In this chapter, the evidence relating to psychopharmacological approaches to reducing challenging behaviour will be briefly reviewed. It is beyond the scope of the present book to provide a comprehensive review of the area or to provide specific guidelines for the use of such medication – to do so would duplicate existing reviews (e.g. Ellis, Singh & Singh, 1997; Kalachnik et al., 1998; Kennedy & Meyer, 1998b; Reiss & Aman, 1998; Rush & Frances, 2000; Schroeder, 1999; Thompson et al., 1994a; Verhoeven & Tuinier, 1999). The intention of this review is to pay particular attention to approaches based on current understanding of the neurobiological bases of challenging behaviour (see Chapter 4).

The importance of gaining a basic understanding of psychopharmacological approaches is underscored by three factors. Firstly, as was indicated in Chapter 4, there is growing evidence to suggest that alterations in dopaminergic, serotoninergic and opioid neurotransmitter systems may play a role in the aetiology of some forms of challenging behaviour. This recent research opens up the possibility of developing a functionally based approach to psychopharmacological interventions which may complement behavioural approaches. Secondly, an appreciation of the behavioural mechanisms of drug action (Kennedy & Meyer, 1998b; Thompson et al., 1994a) is likely to be of value when developing behavioural approaches for people in receipt of psychoactive medication. Finally, psychopharmacological interventions constitute the most common form of treatment received by people with severe intellectual disabilities and challenging behaviour.