Issues in Integrating Psychotropic and Intensive Behavioral Interventions for Students With Emotional and Behavioral Challenges in Schools

The prevalence of psychotropic medication use among students with emotional and behavioral challenges continues to increase as intensive behavioral interventions are designed and evaluated in schools. There is general consensus among clinical professionals that psychotropic medications are not “silver bullets” but should be expected to improve mental health outcomes and enhance the effects of academic and behavioral interventions. Thus, they should be used to supplement, not replace, classroom-based strategies. Unfortunately, effective collaboration between clinical and educational professionals to evaluate medication effects is rare. As a result, psychopharmacological and behavioral interventions often occur simultaneously but are implemented and monitored independently by separate teams of professionals. In the present article, we make a case that a better understanding of behavioral mechanisms of psychotropic drug effects has the potential to improve the integration and evaluation of psychotropic and intensive behavioral interventions for students with emotional and behavioral challenges in schools. First, we review behavior-analytic approaches to intensive intervention models and current use patterns in psychotropic medications for students with emotional and behavioral challenges. Second, we review potential behavioral mechanisms of drug action as a framework for integrating the two treatment models. Third, we discuss implications of this integrated framework for practitioners when implementing and evaluating intensive, integrated interventions in schools.