Historically, medications have been used to sedate individuals or control undesired behavior even when no mental illness had been diagnosed. Kalachnik and his colleagues (Kalachnik et al. 1991) cite a survey done by Lipman in 1967, which revealed that more than 50% of individuals with developmental disabilities in institutions were prescribed psychotropic medication, especially thioridazine (Mellaril) and chlorpromazine (Thora-zine). These authors allude to an order from a U.S. district court judge handed down in 1972 that stated:
Medication shall not be used as punishment, for the convenience of staff, as a substitute for a habilitative program, or in quantities that interfere with the resident's habilitation program. (p. 47)
To examine the efficacy of using antipsychotic medication to treat people with a dual diagnosis of intellectual disability and schizophrenia, Duggan and Brylewski (1999) reviewed the literature and found only one relevant randomized clinical trial (Foote, 1958). This study included four people with a dual diagnosis of schizophrenia and intellectual disability, but results were only available for two people. The reviewers found no evidence to guide the use of antipsychotic medication for those with both intellectual disability and schizophrenia. Until the urgent need for randomized controlled trials is met, clinical practice will continue to be guided by evidence from trials involving people with schizophrenia but without intellectual disability.
In 1980, in response to the overuse and misuse of psychotropic medications for people with developmental disabilities, the Accreditation Council for Services for Mentally Retarded and Other Developmentally Disabled Persons (ACMRDD) recommended the use of interdisciplinary teams for planning and oversight (Davis et al., 1998). These teams would include consumers, family members, and direct service staff, as well as physicians and other specialists. The team would do more than just monitor medication use. They would provide information to improve the data available for making a diagnosis, help to identify and access needed services, promote self-determination, encourage consumer choice, and aid in decision making.
Recognizing that services for people with developmental disabilities are moving from institutions to community settings, Davis and her colleagues (1998) articulated a list of attitudes, skills, and behaviors that should guide interdisciplinary teams. Among other things, these include (1) accessing adequate training on the needs of people with developmental disabilities as well as the use, abuse, and misuse of medications; (2) ensuring the inclusion of consumers and family members in decision making; and (3) focusing on community inclusion of consumers.
Stark, McGee, Menolascino, Baker, and Menousek (1984) attempted to describe quality services for people with this dual diagnosis. They identified seven necessary characteristics of effective alternatives to traditional services. These characteristics, described next, are consistent with many of the principles and values of PsyR. As you read these, see if you can identify which PsyR principles are related:
1. Comprehensive community programs: All learning should take place in real-life community-based situations.
2. Functional, individualized approach: Interventions focus on the individual in a specific environment developing the skills needed by the individual to be successful there.
3. Training rather than testing: Observing individuals in their environments helps to assess skills and deficits and informs the training process. Testing merely provides a description of the person's performance at that particular moment on tasks that often were designed for people with greater cognitive abilities.
4. Unconditional positive regard: The individual is given the respect, concern, courtesy, attention, and affection that would be afforded any human being. It also means that the person is not blamed for his or her disability or the resulting lack of experiences or skills.
5. Understanding behavior as communication: Behavior is a means of communication. This is particularly true for people with little or no ability in expressive language. Behavior therefore is viewed as such and rather than being punished is used to understand the person and inform services.
6. Ecological behaviorism: Behavior is seen as a complex interrelated system that is influenced by the environment rather than a simple example of stimulus-response.
7. Balanced approach: Both psychotropic medication and behavioral programming are useful tools to assist an individual to achieve independence.
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Although nobody gets a parenting manual or bible in the delivery room, it is our duty as parents to try to make our kids as well rounded, happy and confident as possible. It is a lot easier to bring up great kids than it is to try and fix problems caused by bad parenting, when our kids have become adults. Our children are all individuals - they are not our property but people in their own right.