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APPENDIX 1
EXAMPLES OF PSYCHOTROPIC MEDICATION AS OF 1988*
*This list is not necessarily complete, and the field is constantly changing. New medications conditions may be shown to have psychotropic properties, and listed psychotropics may be withdrawn from the market or be shown to be ineffective. Some medications may be useful in several of the categories listed. In addition, Also referred to as major tranquilizersor neuroleptics.
Also referred to as minor tranquilizersor anxiolytics.
These medications typically have otheruses; e.g., carbamazepine for seizures.
*Usage adult prescribing limits is up to 120 *Gradual increases to 2000 mg/day or more may be necessary, there is usually little therapertic gain to be achieved by exceeding *Little evidence that behavior improvement in severely disturbed mentally retarded patients *Daily doses up to 40 mg may be necessary.* *Dosages should not exceed 100 mg. If doses the next dose and succeeding doses should be increased cautiously in increments of 12.5 APPENDIX 2
FDA Maximum Doses
However, the limited clinical usage has not *It is recommended that the initial dose of experience with Haldol Decanoate at doses *The usual optimum total daily dose range *The usual optimum total daily dose range for behavioral problems in mental deficiency *Avoid dosages in excess of 64 mg daily.* recommended that the total daily dose not rarely increases the beneficial response.* *Daily dosage may vary from 1 to 10 mg.
*Dose should be adjusted gradually within *Additional therapeutic effect is rarely to be hospitalized patients if no response after 2 *Since daily dosages larger than 30 mg may severity of side effects it is recommended *It may be necessary to increase dosage up *The maximum dose for outpatients usually *Some patients may require 40-60 mg/day.* *Daily dosage for adults should not exceed *Usual adult dose is 30 mg before bedtime.* *Usual adult dose is 0.25-0.5 g at bedtime.* increased to six tablets daily as required.* *The total daily dose should not exceed four tablets of the 4-50 or eight tablets or any *Adult prescribing limit is up to a total of 16 *Studies have indicated that 2.4 mg is the maximum effective daily dose but doses as high as this have barely been employed.
daily Monday through Friday and 100 mg on *In some instances a dosage of 640 mg/day American Hospital Formulary Service.
*Unless otherwise indicated, the reference for the maximum dose is the FDA package insert as publixhed in the 1987 Physician's Desk Reference (PDR). These values may change over time. This is the primary source used because this is the legal document. If not value could be found, an alternative pharmaceutical reference as listed ***The reference for this is Facts and Comparisons ****This drug may be used as part of a University of Minnesota research study. If dosage levels are different, this is acceptable as long as the research protocol is approved and documented and informed consent from the LAR is APPENDIX 3
Chlorpromazine (CPZ) Equivalence Dose for Neuroleptics and Maximum MED Reduction Steps
The reference for the ratios is Facts and Comparisons unless otherwise indicated.
To achieve this, multiply (1 CPZ) times (the last figure in the ratio). To convert any dose, multiply the (dose) times (the last figure in the ratio). Example: 10 mg Navane is (10) (25) = 250 CPZ.
To achieve this, divide (100 CPZ) by (the last figure in the ratio). To convert any CPZ figure to a drug, divide the (CPZ dose) by (the last figure in the ratio). Example: 2000 CPZ converted to Haldol is (2000) - (50) = 40 Exceptions may occur at very high or very low doses. This may also vary slightly due to dosage forms The reference for this is Schatzberg and Cole, Manual of Clinical Psychopharmacology, 1986. This may change as more data is collected with this drug.
The reference for this is Schatzberg and Cole as in (e).
This is a complex and controversial area. According to the Package Insert, "0.5 ml (12.5 mg) of decanoate every three weeks for every 10 mg of fluphenazine hydrochloride daily." It is impossible to arrive at a simple figure without a complex step-by-step mathematical process. An added variable is time: injections are given from one to six weeks. Based upon the package insert, 1 mg/day depot = 16.9 mg oral/day = 845 mg CPZ.
Reductions should be gradual in general rather than a specific figure per se.
The same factors as (g) apply here. According to the Package Insert, "it is recommended that the initial dose of Haldol Decanoate be 10-15 times the previous daily dose in oral haloperidol equivalents." Based upon the package insert, 1 mg/day depot = 140 CPZ/day. Again, look for gradual reductions rather than specific figure per Treatment
Time of Maximal Risk
Side Effects of Antipsychotic Medications
Features
Reaction
Comments and Notes
Initials
Supervisor's
StaffPerson:
Achieves
Reliability
Shows Role
Comptency
Procedural Training Sequence
Competency
List of Specific Training Procedures
Name of Client:
Phenothiazines
Thioxanthenes
MEDICATION SUMMARY
Antidepressant Drugs (Tricyclics)
Antidepressant Drugs (MAO Inhibitors)
Other Heterocyclic Compounds (e.g., Butyrophenones)
OBSERVATION AND RECORDING SHEET
APPENDIX
Behavioral Definitions and Observation Codes
Scored when the client engages in behaviors that arepotentially injurious to other persons, such as physicalassault (e.g., hitting, kicking, slapping, scratching, andthrowing things at others); forcefully taking things fromothers (e.g., grabbing, taking); and struggling with othersfor the possession of an object.
