Tsakanikos, E., Costello, H., Holt, G., Sturmey, P., & Bouras, N. (2007).  Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism. JADD, 37, 1080-1085.

• increase in services to children and adults with autism
• mostly focused on early intervention and clinical outcomes (Billstedt, Gillberg, & Gillberg, 2005)
• less attention - would behavior problems predict intervention for adults with PDD?
• PDD w/ID - more likeley to have problem behavior
  • many with with PDD benefit from psychotropic medications (Dinca, Paul & Spencer, 2005)
  • don't know much about mental health services for adults with PDD and ID
    • more deinstitutionalization - need for more information on community living for individuals with PDD and ID (Hanson, Weisler, Lakin & Braddock, 2002)
• present study: Did a diagnosis of PDD influence the use of psychiatric services *medication, consultation and admission to hospital?
• participants and setting
  • 168 participants - assessed by psychiatric hospital in London
    • ID
    • behavior problems
    • PDD diagnosis - not confirmed by standardized instrument
  • exclusion - psychiatric disorder such as depresssion
    • Identified by clinical interview
  • PDD - based on clinical interview and ICD-10 criteria
  • PDD matched with controls with ID but no PDD
    • also not assessed beyond clinical interview
    • also a historical record review conducted
• data collection
  • specialized recording sheet at intake
    • age
    • gender
    • epilepsy - not at all assessed in this sample
    • degree of ID
    • PDD Dx
    • medication
      • antipsychotic
      • sedatives
      • anitconvulsants
      • PRN
      • combo
      • none
  • behavioral ratings
    • Disability Assessment Schedule - assessed the level of functioning
      • how often did staff need to intervene, upset others, or effect the social atmosphere
      • DAS-B
        • physical aggression
        • destruction
        • overactivity
        • pesters staff
        • SIB
        • elopement
        • screams
        • tantrums
        • disturbing others at night
        • objectionable habits (spitting, searing, vomiting, pica, swearing, hoarding, etc...)
        • throws objects
        • antisocial/delinquent behavior
        • sexual deliquency
        • other
      • completed by staff or family members - how long did they know the person before filling it out?
• data analysis
  • chi-square
  • binary logistic regression analysis for specific behavioral problems
• results
  • PSS - more likely to show
    • aggression
    • destruction
    • overactive behavior
    • SIB
    • pestering
    • elopement
    • tantrums
    • disturbing others
  • PDD - more likely to be on medication - psychtropic or antipsychotics
    • smaller amount took anticonvulsants
  • PDD - more likely to be involved in the psychiatric system
    • more likely to have an inpatient admission
  • is it a function of the PDD or the behavioral problem, though?
    • forward logistic regression perfomed
      • PDD Dx was only predictor of admission and psychiatric involvement
• discussion
  • PDD - more behavioral issues
  • more psychotropic medications
  • behavioral issues - predicted use of services and medication (JOD)
    • aggression
    • pestering staff - these two were most likely to be medicated
    • aggression and overactivity - involvement from psychiatry
  • PDD - more likely to have an inpatient addression
  • challenging behavior a risk factor for use of services
  • Medication - more pressure to prescribe?
    • externalizing behavior the reason?
  • possible that some risk factos were missed
  • communication problems might have been a factor?
  • behavioral interventions
    • function-based interventions might be the most effective
  • range of variables were limited
    • attitudes not addressed
    • services not addressed
    • not all types of intervention addressed