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Background: Overmedication of people with intellectual disabilities, particularly when psychotropic medications are used for challenging behavior (CB) in the absence of a psychiatric disorder, is a significant public health concern. Support staff play a pivotal role in influencing the prescribing process. Staff views and attitudes toward medication use for CB are therefore of paramount importance. Method: We have conducted four focus groups involving support staff (n = 8), home managers (n = 5) and trainers (n = 3), two of which primarily explored participants' experiences and views on using medication for CB and medication withdrawal. Results: Some participants felt medication use was justified, but others saw that as a form of chemical restraint. Most agreed that polypharmacy of psychotropics might lead to side effects. Some acknowledged the lack of shared decision-making involving people with intellectual disabilities and their families. There was universal anxiety about withdrawing the medication. Conclusions: All agreed on the need for more medication-related information.

The aim was to investigate prescribing practices surrounding the use of medication for the management of behavioural problems in adults with intellectual disabilities with reference to a national guideline development project. A case note review methodology was employed to explore adherence to the audit criteria that were derived from the recommendations made in the guideline. A total of 154 cases were identified as meeting the inclusion criteria. There was some variation in adherence to the examined audit criteria with some areas achieving high compliance whereas others were deemed as lacking. Such areas achieving high compliance included assessment of the behaviour, assessment of surrounding behavioural, medical, psychological/psychiatric and social issues and communication of the treatment plan to other relevant professionals. However, the assessment of capacity issues and acquisition of consent or assent were rarely documented. The results highlighted certain areas of clinical practice that may need to be formally documented in patient case notes in order to provide evidence of the quality of healthcare an individual has received.

This article describes a national guideline for the use of medication in the management of problem behaviours in adults with an intellectual disability. As problem behaviours in this group are common and medication is often prescribed 'off licence', it is important that a framework is established to direct this practice. The article details a guideline development project that is of importance because it is the only national guideline in the area. It also highlights important issues in clinical practice in the field, and addresses the current evidence base on the effectiveness of psychotropic medications in the management of problem behaviours. There is a lack of good research evidence to support use of medication for problem behaviours. Where medication is used for this purpose, it should be used with a clear rationale, following a thorough assessment of the individual, and carefully monitored, and withdrawal should always be considered. People should always be given information in a way that they understand, and they should be given choices about their treatment. [ABSTRACT FROM AUTHOR]