Scored when the client attempts to communicate his/herneeds in an acceptable manner either verbally ornonverbally (e.g., sign language, escape card, picturecommunication board, other adjunctive communicationmethods).
Scored when the client initiates a requested activity within ____ seconds of the first request.
Scored whether crying, either with or without tears, orwhining occurs.
Scored when feces is smeared on clothing, body, andother subjects in the environment Scored when the client breaks into (e.g., question,assertion, tug, gets between conversants) a conversationor activity of another person without explicit permission.
The repetition of a request within a short period of time bythe client to engage in a previously prohibited behavior;and/or repeated requests for toys, objects, privileges, etc.
Verbal or nonverbal refusal to comply with a precedingdemand (e.g., "I'll do it later," "I don't want to," "Why do Ihave to do it?" "Do I have to?" "No!" shaking head "no").
Verbalizations directed at others which may be construed as unpleasant (e.g., yelling demands or questions atothers), profanities directed at others, verbalizationsdirected at others that involve threats to harm persons("I'll kill you") or property ("I'm going to break a window").
Scored when the client fails to initiate a requested activitywithin ____ seconds of the first request.
Scored when the person does not recognize or respondto a request or demand given by a person in authority,and the request is clearly audible.
Scored when inedible items are placed in the mouth (e.g.,lint, paper, feces, grass, etc.) Scored when the client is participating appropriately withtoys, games, and leisure activities (e.g., TV, puzzles,exercise, exercycle, solitaire, walk around block, etc.)when alone.
Scored when the client is participating appropriately withtoys, games, and leisure time activities as a group activityor in a cooperative manner with others.
Scored when the person engages in behaviors that havethe potential for destroying, damaging or rendering anobject in need of repair (e.g., throwing, breaking,pummeling objects).
Scored when the client inserts fingers or objects into therectum.
Scored when the person engages in or attempts toengage in behaviors that have a clear potential to causeinjure to self (e.g., slap face, bite body, bang head onobjects, hit head with fist, scratch arms, etc.) Scored when the client is participating in an assignedactivity.
Scored when the client ceases an assigned activitybefore its completion for a period of excess of 30seconds.
Scored when the client initiates physical contacts such asshaking hands, hugging, touching, kissing.
Scored whenever the person shouts, yells, or talks at asufficient intensity that if carried on for sufficient timewould be extremely unpleasant, for example,verbalizations that can be heard at a distance of morethan 30 feet or in an adjacent room separated by a wall.
Scored when the person gives clear verbal and/orgestural cues that relate a positive reaction. Approval ismore than attention in that approval must include someclear indication of positive interest or involvement (e.g.,"That's a good boy," "Thank you," "That's right," nod,wink).
Scored when the "Mediator" is listening or looking at theclient, where categories such as "approval" are notappropriate. In some cases, it may be difficult to tell if theperson is listening. This problem may be resolved whenand if the person "listening" makes a comment to indicatethat he/she was listening.
Scored when the "Mediator", in response to a sign ofupset, attempts to help the client to communicate his/herdifficulties (e.g., "You seem to be upset, can I help you?""Can you tell me what is wrong?"), and/or encourages theclient to relax, to gain control, to calm down.
Scored when the person gives clear verbal and/orgestural cues that relate to a negative situation (e.g.,frown, shake head, "That's wrong," "You're eating toofast," "I don't like that").
Scored when a Mediator (i.e., parent, staff, teacher)issues a direct, clearly stated request to the client. Thedemand must state the behavior expected of the client,and may take the form of a question. The demand mustbe clearly understood outside of the context in which it isgiven (i.e., requests) that require the person to "start" or"begin" an activity.
The conditions for scoring are similar to those describedabove for "Demand-Start", with the exception that thiscategory is to be scored for demands that require theperson to "cease" an ongoing activity.
Scored when the "Mediator" does not respond to effortsof the client to get attention, to have questions answered,etc. For example, a client approaches a staff person andasks whether he can help. It is clear from that interactionthat the staff person heard the client, but the staff personignores the situation.
Scored when the "Mediator" touches the client in a waythat would be construed as aversive (e.g., slap, spank,shake, hit, pull hair, grasp firmly, force).
