Approach Considerations

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.

Go to Autism and Asperger Syndrome for complete information on these topics.

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.^[40]

Consultations

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.^[41]

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.

Medication

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Media Gallery

Young child with fragile X syndrome who does not have obvious dysmorphic features. Courtesy of Randi J Hagerman, MD, FAAP.

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Author

Sufen Chiu, MD, PhD Associate Clinical Professor (Volunteer Faculty), University of California, Davis, School of Medicine; Staff Physician, Mercy Medical Group

Sufen Chiu, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychiatric Association, California Medical Association, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Randi J Hagerman, MD, FAAP Professor of Pediatrics, Medical Director of the MIND Institute, Endowed Chair in Fragile X Research, Division of Developmental/Behavioral Pediatrics, University of California Davis Medical Center

Randi J Hagerman, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics, Society for Pediatric Research, Society for Developmental and Behavioral Pediatrics, Western Society for Pediatric Research

Disclosure: Received grant/research funds from Roche for pi on study; Received grant/research funds from Novartis for pi on study; Received grant/research funds from Seaside therapeutics for pi on study; Received grant/research funds from Johnson and Johnson for pi on study; Received grant/research funds from Forest for pi on study; Received grant/research funds from curemark for pi on study.

Sandra M DeJong, MD, MSc Assistant Professor of Psychiatry, Harvard Medical School; Active Staff, Department of Psychiatry, Cambridge Health Alliance

Sandra M DeJong, MD, MSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Association of Directors of Psychiatric Residency Training, American Psychiatric Association, Association of Women Psychiatrists, Massachusetts Psychiatric Society, New England Council of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.