Additional management considerations for psychiatric disorders in children and adolescents

Psychiatric disorders can significantly restrict educational, vocational and social participation in young people with developmental disability. Each of these factors must be addressed as part of a comprehensive management strategy, with a systemic approach to effect change. Early childhood early intervention services are available to address developmental concerns and optimise participation.

The principles of management of psychiatric disorders in children and adolescents with developmental disability are similar to those for adults, with the following additional considerations:

• multiple strategies may be needed to address comorbidities (eg neurodevelopmental disorders) and contributing factors
• management should encompass a family systems approach, work in collaboration with the wider system of support around the child, and address attachment problems
• assistance and co-operation must be sought from carers, school and family
• developmental milestones of children and adolescents with developmental disability may be achieved later than in the neurotypical population
• adolescents with developmental disability need additional support during psychosexual development and transition to adult care
• behavioural problems may be exacerbated by developmental factors (eg growth, changing needs)
• functional supports and strategies (eg communication aids) used in childhood may need review as the young person develops.

A comprehensive assessment that identifies maladaptive behaviours and other contributing factors will inform optimal management for children and young people with developmental disability and an evolving or comorbid psychiatric disorder. A positive behaviour support plan, as outlined in Challenging behaviour in people with developmental disability, can address multiple factors and provide targeted management strategies and support; it is a living document that supports a systemic approach, and can be added to as required. Review management plans regularly to ensure strategies and supports are adapted as the young person develops.

Support for carers and family of people with developmental disability is also an important consideration.