ADHD and ASD Flashcards
What is the main diagnostic triad of ADHD?
Inattention
Hyperactivity
Impulsivity
What do the symptoms of ADHD have to be to make a diagnosis?
Developmentally inappropriate
Impairing function
Pervasive across settings
Present for at least 6 months
How is a diagnosis of ADHD in childhood made?
History
Observation at home and school
Diagnostic tools like the ADHD rating scale
What are non-pharmacological options for management of ADHD?
Parent training
Social skills training
Sleep and diet changes
Psychoeducation
What is the pathway of pharmacological treatments of ADHD?
First line: stimulants
Second line: SSRI - atomoxine
Third line: alpha agonist
4th line: antidepressants (imipramine) or antipsychotics (risperidone)
What are examples of stimulants used in ADHD?
Methylphenidate
Dexamfetamine
Lisdexamfetamine
What is the mechanism of methylphenidate as treatment for ADHD?
CNS stimulant associated that works primarily by improving dopamine signalling in the networks associated with executive functioning
What are side effects of methylphenidate?
Headache
Poor appetite
Insomnia
How do SSRIs work in ADHD?
Non-stimulant - work by inhibiting noradrenaline uptake
What are side effects of SSRIs in ADHD?
Nausea
Dry mouth
Weight loss
What alpha agonists are used in ADHD?
Clonidine
Guanfacine
What are the domains in which people with ASD struggle?
Social interactions
Social imagination
Communication
Repetitive behaviours
What is meant by social imagination?
Ability to imagine and understand what others are thinking or their point of view
Ability to imagine yourself in the future and plan for goals
In what ways do people with ASD struggle with social interaction?
Find relationships difficult to establish and sustain
Struggle to figure out social situations so can appear self-focused and lacking in empathy
Lack interest in others
In what ways do people with ASD struggle with communication?
Delay in receptive and expressive language
Struggle to make eye contact
Struggle to understand sarcasm, metaphors, underlying meanings of conversation
Struggle to initiate and sustain conversation
Stress, pitch or rhythm of speech may be odd or monotonous
Language can be pedantic and idiosyncratic
What kind of repetitive behaviours do people with ASD exhibit?
Restricted, repetitive and stereotyped behaviour such as spinning or rubbing head
Routine orientated and struggle to cope with change in routine
Interested or fixated on one task or hobby
How is diagnosis of ASD made?
Symptoms present in early developmental period
Symptoms cause significant impairment in social, occupational or other areas of functioning
Disturbances not better explained by other mental health problems, intellectual disability or developmental delay
What are non-pharmacological options for management of ASD?
School interventions
Social skills training
Speech and language therapy
What are pharmacological options for management of ASD?
Risperidone/aripiprazole short term for significant aggression, tantrums or self-injury
Methylphenidate for ADHD symptoms
Anti-anxiety, antidepressants, melatonin
What are intellectual disabilities?
Conditions the cause a reduced intellectual ability and difficulty with everyday tasks, socialising or managing money - which affects someone for their whole life
What criteria are needed for an intellectual disability?
IQ <70
Onset before age 18
Impairment in a wide range of functions
What are the categories for severity of intellectual disability?
Mild: IQ 50-69
Moderate: IQ 35-49
Severe: IQ 20-34
Profund: IQ <20
What are the features of a mild intellectual disability?
Most common Delayed speech Full independence Difficulties reading + writing Capable of unskilled or semiskilled work
What are the features of a moderate intellectual disability?
Slow with comprehension and language Limited achievements Delayed self care and motor skills Simple practical tasks (often with supervision) Usually fully mobile E.g. Down syndrome
What are the features of a severe intellectual disability?
Mental age 3-6 years
Require support throughout life
Difficulty following instructions - may need information presented in a different way, e.g. hand gestures
What are the features of a profound intellectual disability?
Mental age less than 3 years
Severe limitation in ability to understand or comply with requests/instructions
Little or no self care
Often severe mobility restrictions
What is borderline intellectual disability?
Not officially an ID
IQ 70-84
Mental age 12-15
What are pre-natal causes of intellectual disability?
Genetics
Substance misuse
Medications in pregnancy
Infection in pregnancy - rubella, CMV
What are perinatal causes of intellectual disability?
Prematurity
Tumours
Metabolic disorders (phenylketonuria, neonatal hypothyroidism, hyper bilirubinemia)
Infection: meningitis, pneumonia
What are examples of genetic conditions associated with intellectual disability?
Neurofibromatosis Tuberous sclerosis Down syndrome: trisomy 21 Patau syndrome: trisomy 13 Edwards syndrome: trisomy 18 Fragile X syndrome Prader-Willi syndrome Angelman syndrome DiGeorge syndrome Cri Du Chat syndrome Lesch-Nyhan syndrome
How does Prader-Willi syndrome present?
Obesity, compulsive over eating and self injurious behaviour
How does Angelman syndrome present?
Ataxia leading to puppet like movement and paroxysms of laughter
How does DiGeorge syndrome present?
Small head, facial abnormalities, prominent nose, congenital heart disease and increased risk of schizophrenia
How does Cri Du Chat syndrome present?
Microcephaly and characteristic cat like cry
How does Lesch-Nyhan syndrome present?
Gout, renal stones and self injurious behaviour, which is characteristically by biting
How are psychiatric symptoms different in people with intellectual disabilities?
Depression more likely to present with somatic symptoms
Schizophrenia typically presents with negative symptoms or behavioural changes
Autism is more common - 30%
