title: 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.
authors.affiliation: 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;
authors.forename: Kelly
authors.initials: K
authors.lastname: McGuire
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California;
authors.forename: Lawrence K
authors.initials: LK
authors.lastname: Fung
authors.affiliation: Departments of Behavioral Psychology and.
authors.forename: Louis
authors.initials: L
authors.lastname: Hagopian
authors.affiliation: Psychiatry, Kennedy Krieger Institute, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Roma A
authors.initials: RA
authors.lastname: Vasa
authors.affiliation: Psychiatry, Kennedy Krieger Institute, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Psychiatry, Children's Health Council, Palo Alto, California;
authors.forename: Pilar
authors.initials: P
authors.lastname: Bernal
authors.affiliation: Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York;
authors.forename: Anna E
authors.initials: AE
authors.lastname: Silberman
authors.affiliation: MassGeneral Hospital for Children, Boston, Massachusetts;
authors.forename: Audrey
authors.initials: A
authors.lastname: Wolfe
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Coury
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California;
authors.forename: Antonio Y
authors.initials: AY
authors.lastname: Hardan
authors.affiliation: 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.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Veenstra-VanderWeele
authors.affiliation: Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; whitakea@nyspi.columbia.edu.
authors.forename: Agnes H
authors.initials: AH
authors.lastname: Whitaker
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology / Q000628:therapy; D000067877:Autism Spectrum Disorder / Q000523:psychology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007508:Irritable Mood; D010372:Pediatrics / Q000379:methods*; D011320:Primary Health Care / Q000379:methods; D000066553:Problem Behavior