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Collaboration of Care: Medication Management

Importance Of Medication Management

Given the number of individuals with autism who are also treated with psychiatric medication, collaboration of care with primary care physicians, psychiatrists, or other medical and/or behavioral health specialists is essential for the best treatment outcomes for a member. There are no FDA approved medications that target the core symptoms of ASD itself. However, co-occurring psychiatric disorders are common, affecting up to 70% of children with ASD (anxiety, ADHD, ODD most commonly). Medication is frequently prescribed to target non-core symptoms of ASD, such as irritability, aggression, hyperactivity, and anxiety. Behavior Analysts with their specialized expertise are an integral member of a multi-disciplinary treatment team. Coordinated efforts regarding medication management are important to:

  • Maximize therapeutic outcomes
  • Identify opportunities for titration of medications and reduction of dosage
  • Review for opportunities of non-pharmacological, psychosocial treatments
  • Assess for side effects and co-occurring medical complications
  • Encourage collaboration that can positively influence the treatment plan

A Behavior Analyst’s Role

  •  Provide data on the effects of behavioral treatments on a member’s skill acquisition and/or behavior reduction prior to the introduction of medication.
  • Share baseline data on any challenging behaviors that may be a barrier to learning in treatment.
  • Share both qualitative and quantitative data with medical providers related to a member’s behavior. This valuable information supports the evaluation of the efficacy of a medication and provides opportunities for shaping treatment with medication.
  • Observe side effects of medication and partner with members, parents, and/or caregivers to communicate concerns to medical providers.

Benefits Of Medication Management Collaboration

  • Develop a better understanding of the intent/purpose and desired results for the treatment with medication.
  • Ensure metabolic labs and assessments occur for members on antipsychotics to enable early identification for potential comorbidities.
  • Enable members to be more receptive to behavioral interventions, thereby improving the effectiveness of treatment with ABA.
  • Improve treatment outcomes that can be achieved through integrated, collaborative care that relies on the expertise found in each discipline.

References: Lamy, M., Pedapati, E.V., Dominick, K.L. et al. Recent Advances in the Pharmacological Management of Behavioral Disturbances Associated with Autism Spectrum Disorder in Children and Adolescents. Pediatr Drugs 22, 473–483 (2020); Fallah, Merrick S et al. “Atypical Antipsychotics for Irritability in Pediatric Autism: A Systematic Review and Network Meta-Analysis.” Journal of child and adolescent psychopharmacology vol. 29,3 (2019): 168-180; Li, A., Poling, A. Board Certified Behavior Analysts and Psychotropic Medications: Slipshod Training, Inconsistent Involvement, and Reason for Hope. Behav Analysis Practice 11, 350–357 (2018).