Separate and Combined Effects of Methylphenidate and a Behavioral Intervention on Disruptive Behavior in Children With Mental Retardation

Abstract

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.

Interactions between behavior function and psychotropic medication

“…Studies that have examined the relative effectiveness of combined (pharmacological and behavioral) versus unimodal pharmacological interventions have produced mixed results (Blum, Mauk, McComas, & Mace, 1996;Fisher, Piazza, & Page, 1989;Frazier et al, 2010;Northup et al, 1999;Pelham et al, 1993Pelham et al, , 2000; Rodrigues, Thompson, Schlichenmeyer, & Stocco, 2012). Mace, Blum, Sierp, Delaney, and Mauk (2001) compared the effect of haloperidol on SIB to a combined intervention of function-based behavioral treatment and haloperidol in individuals with IDD.…”

Drug-behavior interactions in persons with mental retardation and developmental disabilities

“…According to Kazdin [1982], variables important to examine to decrease threats to external validity include replication across participants, time, measures, settings, environments, and assessments. For example, Blum et al [1996], Johnson et al [1994], and Schell et al [1986] all examined the effects of methylphenidate in persons with developmental disabilities. Although not exact replications, there was some overlap in the methodology and behavioral interventions.…”

“…Two of the eight articles [Blum et al, 1996;Johnson et al, 1994] met five of the six criteria. Blum et al [1996] studied the separate and combined effects of methylphenidate (Ritalin) and a behavioral intervention in three children with mental retardation who displayed aggressive and disruptive behavior.…”

“…Blum et al [1996] studied the separate and combined effects of methylphenidate (Ritalin) and a behavioral intervention in three children with mental retardation who displayed aggressive and disruptive behavior. Using an alternating-treatments design embedded within each phase of a double-blind, placebo-controlled medication intervention, the authors measured the percentage of time engaged in disruptive behavior as well as the percentage of time the participants were engaged in a task.…”

“…Blum et al [1996], for example, provided an effective evaluation of medication and behavioral interventions alone and in combination using an alternating-treatment design. This design can be effective when the medication is short acting (e.g., methylphenidate) and conditions can be quickly manipulated.…”