Scored when the "Mediator" touches the client in afriendly, affectionate manner (e.g., hug, kiss, pat, stroke,ruffling hair, arm around shoulders, holding hands,jostling in a fun way, tickling, etc.) Scored when the "Mediator" delivers a punishing stimuluscontingent upon the emission of a behavior (e.g., spank,lemon squirt, vapor spray, muscle squeeze). Thiscategory may also be scored in addition to Pc-.
Scored when the "Mediator" removes a privilege,withdraws a pleasant event, removes the client to "TimeOut," contingent upon the emission of a behavior. Thiscategory includes events that are typically classified as"Time Out," and "Response Cost." Scored when the "Mediator" expresses an intent topunish, apply some aversive stimulus, or remove somepositive stimulus (e.g., "If you do that you will have to goto bed early," "I'm going to spank you," "If you don't giveme that, you know what is going t happen.").
Scored when the "Meidator" gives a tangible object orprivilege contingent upon the client's behavior.
This category is scored when the "Mediator" raises his orher voice toward the client. The voice should be ofsufficient intensity to be construed as aversive if it werecontinued for a period of time.
Function Hypotheses
c Thomas J. Willis, Ph.D., and Gary W. LaVigna, Ph.D.
Institute for Applied Behavior Analysis, 1988 Consequence
FUNCTIONAL ANALYSIS WORKSHEET
Antecedent
Behavior
Description of
Ecological Strategies
Reactive Strategies
c. Thomas J. Willis, Ph.D., and Gary W. LaVigna, Ph.D.
Institute for Applied Behavior Analysis, 1988 Direct Treatment Strategies
Programming
Positive
Functional Analysis Worksheet
C=Cry; S=Scream; F=Flop; E=Elope; Si=Silly; N=Noncompliance; A=Aggression; P=Property Destruction For each 15 minutes throughout the program day, circle the appropriate code if the target behavior occurs. At the end of each 1/2 hour, indicate whether the reinforcer was earned in the columns to the right. Use the column labelled "1st" to indicate that the reinforcer was or was not earned during the 1st 30 minutes of the hour, and the column marked "2nd" for the second 30 minute period.
Method of Recording
Data Summary
Interval Recording Sheet
Institute for Applied Behavior Analysis
DISCRETE TRIAL COMPLIANCE TRAINING RECORD
__________________________________________________________________ __________________________________________________________________ R e q u e s t / D e m a n d
Behavior Data Sheet
Institute for Applied Behavior Analysis
DAILY BEHAVIOR RECORD-DAYS
Name of Client ___________________
Date of Observation __________________
Behavior
Brief Definition
Comments:
Institute for Applied Behavior Analysis
DAILY BEHAVIOR RECORD-MINUTES
Name of Client ___________________
Date of Observation __________________
Activity
Behavior
Brief Definition
Comments:
Data Based Training Record
Assistance Codes/Levels
Date or Trials
Steps or Behaviors
1. Number of Steps2. Total Assistance Used3. Average Assistance4.
5. Steps Independent (0)6. Percent Independence 5 = Sum all 0; 6 = Divide Step 5 by Step 1 A-B-C Incident Analysis
Thomas J. Willis, Ph.D., and Gary W. LaVigna, Ph.D.
(e.g., aggression, property destruction, tantrum, etc.) Where was client when behavior occurred (location)? Where were staff at the time of the incident? Who was next to the client at the time of the incident? with a fist, kicked with foot, broke window with brick, etc.).
Describe the severity of the incident (e.g., environment, injuries to others, etc.).
did staff and other clients react to this behavior? because I asked her to "stop" teasing).
., the code should be placed in row 7:00 and column 15.
.MA : Assign a code for each behavior targeted for intervention (x, o, /), and indicate the code in the appropriate place. Each tar Instructions
the delivery of reinforcement according to some pre-specified schedule. When reinforcement is delivered for a behavior, place t appropriate box. For example, for reinforcement delivered at 7:15 Observations should be done for one hour using identical data collection sheets. At the end of the hour, primary and seconda scores are compared according to the following formula: Record score (according to client and behavior stated above) and other information below.
BEHAVIORAL PROGRAMMING COMPETENCY CHECKLIST INSTRUCTIONS Test to determine if staff can correctly verbalize behavior program components. Ask thefollowing questions for each behavior program. Staff must answer each part correctly toget a plus (+) on the BPCC.
How do you reinforce? (social, token, tangible) What do you do when the target behavior occurs? Test to determine if staff can correctly role-play behavior program in a simulatedsituation. Practice until there is at least 85% procedural reliability in simulated situation.
(This does not necessarily have to be data-based, because the procedural reliability isdata-based and is the next step). Be sure staff are comfortable enough in the simulatedsituation that this will translate to reliability in a real situation.
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