Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care

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. Dr McGuire contributed to the design of the practice pathway, played a leading role in drafting the initial manuscript, and revised the manuscript; Drs Fung, Hagopian, Vasa, Mahajan, Bernal, and Coury and Ms Silberman and Ms Wolfe contributed to the design of the practice pathway and reviewed and revised the manuscript; Drs Hardan and Veenstra-VanderWeele contributed to the conceptualization and design of the practice pathway and reviewed and revised the manuscript; Dr Whitaker played a leading role in conceptualizing and designing the practice pathway, drafted portions of the initial manuscript, and reviewed and revised the manuscript; and all authors approved the fi nal manuscript as submitted.

Homogeneous Subgroups of Young Children with Autism Improve Phenotypic Characterization in the Study to Explore Early Development

“…Children with mild language and motor delay with dysregulation had average nonverbal problem solving skills and mild impairments in language and motor functioning. These children also had many behavior problems and sleep dysregulation, which may indicate unique etiologies and service needs (McGuire et al 2016). Circadian dysfunction has been linked to language delays in children with ASD (Hu et al 2009) although no identified studies have linked circadian dysfunction, self-injurious behaviors, and behavior problems in children with ASD.…”

Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders

“…[42][43][44] The ATN pathway for the treatment of accompanying irritability and problem behaviors can also be followed to manage these behaviors. 45 Youth with ASD frequently experience situational anxiety such as during family events, holiday time, blood draws, and other medical procedures. There are no data on pharmacologic treatments for situational anxiety.…”

Resveratrol as adjunctive therapy in treatment of irritability in children with autism: A double‐blind and placebo‐controlled randomized trial

“…Among these symptoms, management of irritability has significant importance as it complicates the adjustment of ASD patients both at home and in clinical settings, needing pharmacological treatment. Irritability is defined as outbreaks of vocal or motor expression of rage, aggression and distress, which might lead to self‐injurious behaviours . As for now, atypical antipsychotics have been the main pharmacological treatment for irritability associated with ASD.…”