Integrating behavioral and pharmacological interventions in treating clients with psychiatric disorders and mental retardation.

While the literature on treatment of dually diagnosed individuals continues to grow, few studies have examined the potential interactions between behavioral interventions and pharmacological interventions in treating persons with a developmental disability and a concurrent psychiatric disorder. The current theoretical paper discusses different manners in which psychotropic medications and behavioral interventions can interact, including the potential for facilitative or inhibitory effects of one treatment modality on the other. Possible permutations of these interactions are discussed. Case examples, including objective measures of psychiatric and behavioral symptoms over time, representing possible illustrations of these permutations, are presented. The authors argue that in many cases the potential effect of one treatment procedure on the efficacy of another may be an important consideration in treating dually diagnosed individuals.

Empirically derived subtypes of pervasive developmental disorders: a cluster analytic study.

A cluster analytic study was conducted to empirically derive behaviorally homogeneous subtypes of pervasive developmental disorders (PDD). Subjects were clustered based on a broad range of behavioral symptoms which characterize autism. Behavioral variables were measured using several of the standardized psychometric instruments most commonly employed in assessing autistic individuals. The cluster solution indicated the presence of four distinct groups. Validity checks generally confirmed significant between-group differences on independent measures of social, language, and stereotyped behaviors. In addition, the four-group cluster solution was compared to previously developed typological systems of PDD (i.e., subcategories based on IQ early onset, styles of social interaction, and DSM-III-R diagnosis). Results generally supported both the behavioral homogeneity of the four subgroups and also several important between-group differences. The potential utility of using cluster analyses to explore subtypes of PDD is discussed.

The Behavior Problem Inventory: a further replication of its factor structure.

The Behavior Problem Inventory was administered to a random sample of people living in a state school. The scores from all items and from self-injury items only were factor analysed. The three scales of the Behavior Problem Inventory were highly internally consistent. Factor analysis of all the items showed some similarities to previous studies, and factor analysis of the self-injury items showed a very close correspondence to two previous studies. The results are discussed in terms of the design of this instrument, the possible multi-factorial nature of self-injury and future research on the design of measures of assessments of maladaptive behaviours in people with developmental disabilities.

Theories of dual diagnosis in mental retardation.

Dual diagnosis, defined in this instance as the co-occurrence of mental health disorders with mental retardation, has become a major area of clinical practice and research in the past 10 years. Whereas areas such as differential diagnosis, assessment, and prevalence have been major focuses of research, etiologies of dual diagnosis have received less attention. Current etiological theories have practical implications for the treatment and prevention of dual diagnoses and suggest important directions for future research. This article provides a historical review of theory development in the field of dual diagnosis. Current status of etiological theories and future directions are discussed with an aim toward encouraging further study.

Efficacy and specificity of pharmacological therapies for behavioral disorders in persons with mental retardation.

This review assesses the efficacy and specificity of psychotropic medications used to control aberrant behavior in persons with mental retardation. It is concluded that neuroleptics, the most widely used psychotropic agents in this population, suppress aberrant behavior, but do so by suppressing behavior generally. An exception to this conclusion is that it may be possible to selectively suppress stereotyped behavior with neuroleptics. In addition, the empirical evidence indicates that, in some persons with mental retardation, opioid antagonists and methylphenidate are useful therapies for self-injurious behavior and hyperactivity, respectively. Lithium and beta-blockers are potentially useful for treating aggression.

An evaluation of two methods for increasing self-initiated verbalizations in autistic children.

Three children with autism and mental retardation were treated for deficits in self-initiated speech. A novel treatment package employing visual cue fading was compared with a graduated time-delay procedure previously shown to be effective for increasing self-initiated language. Both treatments included training multiple self-initiated verbalizations using multiple therapists and settings. Both treatments were effective, with no differences in measures of acquisition of target phrases, maintenance of behavioral gains, acquisition with additional therapists and settings, and social validity.

A comparison and evaluation of three commonly used autism scales.

Reliability and validity of three commonly used autism scales, the Autism Behavior Checklist (Krug, Arick, & Almond, 1980), the Real Life Rating Scale (Freeman, Ritvo, Yokota, & Ritvo, 1986), and the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1988), were investigated. Data analyses were based on completed protocols for 24 children or adolescents who met DSM-III-R criteria for pervasive developmental disorders. First, to replicate previous findings, interrater reliability of each of the two direct observational scales was assessed. Second, correlations between pairs of the three scales were calculated. Third, diagnostic classifications based on autism scale cutoff scores were compared to classifications based on DSM-III-R criteria. Fourth, relationships between autism scale scores and adaptive behavior scores were investigated. Results and implications for the use of these scales in the assessment of autistic behaviors are discussed.

Comparison and item analysis of the MESSY for autistic and normal children.

Seventeen autistic children were matched for age, race, and sex with 17 nonautistic children, and group differences in social skills were assessed. Appropriate social skills and levels of inappropriate assertiveness/impulsiveness were assessed and evaluated using the Matson Evaluation of Social Skills with Youngsters (MESSY). Significant differences in both the appropriate and inappropriate social behaviors displayed by the two groups were found. The implications of these results are discussed.

Pharmacologic control of aberrant behavior in the mentally retarded: toward a more rational approach.

Drugs are frequently used to control aberrant behavior in the mentally retarded. However, despite decades of research, this approach to behavioral management has had very limited success. Slow progress in this area can be attributed, in part, to the lack of a theoretical framework to guide research. The main purpose of this review is to integrate clinical research in this area with evidence concerning the neurochemical mechanisms that mediate aberrant behaviors. It is concluded that a theoretical framework that takes into account the biological mechanisms that underlie disordered behavior and the actions of drugs provides the basis for a more rational approach to the development of pharmacological therapies in the mentally retarded.

Teaching self-help skills to autistic and mentally retarded children.

Three autistic, mentally retarded children, ranging in age from 4 to 11 years, and a six-year-old mentally retarded girl, were taught various adaptive behaviors using a multiple baseline design. Skills taught were shoe typing, toothbrushing, hair combing, putting on pants, shirt, and socks, and eating and drinking. Training included modeling, verbal instructions, prompting, and edible and social reinforcement. Treatment procedures involved the whole-task method of teaching self-help skills and consisted of three phases: (a) the trainer modeled and verbally described the target behavior; (b) the trainer physically and verbally guided the child through the entire sequence of task-analyzed steps; and, (c) the child was instructed to perform the behavior independently. The results of this study and their implications for future research are discussed.

Increasing spontaneous language in three autistic children.

A time delay procedure was used to increase spontaneous verbalizations of 3 autistic children. Multiple baseline across behaviors designs were used with target responses, selected via a social validation procedure, of two spontaneous responses ("please" and "thank you") and one verbally prompted response ("you're welcome"). The results indicate gains across target behaviors for all children, with occurrence across other stimuli and settings. These gains were validated socially with 10 adults. Furthermore, increases in appropriate language had no effect on levels of inappropriate speech.