Treatment, Management, and Systems of Care
Core concepts
Management is multimodal: behavioral, educational, pharmacologic, and family-centered. Know evidence-based behavioral interventions (ABA for autism, parent training, social skills), school supports (IEP, 504, related services), and early intervention. Understand pharmacotherapy: stimulants for ADHD (methylphenidate, amphetamines) with monitoring for growth and cardiovascular effects; alpha-2 agonists; SSRIs for anxiety/OCD; risperidone/aripiprazole for irritability in autism; and antiepileptics for seizures. Know the principles of treating comorbid epilepsy, sleep disorders, and GI issues. Review care coordination: medical home, transition planning, insurance, and advocacy. Understand the role of genetic counseling and family support.
Traps
Questions test that medication treats symptoms, not the core disorder, and that behavioral therapy is first-line for many presentations. Watch for off-label use without monitoring, and for ignoring family or school context. Another trap is failing to address transition to adult care.
Rule of thumb
Start with the least restrictive, evidence-based intervention, target the most impairing symptom, and monitor objectively.
Worked example: A child with autism and severe irritability-behavioral support first, then risperidone if aggression persists, with metabolic monitoring.