ADHD and ASD Flashcards
What are the triad of difficulties seen in ADHD
Inattention
Hyperactivity
Impulsivity
Do symptoms of ADHD change in different environments
No
They should be pervasive across all settings
When does ADHD usually become apparent
From age 5
May become more noticeable later on but should have signs from this age
What is the impact of childhood ADHD
Increased level of home stress
Emotional dysregulation leads to difficulties in peer relationships and reckless and dangerous behaviour
Poor problem solving ability
Struggle at school - can affect learning/education
Higher likelihood of antisocial behaviours
Low self-esteem - always getting told off
What is the impact of adult ADHD
There is an increase in the frequency of psychiatric comorbidity
Higher levels of criminality, antisocial behaviour
Higher level of substance misuse
Poor impulse control
Occupational difficulty
Can people grow out of ADHD
Kind of
Thought that some can compensate better for the cognitive deficit as they mature
Still have the disorder just cope better
What causes ADHD
Genetic predisposition
Perinatal precipitants
Psychosocial adversity
This lead to neuroanatomical brain changes and the symptoms
Is there a genetic component to ADHD
Yes
ADHD shows familial clustering
Strong increased risk for ADHD in the offspring of those with ADHD
What perinatal factors can increase chance of ADHD
ADHD is common in kids with foetal alcohol syndrome
Alcohol and tobacco in pregnancy
Significant prematurity and perinatal hypoxia
Stressful birth
Which area of the brain is underactive in ADHD
Frontal lobe
This leads to trouble reasoning, decision making, controlling impulses etc
Also affects long term memory - without this you can’t learn from mistakes
How does ADHD affect your neurochemistry
Seems to be an excessively efficient dopamine-removal system - lose interest or pleasure faster
May also have reduced serotonin and norepinephrine
What are the diagnostic criteria for ADHD in children
6 or more symptoms of inattentiveness; and/or
6 or more symptoms of hyperactivity and impulsiveness
Present before age 5 years
Reported by parents, school and seen in clinic
Symptoms get on the way of daily life
What are the diagnostic criteria for ADHD in adults
In general, 5 or more of the symptoms of inattentiveness; and or
5 or more of hyperactivity and impulsiveness
Still look for inattentive and risk taking in adults – speeding, sexual behaviour etc
Historical concerns since early age
Affect several areas of daily life
When is pharmacological treatment used in ADHD
Only in moderate and severe cases
List some psychosocial intervention used to treat ADHD
Parent training and education
Social skills training
Sleep and Diet: eliminations and supplements
Behavioural classroom management strategies - reward charts or traffic like system
Specific educational interventions
List the drugs used in the treatment of ADHD
1st Line = stimulants Methylphenidate Dexamfetamine 2nd Line = SNRI Atomoxetine 3rd Line = alpha agonist Clonidine 4th Line = Antidepressants (imipramine) Antipsychotics (Risperidone)
How effective is medication for ADHD
EXTREMELY
NNT is only 4
What 5 disorders come under the umbrella of ASD
Asperger’s Syndrome Rett’s Syndrome Childhood Autism Pervasive Developmental Disorder Pervasive Developmental Disorder NOS
What are the triad of impairments seen in ASD
Social communication
Social interaction
Social imagination
(Repetitive behaviours are non-essential for diagnosis but very very common)
How do autistic people struggle with social communication
Good language skills but struggle to pick up underlying meanings
Difficulty with jokes, sarcasm etc
They often have narrow interests which dominate their conversation
Can be very pedantic – will correct grammar
Difficulty expressing emotion
How do autistic people struggle with social interaction
Difficulties picking up non-verbal cues
Appear self-focused and lacking in empathy - not really the case
Continually struggle to make and sustain personal and social relationships
How do autistic people struggle with social imagination
Difficulties thinking flexibly and in abstract ways
Inability to understand other people’s points of view, taking things literally
Difficulties applying knowledge and skills across settings with different people
Difficulties projecting themselves into the future
Which sex is more likely to have ASD
Males (5:1)
May be because girls are easier to miss – better at coping socially
What is the link between autism and gender identity
Higher than population rate of ASD in those accessing gender identity clinics
In females it is common in those with CAH - higher testosterone
What causes autism
Currently unknown - genetics, biological and environmental factors
Could be triggered by rubella in pregnancy, Fragile X, encephalitis, untreated PKU
Is there a genetic component to ASD
Yes
Strongly heritable
identical twins have 90% chance of having ASD if the other one does
What perinatal factors could increase risk of autism
Umbilical-cord complications Foetal distress Birth injury or trauma Multiple birth and maternal haemorrhage Low birth weight/small for gestational age Congenital malformation, Meconium aspiration
Which areas of the brain are affected in autism
Frontal lobes, amygdala and cerebellum appear pathological
Amygdala is larger - leads to anxiety and worse social skills
Also object recognition areas are underactive – may lead to confusion and stress in unfamiliar situation
Which NT’s are affected in autism
Glutamate receptors = dysregulation can lead to neuronal damage
GABA = allows us to relax
Serotonin = regulation of crucial steps of neuronal development
Which area of development is commonly delayed in those with autism
Speech delay is common
Often repeat others or repeat the same words over and over
What are the essential diagnostic criteria for autism
Symptoms must be present in the early developmental period
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
Disturbances are not better explained by other mental health problems, intellectual disability or global developmental delay
Mainly a subjective clinical diagnosis
Which emotional disorders are commonly seen alongside ASD
Depression
Anxiety
Eating Disorders
Which neurodevelopmental disorders are commonly seen alongside ASD
Tourette's OCD ADHD Dyspraxia Sensory processing disorder Dyslexia
List some non-pharmacological management strategies for ASD
Assist with communications – speech and language
Social skills training – limited evidence but worth a try
Teach them how they should behave in certain situations – repeat this often so that they learn
Family and school support
Diet works for some people
Which drugs can be used in ASD
Risperidone – licensed for management of severe aggression and significant self-injury
Otherwise it is just treating comorbidities :
e.g. anti-epileptics, SSRI for social anxiety, melatonin for insomnia
