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Psychiatry Year 3 Dundee > ADHD and ASD > Flashcards

ADHD and ASD Flashcards

1
Q

What are the triad of core symptoms that are up ADHD?

A

Inattention
Hyperactivity
Impulsivity

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2
Q

What other symptoms co-occur with the core triad in ADHD?

A

Developmentally inappropriate
Impairs function
Pervasive across all settings
Longstanding from the age of 5

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3
Q

List some impacts ADHD has.

A

Emotional dysregulation- difficult family and peer relations
Poor problem solving
Learning barrier as often excluded from education

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4
Q

ADHD in adults often leads to…

A

Increased frequency of psychiatric comorbidity
Higher levels of criminality/antisocial behaviour
Higher levels of substance abuse
Impaired occupational function

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5
Q

Why do symptoms of ADHD decrease over time?

A

As the brain matures the thickness of the cortices increases allowing for the compensation of cognitive deficit.

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6
Q

List some perinatal factors that can increase the risk of a child developing ADHD.

A

Tobacco and alcohol use in pregnancy
Significant hypoxia - prematurity and perinatal
Eclampsia

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7
Q

Neurobiologically how do ADHD patients present?

A

Underactive frontal lobe

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8
Q

Neurochemically how do ADHD patients present?

A

Excessive dopamine removal

Reduction in norepinephrine and seretonin

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9
Q

How are children assessed with ADHD?

A

Parent or school referral and observation

Screening or diagnostic questionnaire

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10
Q

How are adults assessed with ADHD?

A

Referred by patient

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11
Q

What do children need to have in order to be diagnosed with ADHD?

A

6 or more hyperactivity and impulsions
+ 6 symptoms of innattentivness
Presenting before the age of 5
Reported and seen by both school and home.

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12
Q

What do adults need to have in order to be diagnosed with ADHD?

A 
5 or more of hyperactivity and impulsiveness 
\+ 5 or more innatentivness
Historical concerns
Underachieving 
Reckless behaviour
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13
Q

Treatments for in mild ADHD

A

Psychosocial
Parent training
Sleep and diet modification and elimination
Behavioural classroom management

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14
Q

Treatments for moderate to severe ADHD.

A

Psychosocial

Pharmacological

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15
Q

List the pharmacological treatment for ADHD

A

1st line - Stimulants
2nd line - SNRIs
3rd line - Alpha agonists
4th line - Antidepressants or Antipsychotics

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16
Q

What Stimulants are used in ADHD?

A

Methyphenidate

Dexamfetamine

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17
Q

What SNRIs are used in ADHD?

A

Atomoxetine

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18
Q

What Alpha Agonists are used in ADHD?

A

Clonidine

Guanfacine

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19
Q

What Antidepressants or Antipsychotics are used in ADHD?

A

Antidepressants - Imipramine

Antipsychotics - Risperidone

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20
Q

How does Methyphenidate reduce the symptoms of ADHD?

A

Increases Dopamine by blocking its transporters

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21
Q

How does dexamfetamine reduce the symptoms of ADHD?

A

Increases dopamine

Increases extracellular norepinephrine and seretonin

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22
Q

How do SNRIs reduce the symptoms of ADHD?

A

Increase Norepinephrine by blocking its transporters

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23
Q

How do Alpha Agonists reduce the symptoms of ADHD?

A

Reduce sympathetic stimulation

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24
Q

What is the role of Norepinephrine in ADHD?

A

Affects the concentration

Leads to hesitation Obsession and doubt

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25
Q

What is the role of Dopamine in ADHD?

A

Affects Alertness

Working memory Compulsions Foggy clarity

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26
Q

What is the role of seretonin in ADHD?

A

Affects Satisfaction

Restlessness Confusion Anxiety

27
Q

ASD

A

Autism Spectrum Disorder

28
Q

What disorders come under ASD?

A 
Asperges
Retts
Childhood autism
Pervasive Developmental Disorder
PDD NOS
29
Q

What are the core features of ASD?

A

Social communication
Social Interaction/Imagination
Repetitive Behaviours

30
Q

Social Communication in ASD

A

Generally good language skills but miss underlying meaning
Jokes Idioms Metaphors Sarcasm - taken literally
Often sound monotonous
Pedantic and idiosyncratic language
Narrow interest which dominate their conversation

31
Q

Social Interaction in ASD

A

Difficulty in picking up non verbal cues
Appear self focused an apathetic - usually just struggling to process social situations
Difficulty finding and maintaining personal and social relationships.

