Irritability and problem behavior in Autism Spectrum Disorder: A practice pathway for pediatric primary care

Kelly McGuire, Lawrence K. Fung, Louis Hagopian, Roma A. Vasa, Rajneesh Mahajan, Pilar Bernal, Anna E. Silberman, Audrey Wolfe, Daniel L. Coury, Antonio Y. Hardan, Jeremy Veenstra-VanderWeele, Agnes H. Whitaker

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)S136-S148
JournalPediatrics
Volume137
DOIs
StatePublished - Feb 1 2016

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Pervasive Child Development Disorders
Primary Health Care
Pediatrics
Practice (Psychology)
Autistic Disorder
Frustration
Anger
Aggression
Psychiatry
Referral and Consultation
Communication
Health
Reinforcement (Psychology)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Irritability and problem behavior in Autism Spectrum Disorder : A practice pathway for pediatric primary care. / McGuire, Kelly; Fung, Lawrence K.; Hagopian, Louis; Vasa, Roma A.; Mahajan, Rajneesh; Bernal, Pilar; Silberman, Anna E.; Wolfe, Audrey; Coury, Daniel L.; Hardan, Antonio Y.; Veenstra-VanderWeele, Jeremy; Whitaker, Agnes H.

In: Pediatrics, Vol. 137, 01.02.2016, p. S136-S148.

Research output: Contribution to journalArticle

McGuire, K, Fung, LK, Hagopian, L, Vasa, RA, Mahajan, R, Bernal, P, Silberman, AE, Wolfe, A, Coury, DL, Hardan, AY, Veenstra-VanderWeele, J & Whitaker, AH 2016, 'Irritability and problem behavior in Autism Spectrum Disorder: A practice pathway for pediatric primary care' Pediatrics, vol 137, pp. S136-S148. DOI: 10.1542/peds.2015-2851L

McGuire, Kelly; Fung, Lawrence K.; Hagopian, Louis; Vasa, Roma A.; Mahajan, Rajneesh; Bernal, Pilar; Silberman, Anna E.; Wolfe, Audrey; Coury, Daniel L.; Hardan, Antonio Y.; Veenstra-VanderWeele, Jeremy; Whitaker, Agnes H. / Irritability and problem behavior in Autism Spectrum Disorder : A practice pathway for pediatric primary care.

In: Pediatrics, Vol. 137, 01.02.2016, p. S136-S148.

Research output: Contribution to journalArticle

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