Neurodevelopmental disorders begin in the developmental period, often before school age, and cause deficits in personal, social, academic, or occupational functioning. They reflect differences in brain development with strong genetic contributions, plus prenatal and perinatal factors (prematurity, prenatal alcohol or drug exposure, infection, hypoxia). Disruptive, impulse-control, and conduct disorders involve problems in the self-control of emotions and behavior that violate the rights of others or bring the person into conflict with social norms or authority.

Neurodevelopmental disorders

Disruptive, impulse-control, and conduct disorders

Disruptive mood dysregulation disorder (DMDD) is classified with depressive disorders but is often assessed alongside these conditions: chronic, severe irritability with frequent temper outbursts (3 or more times a week) and persistently irritable mood between them, for at least 12 months; onset before age 10; diagnosed between ages 6 and 18.

• Developmental history and milestones (speech, motor, social); prenatal and birth history; family history
• ASD red flags: no babbling or pointing by 12 months, no single words by 16 months, no two-word phrases by 24 months, any loss of language or social skills at any age, poor eye contact, lack of pretend play
• Atypical pain and sensory response in ASD: a child may show little change in behavior even with a fever of 39 °C (102.2 °F) or an injury because of differences in sensory processing — assess objectively (vital signs, examination) rather than relying on complaints
• Behavior in several settings (home, school) from parents and teachers
• Aggression: frequency, triggers, targets, access to weapons, cruelty to animals, fire setting
• Before applying limits or restrictive measures to an aggressive youth, assess the level of risk and the young person's physical strength and size to plan a safe number of staff and approach
• Co-occurring conditions: anxiety, depression, learning disorders, sleep problems, substance use, trauma, abuse
• Self-esteem, peer relationships, family stress and parenting style

ADHD (AAP 2019 guideline)

• Age 4–5: parent training in behavior management first; add methylphenidate if symptoms remain significant
• Age 6–11: FDA-approved medication plus behavioral treatment and school supports (individualized education or accommodation plan)
• Adolescents: medication with the adolescent's assent, plus behavioral support

ASD

• Early intensive behavioral and developmental intervention (e.g., applied behavior analysis), speech, occupational (sensory), and social skills therapy; special education
• Risperidone and aripiprazole are approved for irritability associated with ASD — weight gain, metabolic syndrome (monitor weight, glucose, lipids), hyperprolactinemia (risperidone), extrapyramidal symptoms, sedation
• No medication treats the core social features

Tic disorders — education and reassurance; Comprehensive Behavioral Intervention for Tics (CBIT) is first-line when treatment is needed; alpha-2 agonists or antipsychotics (aripiprazole) for severe tics

Intellectual developmental disorder — early intervention, special education, treatment of associated conditions, community supports

ODD and CD — parent management training, CBT, problem-solving skills training, multisystemic therapy (home, school, community); treat co-occurring ADHD. Medication is not first-line; antipsychotics or mood stabilizers only for severe aggression, with metabolic monitoring

DMDD — parent training, CBT; stimulants if ADHD co-occurs; SSRIs or antipsychotics in selected cases

Kleptomania, pyromania, IED — CBT (cue awareness, covert sensitization, relapse prevention); SSRIs or naltrexone in selected cases

Listed in priority order.

1. Safety
   • Protect the child and others from aggression and self-injury (head banging, biting); remove dangerous objects
   • Assess risk level before setting limits; use de-escalation first; physical intervention only as a last resort, with enough trained staff
   • Supervise closely for elopement in ASD and impulsive ADHD
2. Environment and routine
   • For an agitated autistic child (hand flapping, jumping, loud vocalizing in a busy waiting room): move to a quiet, low-stimulation space, reduce noise and lights, speak calmly
   • Keep consistent routines; prepare for changes with visual schedules or social stories; allow comfort objects
   • Use the child's special interests in structured play to build social communication skills
3. Behavior management
   • Clear, consistent rules and reasonable, predictable consequences (ODD, CD); avoid power struggles
   • Positive reinforcement for desired behavior; token economy; time-out applied calmly
   • For conduct disorder: identify and reinforce strengths and adaptive behavior; CBT to correct hostile attribution bias (assuming others mean harm) and build empathy and problem-solving skills; hold the youth accountable for behavior
4. Skill building
   • Intellectual developmental disorder: break skills into small steps (task analysis), demonstrate, practice, and reinforce each success
   • ADHD: one instruction at a time, eye contact, short tasks with breaks, reduce distractions
   • Tics: explain that tics are neurologic and hard to suppress; do not punish or draw attention to them; teach child and parents about triggers (stress, fatigue)
5. Medication monitoring — height, weight, appetite, sleep, heart rate, blood pressure, mood, tics; metabolic monitoring for antipsychotics
6. Family support — respite, parent training, school coordination, support groups

Parents of children with ADHD

• Give stimulants in the morning (last dose early afternoon) to limit insomnia; give with or after breakfast and offer nutritious snacks and a substantial evening meal to offset appetite loss
• Report chest pain, fainting, palpitations, new tics, mood change, or suicidal thoughts (nonstimulants)
• Keep medications locked; never share them; count tablets
• Do not stop clonidine or guanfacine suddenly
• Correct behavior privately and calmly — never with public shaming or harsh scolding; praise specific positive behavior immediately
• Keep a predictable routine, homework in a quiet place, and short checklists

Parents of children with ASD

• Early intervention improves outcomes; follow a consistent routine and use visual supports
• Watch for signs of illness or pain that the child may not report
• Secure the home against wandering (door alarms, identification, water safety)

Parents of children with ODD or CD

• Set consistent rules with predictable consequences; both caregivers follow the same plan
• Spend daily positive time with the child; notice and reward good behavior

• ASD = social communication deficits plus restricted, repetitive behaviors, including sensory hyper- or hyporeactivity; screen with M-CHAT-R/F at 18 and 24 months
• Agitated autistic child → quiet, low-stimulation space; keep routines; use interests in structured play
• ADHD: symptoms before 12, in 2 or more settings, for 6 months
• Stimulants → decreased appetite and insomnia, growth slowing, raised HR/BP; give in the morning; abuse boxed warning
• Atomoxetine and viloxazine → suicidality boxed warning; alpha-2 agonists → taper to avoid rebound hypertension
• Intellectual developmental disorder: severity by adaptive functioning; teach in small steps with reinforcement
• Tourette: multiple motor + at least one vocal tic, more than 1 year, onset before 18; tics are hard to suppress
• ODD = argumentative, defiant toward authority; CD = violates others' rights
• CD care: reinforce strengths, correct hostile attribution, consistent limits; assess risk before limits
• DMDD = chronic irritability + frequent severe outbursts, onset before 10
• Kleptomania = stealing items not needed, tension then relief — not sexual