The Use of Medication for Challenging Behaviors in People with Intellectual Disabilities: Reflections and Evolving Challenges from a Taiwanese Psychiatrist

Abstract

Dear Editor, I recently read with great interest the article, “The Use of Medication for Challenging Behaviors in People with Intellectual Disabilities: The Direct Care Providers’ Perspective” (Deb et al., 2023). As a psychiatrist based in Taiwan, I am responsible for a medical team that cares for 66 acute psychiatric patients, some of whom have intellectual disabilities. I would like to commend the authors for their insightful work and share some reflections on the challenges I face in clinical practice, including recent developments concerning attention deficit hyperactivity disorder (ADHD). In my 20 years of experience as a psychiatrist, I have often hesitated to prescribe medication for challenging behaviors in individuals with intellectual disabilities. Many of these patients exhibit behavioral issues rather than psychiatric symptoms, such as hallucinations or delusions. Consequently, the use of medication is sometimes considered a form of chemical restraint, a notion that Deb et al. (2023) also highlight. Deciding on the appropriate type and dosage of medication has always been a critical consideration for me. I typically prescribe haloperidol, a traditional antipsychotic medication, and benzodiazepines for their sedative effects. Although haloperidol is known to cause extrapyramidal symptoms (EPS), I have found it to be relatively safe throughout my years of clinical practice, leading me to prefer traditional medications. Deb et al. (2023) emphasize the need for a holistic approach and greater information on medications, their indications, and side effects. They also highlight the importance of involving individuals with intellectual disabilities and their families in shared decision-making. These findings prompt me to reevaluate my approach to managing challenging behaviors in people with intellectual disabilities, striving to better inform myself and collaborate with care providers, families, and the individuals themselves. In recent years, public awareness of ADHD has increased in Taiwan. Family members and educators of individuals with intellectual disabilities now sometimes express concerns about inattention and request ADHD medications, such as methylphenidate. This emerging issue was not as prevalent 20 years ago when I began my career as a psychiatrist. Deciding whether to prescribe these medications and determining which ones are most suitable presents a serious challenge for clinicians like myself. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2023, VOL. 16, NO. 3, 275–276 https://doi.org/10.1080/19315864.2023.2223543