ADHD and ASD

Question 1

What is the triad that characterises ADHD?

Answer 1

inattention
hyperactivity
impulsivity

Question 2

What is the autistic triad?

Answer 2

communication
social interaction
flexibility of thought/imagination
repetitive behaviours

Question 3

Describe communication in ASD.

Answer 3

expressive language > receptive language

both are delayed; expressive language is often echoed, at odd donation/pitch and can be chunks of video speak.
Receptive language is delayed and abstract language is difficult.

Question 4

Which features of social interaction do those with ASD have difficulty with?

Answer 4

joint attention & referencing
turn taking
unable to share pleasure
not motivated by social approval
empathy 
relationships 
others POV/feelings

Question 5

What sensory issues do those with ASD have?

Answer 5

fussy eater/medications
textures of clothes
sleep
toilet training
hair washing/cutting
nail cutting
noise

Question 6

What is the difference between child AdHD and adult ADHD?

Answer 6

adult has less obvious symptoms of hyperactivity/impulsivity and more inattentive symptoms

Question 7

What is the impact of childhood ADHD?

Answer 7

parenting difficulties
increased levels of home stress & high expressed emotions
difficulties in peer relationships
reckless & dangerous behaviour
developmentally inappropriate decision making
barrier to learning and potentially exclusion from school
higher likelihood of antisocial behaviours

Question 8

What are some perinatal factors in ADHD?

Answer 8

tobacco and alcohol use
significant prematurity and perinatal hypoxia
unusually short or long labour, foetal distress, low forceps delivery and eclampsia
Exposure to viral infection during 1st trimester?

Question 9

Which type of parenting might be linked to a higher chance of a child developing ADHD?

Answer 9

inconsistent parenting

Question 10

Which psychosocial adverse situations are associated with higher rates of ADHD?

Answer 10

severe martial discord
low social class
large family size
paternal criminality
maternal mental disorder
emotional trauma

Question 11

What would a typical brain map pattern show in children with ADHD?

Answer 11

underachieve function within frontal lobe

Question 12

What neurochemistry is seen in ADHD?

Answer 12

excessively efficient dopamine removal system - higher conc of dopamine transporters

Leads to reduction in NA and serotonin

Question 13

What is the diagnostic criteria for child ADHD?

Answer 13

6 or more symptoms of inattentiveness ±
6 or more symptoms of hyperactivity & impulsiveness
present <5 y/o
reported by parents, school & seen in clinic
symptoms interfere with daily life

Question 14

What is the diagnostic criteria for adult ADHD?

Answer 14

5 or more symptoms of inattentiveness ±
5 or more of hyperactivity & impulsiveness
Historical concerns since early age.

Question 15

In adults, it is essential for the diagnosis that symptoms should have a moderate effect on different areas of their life, such as…

Answer 15

underachieving at work / in education
driving dangerously
difficulty making / keeping friends
difficulty in relationships with partners

Question 16

What is the first line pharmacological treatment for moderate and severe ADHD?

Answer 16

1st = stimulants (methylphenidate, dexamfetamine)

Question 17

How do the 1st line stimulants work?

Answer 17

methylphenidate increased dopamine by blocking its transporter
dexamphetamine does this too and also increases extracellular NA & possibly serotonin

Question 18

What is the role of SNRIs in ADHD?

Answer 18

non-stimulants (SNRI, e.g. atomoxetine) increase NA by blocking its transporter or by reducing sympathetic stimulation (alpha-agonists)

Question 19

What are the specific cases that can cause autistic behaviour?

Answer 19

rubella in pregnant lady
tuberous sclerosis 
fragile X syndrome 
encephalitis 
untreated phenylketonuria (PKU)

Question 20

What is the most common inherited form of intellectual disability?

Answer 20

fragile X syndrome

Question 21

Which areas of the brain appear pathological in autism?

Answer 21

frontal lobes, amygdala and cerebellum

Question 22

A large amygdala is associated with what symptoms?

Answer 22

severe anxiety and worse social and communication skills

Question 23

Which speech & language difficulties can aid diagnosis in children?

Answer 23

Lack of babble / vocal sounds
Can repeat words/phrases spoken by others without formulating their own language, or in parallel to developing their language skills.
Older children have issues with non-verbal behaviours

Question 24

What are some common co-morbid emotional disorders?

Answer 24

depression and anxiety (40-60%)
eating disorders (20%)

Question 25

Which drug is licensed for use in autism when there is severe aggression and significant self-injury?

Answer 25

risperidone