Pervasive Developmental Disorder Treatment & Management
- Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD more...
Thorough medical evaluation is warranted before psychiatric hospitalization is considered.
Inpatient care is warranted to manage acute medical issues or for a workup of subclinical medical disorders.
Patients often present with medical problems that manifest as changes in behavior.
Psychiatric hospitalization is indicated whenever the safety of the patient cannot be maintained.
Applied behavioral analysis
Applied behavioral analysis (ABA) is considered the best evidence-based treatment for ASD. ABA focuses on reinforcement and extinction of behaviors. Skills are taught using discrete trial training or pivotal response training. Problematic behaviors are addressed through functional communication training (FCT). Functional analysis (FA) identifies factors that maintain the challenging behaviors.
Widespread implementation of FA and FCT via in-home therapy is limited by cost and geographic availability. A preliminary telehealth study demonstrated the feasiblity of providing these services with >90% reduction of problematic behavior at reduced cost compared to in-home therapy.
Consult a child psychiatrist and/or a developmental/behavioral pediatrician to evaluate and treat comorbid diagnoses such as depression, ADHD, or OCD and to lead a multidisciplinary team for case management, which may include family psychoeducational therapy, psychopharmacologic treatment, speech therapy, occupational therapy, physical therapy, and behavioral therapy.
Consult a psychologist and/or an education specialist to assess baseline functions for intellectual capacity and learning disabilities and to design cognitive behavioral strategies for facilitating education and for modifying difficult behaviors. (This area is rapidly growing, with increasing evidence suggesting that specific types of therapy for early intervention can enhance generalization of social skills.)
Additional Patient Management Considerations
Outpatient management requires a multidisciplinary approach.
Comorbid medical problems, including seizures and constipation, are frequent.
Certain behaviors may require medication prescribed by a child and adolescent psychiatrist or behavioral-developmental pediatrician.
A speech pathologist's expertise is essential to develop a communication plan. The use of augmentative and communication devices is essential for the nonverbal child.
A special education professional may be needed to design a specific curriculum for each child with pervasive developmental disorder (PDD).
Occupational and physical therapists may be indicated for motor deficits and sensory processing deficits.
A social worker not only helps find financial, educational, and emotional resources but also provides important psychosocial support for the family.
Psychologists often develop behavioral plans and ongoing therapy to improve social relationships.
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