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.