Behavioral monitoring of pharmacological interventions for self-injury

Pharmacological interventions are often the treatment of choice for controlling the maladaptive behavior of institutionalized mentally retarded children. However, the efficacy of various psychotropic drugs for controlling the behavior of given individuals has not been well established. Further, it is not always clear that decisions to alter a drug regimen are based on actual changes in the behavior of interest. The present study illustrates the use of behavioral observation to assess the effects of various drugs prescribed for the self-injurious behavior of a profoundly mentally retarded 15 year old male. The clinical effectiveness of various dosages of carbamazepine (Tegretol), thioridazine (Melleril), and chlorpromazine (Largactil) was assessed. Except for Melleril 100 mg, tid, when a marked downward trend in the daily rate was observed, no significant reduction in self-injury occurred. Subsequently overcorrection (forced arm exercise) made contingent on each response reduced self-injury to near zero, but only when the last prescribed drug, Tegretol 200 mg, tid, had been withdrawn for several days.