32
Q

Social Imagination in ASD

A

Difficulty in thinking outside of the box
Inability to see others POV
Difficulty in projecting themselves in to future plans or goals

33
Q

Repetitive Behaviours in ASD

A

Stereotyped or repetitive motor movements
Inflexibility to change in their routine
Highly restricted interests
Hyper or Hypo reactive to sensory input

34
Q

ASD epidemiology

A

5:1 M:F

1 in 56

35
Q

Why is ASD more common in Men?

A

Sex hormones wide involved in brain development and organisation of brain circuits.
Poor specificity of diagnostic tests in females

36
Q

What hormone is linked to ASD and why?

A

Testosterone
Sex Hormone Binding Globulin is reduced in females with autism, as such they have much higher levels of free testosterone.

37
Q

What is 3 to 4x more likely in a child with ASD?

A

Gender Identity issues

38
Q

What can trigger autistic behaviour in children?

A 
Rubella as a foetus
Tuberous Sclerosis
Fragile X Syndrome
Encephalitis
Untreated Phenylketonuria
39
Q

What perinatal factors can lead to ASD?

A 
Umbilical chord complications
Foetal distress
Injury or trauma during delivery
Low birth weight
Meconium aspiration
40
Q

What environmental factors can lead to ASD?

A

Teratogenic exposure during first 8 weeks post conception

41
Q

How does the brain of someone with ASD appear?

A

Frontal lobe Amygdala and Cerebellum are all pathological

Amygdala is enlarged - sever anxiety

42
Q

What are all receptors and neurotransmitters are reduced in ASD?

A

Glutamate receptors
GABA
Seretonin

43
Q

How can a reduction in GABA result in ASD?

A

GABA helps in the developmental stages of cell migration and neuronal differentiation and maturation.

44
Q

How can a reduction in Serotonin result in ASD?

A

Helps in cellular and brain maturation

45
Q

How can blocking of Glutamate receptors lead to ASD

A

Glutamate dysregulation can lead to neuronal damage

46
Q

What should be looked at in the investigation into a child with ASD?

A

Speech and language
Social Skills
Sensory

47
Q

What could be observed in a child with ASD?

Speech and Language

A

Doesn’t babble or make other vocal sounds
Parrot- repeat or mimic words or phrases without developing their own language
Older children have trouble using non verbal behaviours e.g. maintaining eye contact facial expressions body language and gestures

48
Q

What could be observed in a child with ASD?

Social skills

A 
Lack awareness of interest in other children
Gravitate to older or younger children
Play alone
Little or no imaginative play 
Change to routine triggers tantrums 
Flap hand or twist fingers when excited
49
Q

What could be observed in a child with ASD?

Sensory

A

Taste - restricted diet as sensitive to textures
Sound - inability to filter out background noise concentration is impaired
Touch - often painful or uncomfortable brushing or cutting hair
Sight- Poor depth perception and increased clumsiness
Focused in on details not whole thing
Sensitive to light - difficulty sleeping

50
Q

What could be observed in an adult with ASD?

Communication

A

Difficulty seeing others perspective, picking up non verbal cues, making eye contact
Shows compassion but confused by social signals
Problems initiating and continuing a conversation - small talk is difficult
Difficulty seeing peoples intentions

51
Q

What could be observed in an adult with ASD?

Social

A

Appear blunt
Take things literals
Difficulty fitting in as doesn’t follow norms
Appear shy or avoid interaction

52
Q

What is a good diagnostic tool in ASD?

A

ADOS

Autism Diagnostic Observation Schedule

53
Q

What neurodevelopment disorders are common comorbidities with ASD?

A 
Tourettes
OCD
ADHD
Dyspaxia
Dyslexia
Language Impairment
54
Q

What percentage of ASD patients have Tourettes?

A

7%

55
Q

What percentage of ASD patients have OCD?

A

30%

56
Q

What percentage of ASD patients have ADHD?

A

65%

57
Q

What percentage of ASD patients have Dyspraxia ?

A

17%

58
Q

What percentage of ASD patients have Dyslexia?

A

70%

59
Q

What percentage of ASD patients have a language impairment?

A

70%

60
Q

What percentage of patients with ASD and a learning disorder have an IQ <70

A

65%

61
Q

What percentage of patients with ASD and a learning disorder have an IQ <50

A

35%

62
Q

What is the main management of ASD?

A

Psychosocial

No real pharmacological treatment

63
Q

What psychosocial management is given to ASD patients?

A 
Self and family psychoeducation
Speech and language therapy 
Social skills training
Family and school based support
Diet - Conflicting evidence diet has an influence
64
Q

What medication is used in ASD?

A

Risperidone - antipsychotic

Used acutely for severe aggression and self injury

Psychiatry Year 3 Dundee (21 decks)

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