Evaluation of pharmacologic treatment of destructive behaviors: Aggregated results from single-case experimental studies

In this investigation, 20 clients with mental retardation and destructive behavior disorders were treated with psychotropic medication based on symptoms associated with a psychiatric disorder. For each patient, single-case design and direct observation procedures were utilized to evaluate outcome. Three clients (15%) showed at least a 50% reduction in destructive behavior; seven (35%) experienced a 50% or greater increase in destructive behavior; 10 (50%) experienced no change in their destructive behavior. The best response was to stimulant medications prescribed on the basis of pervasive hyperactivity and distractibility. The worst response was to lithium prescribed on the basis of manic-like symptoms (e.g., psychomotor agitation) or cyclical behavior disturbance. The low response rate was hypothesized to be a function of the unique underlying brain dysfunction in severely to profoundly retarded individuals with destructive behavior disorders, and the difficulties with applying psychiatric diagnoses in the population. Given the individual variability of response among clients and the prevalence of behavior dysfunction of the population, single-case methodology may have a useful role in the assessment of psychopharmacotherapy with individuals with severe to profound mental retardation and destructive behavior disorders.