Kelly McGuire1, Lawrence K Fung2, Louis Hagopian3, Roma A Vasa4, Rajneesh Mahajan4, Pilar Bernal5, Anna E Silberman6, Audrey Wolfe7, Daniel L Coury8, Antonio Y Hardan2, Jeremy Veenstra-VanderWeele9, Agnes H Whitaker10. 1. Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; Center for Autism and Developmental Disorders, Maine Behavioral Healthcare, South Portland, Maine; 2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; 3. Departments of Behavioral Psychology and. 4. Psychiatry, Kennedy Krieger Institute, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; 5. Psychiatry, Children's Health Council, Palo Alto, California; 6. Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; 7. MassGeneral Hospital for Children, Boston, Massachusetts; 8. Nationwide Children's Hospital, Columbus, Ohio; and. 9. Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; New York Presbyterian Hospital Center for Autism and the Developing Brain, White Plains, New York. 10. Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; whitakea@nyspi.columbia.edu.
Abstract
OBJECTIVE: Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB). METHODS: The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway. RESULTS: The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment. CONCLUSIONS: The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.
OBJECTIVE: Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB). METHODS: The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway. RESULTS: The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment. CONCLUSIONS: The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.
Authors: Lisa D Wiggins; Lin H Tian; Susan E Levy; Catherine Rice; Li-Ching Lee; Laura Schieve; Juhi Pandey; Julie Daniels; Lisa Blaskey; Susan Hepburn; Rebecca Landa; Rebecca Edmondson-Pretzel; William Thompson Journal: J Autism Dev Disord Date: 2017-11
Authors: Kelly McGuire; Craig Erickson; Robin L Gabriels; Desmond Kaplan; Carla Mazefsky; John McGonigle; Jarle Meservy; Ernest Pedapati; Joseph Pierri; Logan Wink; Matthew Siegel Journal: J Am Acad Child Adolesc Psychiatry Date: 2015-12 Impact factor: 8.829