Title: How (Not What) to prescribe: Managing disruptive behaviors in individuals with neurodevelopmental disorders

Abstract

Disruptive behaviors (DBs) are a class of externalizing behaviors that include physical aggression, property destruction, temper outbursts, verbal aggression, and some forms of self-injurious behaviors. DBs are the most frequent reason for behavioral health referrals among individuals with neurodevelopmental disorders (NDDs), including children and adolescents. Unfortunately, the psychopharmacologic management of DBs in individuals with NDDs lacks a strong evidence base. One factor contributing to this short coming is that DBs are complex and poorly understood manifestations of numerous etiological pathways interacting with diverse environmental influences. Further, our current psychopharmacologic approaches frequently disregard the diversity of this patient cohort. Lastly, treatment studies do not address the heterogeneity of DBs in individuals with NDDs. This world of dueling heterogeneity partially explains why the evidence to support any given treatment is sparse. So how does the medical community compensate for the myriad complications in treatment and subsequently develop effective protocols for managing DBs? The answers lie with the best teachers in medicine: our patients. Our objective with this talk is to illustrate best practices for the management of DBs in individuals with NDDs using a case vignette. Audience members will leave with key principles of best prescribing practices and future directions for ongoing research in psychopharmacology for DBs.