008-9193-2. CrossRef
go back to reference Pogge, D. L., Young, K., Insalaco, B., & Harvey, P. D. (2007). Use of atypical antipsychotic medications in adolescent psychiatric inpatients: A comparison with inpatients who did not receive antipsychotic medications during their stay. International Journal of Clinical Practice, 61, 896–902. doi: 10.​1111/​j.​1742-1241.​2007.​01379.​x. PubMedCrossRef Pogge, D. L., Young, K., Insalaco, B., & Harvey, P. D. (2007). Use of atypical antipsychotic medications in adolescent psychiatric inpatients: A comparison with inpatients who did not receive antipsychotic medications during their stay. International Journal of Clinical Practice, 61, 896–902. doi: 10.​1111/​j.​1742-1241.​2007.​01379.​x. PubMedCrossRef
go back to reference Pottick, K. J., Warner, L. A., & Yoder, K. A. (2005). Youths living away from families in the US mental health system: Opportunities for targeted intervention. Journal of Behavioral Health Services & Research, 32, 264–281. doi: 10.​1007/​BF02291827. CrossRef Pottick, K. J., Warner, L. A., & Yoder, K. A. (2005). Youths living away from families in the US mental health system: Opportunities for targeted intervention. Journal of Behavioral Health Services & Research, 32, 264–281. doi: 10.​1007/​BF02291827. CrossRef
go back to reference Prinz, R. (2009). Dissemination of a multilevel evidence-based system of parenting interventions with broad application to child welfare populations. Child Welfare: Journal of Policy, Practice, and Program, 88, 127–132. Prinz, R. (2009). Dissemination of a multilevel evidence-based system of parenting interventions with broad application to child welfare populations. Child Welfare: Journal of Policy, Practice, and Program, 88, 127–132.
go back to reference Rawal, P. H., Lyons, J. S., MacIntyre, J. C., I. I., & Hunter, J. C. (2004). Regional variation and clinical indicators of antipsychotic use in residential treatment: A four-state comparison. Journal of Behavioral Health Services & Research, 31, 178–188. Rawal, P. H., Lyons, J. S., MacIntyre, J. C., I. I., & Hunter, J. C. (2004). Regional variation and clinical indicators of antipsychotic use in residential treatment: A four-state comparison. Journal of Behavioral Health Services & Research, 31, 178–188.
go back to reference Schachter, H. M., Pham, B., King, J., Langford, S., & Moher, D. (2001). How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. Canadian Medical Association Journal, 165, 1475–1488. PubMedCentralPubMed Schachter, H. M., Pham, B., King, J., Langford, S., & Moher, D. (2001). How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. Canadian Medical Association Journal, 165, 1475–1488. PubMedCentralPubMed
go back to reference Singh, N. N., Landrum, T. J., Donatelli, L. S., & Hampton, C. (1994). Characteristics of children and adolescents with serious emotional disturbance in systems of care: I. Partial hospitalization and inpatient psychiatric services. Journal of Emotional and Behavioral Disorders, 2, 13–20. CrossRef Singh, N. N., Landrum, T. J., Donatelli, L. S., & Hampton, C. (1994). Characteristics of children and adolescents with serious emotional disturbance in systems of care: I. Partial hospitalization and inpatient psychiatric services. Journal of Emotional and Behavioral Disorders, 2, 13–20. CrossRef
go back to reference Spellman, D. F., Griffith, A. K., Huefner, J. C., Wise, N., III, McElderry, E., & Leslie, L. K. (2010). Psychotropic medication management in a residential group care program. Child Welfare, 89, 151–167. PubMed Spellman, D. F., Griffith, A. K., Huefner, J. C., Wise, N., III, McElderry, E., & Leslie, L. K. (2010). Psychotropic medication management in a residential group care program. Child Welfare, 89, 151–167. PubMed
go back to reference Swanson, J., Arnold, L. E., Kraemer, H., Hechtman, L., Molina, B., Hinshaw, S., et al. (2008). Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment study of children with ADHD (MTA): Part I: Executive summary. Journal of Attention Disorders, 12, 4–14. doi: 10.​1177/​1087054708319345​. PubMedCrossRef Swanson, J., Arnold, L. E., Kraemer, H., Hechtman, L., Molina, B., Hinshaw, S., et al. (2008). Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment study of children with ADHD (MTA): Part I: Executive summary. Journal of Attention Disorders, 12, 4–14. doi: 10.​1177/​1087054708319345​. PubMedCrossRef
go back to reference Timimi, S., & Maitra, B. (2006). New directions. In S. Timimi & B. Maitra (Eds.), Critical voices in child and adolescent mental health (pp. 222–228). London: Free Association Books. Timimi, S., & Maitra, B. (2006). New directions. In S. Timimi & B. Maitra (Eds.), Critical voices in child and adolescent mental health (pp. 222–228). London: Free Association Books.
go back to reference Trout, A. L., Hagaman, J., Casey, K., Reid, R., & Epstein, M. H. (2008). The academic status of children and youth in out-of-home care: A review of the literature. Children and Youth Services Review, 30, 979–994. CrossRef Trout, A. L., Hagaman, J., Casey, K., Reid, R., & Epstein, M. H. (2008). The academic status of children and youth in out-of-home care: A review of the literature. Children and Youth Services Review, 30, 979–994. CrossRef
go back to reference Van Bellinghen, M., & De Troch, C. (2001). Risperidone in the treatment of behavioral disturbances in children and adolescents with borderline intellectual functioning: A double-blind, placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 11, 5–13. doi: 10.​1089/​1044546017501433​48. PubMedCrossRef Van Bellinghen, M., & De Troch, C. (2001). Risperidone in the treatment of behavioral disturbances in children and adolescents with borderline intellectual functioning: A double-blind, placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 11, 5–13. doi: 10.​1089/​1044546017501433​48. PubMedCrossRef
go back to reference Zakriski, A. L., Wheeler, E., Burda, J., & Shields, A. (2005). Justifiable psychopharmacology or overzealous prescription? Examining parental reports of lifetime prescription histories of psychiatrically hospitalised children. Child and Adolescent Mental Health, 10, 16–22. doi: 10.​1111/​j.​1475-3588.​2005.​00111.​x. CrossRef Zakriski, A. L., Wheeler, E., Burda, J., & Shields, A. (2005). Justifiable psychopharmacology or overzealous prescription? Examining parental reports of lifetime prescription histories of psychiatrically hospitalised children. Child and Adolescent Mental Health, 10, 16–22. doi: 10.​1111/​j.​1475-3588.​2005.​00111.​x. CrossRef
go back to reference Zito, J. M., Safer, D. J., Zuckerman, I. H., Gardner, J. F., & Soeken, K. (2005). Effect of medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services, 56, 157–163. PubMedCrossRef Zito, J. M., Safer, D. J., Zuckerman, I. H., Gardner, J. F., & Soeken, K. (2005). Effect of medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services, 56, 157–163. PubMedCrossRef
Metagegevens
Titel
Reducing Psychotropic Medications in an Intensive Residential Treatment Center
Auteurs
Jonathan C. Huefner
Annette K. Griffith
Gail L. Smith
Dennis G. Vollmer
Laurel K. Leslie
Publicatiedatum
01-05-2014
Uitgeverij
Springer US
Gepubliceerd in
Journal of Child and Family Studies / Uitgave 4/2014
Print ISSN: 1062-1024
Elektronisch ISSN: 1573-2843
DOI
https://doi.org/10.1007/s10826-012-9628-7

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