ADHD and ASD Flashcards
What are the triad of core symptoms that are up ADHD?
Inattention
Hyperactivity
Impulsivity
What other symptoms co-occur with the core triad in ADHD?
Developmentally inappropriate
Impairs function
Pervasive across all settings
Longstanding from the age of 5
List some impacts ADHD has.
Emotional dysregulation- difficult family and peer relations
Poor problem solving
Learning barrier as often excluded from education
ADHD in adults often leads to…
Increased frequency of psychiatric comorbidity
Higher levels of criminality/antisocial behaviour
Higher levels of substance abuse
Impaired occupational function
Why do symptoms of ADHD decrease over time?
As the brain matures the thickness of the cortices increases allowing for the compensation of cognitive deficit.
List some perinatal factors that can increase the risk of a child developing ADHD.
Tobacco and alcohol use in pregnancy
Significant hypoxia - prematurity and perinatal
Eclampsia
Neurobiologically how do ADHD patients present?
Underactive frontal lobe
Neurochemically how do ADHD patients present?
Excessive dopamine removal
Reduction in norepinephrine and seretonin
How are children assessed with ADHD?
Parent or school referral and observation
Screening or diagnostic questionnaire
How are adults assessed with ADHD?
Referred by patient
What do children need to have in order to be diagnosed with ADHD?
6 or more hyperactivity and impulsions
+ 6 symptoms of innattentivness
Presenting before the age of 5
Reported and seen by both school and home.
What do adults need to have in order to be diagnosed with ADHD?
5 or more of hyperactivity and impulsiveness \+ 5 or more innatentivness Historical concerns Underachieving Reckless behaviour
Treatments for in mild ADHD
Psychosocial
Parent training
Sleep and diet modification and elimination
Behavioural classroom management
Treatments for moderate to severe ADHD.
Psychosocial
Pharmacological
List the pharmacological treatment for ADHD
1st line - Stimulants
2nd line - SNRIs
3rd line - Alpha agonists
4th line - Antidepressants or Antipsychotics
What Stimulants are used in ADHD?
Methyphenidate
Dexamfetamine
What SNRIs are used in ADHD?
Atomoxetine
What Alpha Agonists are used in ADHD?
Clonidine
Guanfacine
What Antidepressants or Antipsychotics are used in ADHD?
Antidepressants - Imipramine
Antipsychotics - Risperidone
How does Methyphenidate reduce the symptoms of ADHD?
Increases Dopamine by blocking its transporters
How does dexamfetamine reduce the symptoms of ADHD?
Increases dopamine
Increases extracellular norepinephrine and seretonin
How do SNRIs reduce the symptoms of ADHD?
Increase Norepinephrine by blocking its transporters
How do Alpha Agonists reduce the symptoms of ADHD?
Reduce sympathetic stimulation
What is the role of Norepinephrine in ADHD?
Affects the concentration
Leads to hesitation Obsession and doubt
What is the role of Dopamine in ADHD?
Affects Alertness
Working memory Compulsions Foggy clarity
What is the role of seretonin in ADHD?
Affects Satisfaction
Restlessness Confusion Anxiety
ASD
Autism Spectrum Disorder
What disorders come under ASD?
Asperges Retts Childhood autism Pervasive Developmental Disorder PDD NOS
What are the core features of ASD?
Social communication
Social Interaction/Imagination
Repetitive Behaviours
Social Communication in ASD
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
Social Interaction in ASD
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.
Social Imagination in ASD
Difficulty in thinking outside of the box
Inability to see others POV
Difficulty in projecting themselves in to future plans or goals
Repetitive Behaviours in ASD
Stereotyped or repetitive motor movements
Inflexibility to change in their routine
Highly restricted interests
Hyper or Hypo reactive to sensory input
ASD epidemiology
5:1 M:F
1 in 56
Why is ASD more common in Men?
Sex hormones wide involved in brain development and organisation of brain circuits.
Poor specificity of diagnostic tests in females
What hormone is linked to ASD and why?
Testosterone
Sex Hormone Binding Globulin is reduced in females with autism, as such they have much higher levels of free testosterone.
What is 3 to 4x more likely in a child with ASD?
Gender Identity issues
What can trigger autistic behaviour in children?
Rubella as a foetus Tuberous Sclerosis Fragile X Syndrome Encephalitis Untreated Phenylketonuria
What perinatal factors can lead to ASD?
Umbilical chord complications Foetal distress Injury or trauma during delivery Low birth weight Meconium aspiration
What environmental factors can lead to ASD?
Teratogenic exposure during first 8 weeks post conception
How does the brain of someone with ASD appear?
Frontal lobe Amygdala and Cerebellum are all pathological
Amygdala is enlarged - sever anxiety
What are all receptors and neurotransmitters are reduced in ASD?
Glutamate receptors
GABA
Seretonin
How can a reduction in GABA result in ASD?
GABA helps in the developmental stages of cell migration and neuronal differentiation and maturation.
How can a reduction in Serotonin result in ASD?
Helps in cellular and brain maturation
How can blocking of Glutamate receptors lead to ASD
Glutamate dysregulation can lead to neuronal damage
What should be looked at in the investigation into a child with ASD?
Speech and language
Social Skills
Sensory
What could be observed in a child with ASD?
Speech and Language
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
What could be observed in a child with ASD?
Social skills
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
What could be observed in a child with ASD?
Sensory
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
What could be observed in an adult with ASD?
Communication
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
What could be observed in an adult with ASD?
Social
Appear blunt
Take things literals
Difficulty fitting in as doesn’t follow norms
Appear shy or avoid interaction
What is a good diagnostic tool in ASD?
ADOS
Autism Diagnostic Observation Schedule
What neurodevelopment disorders are common comorbidities with ASD?
Tourettes OCD ADHD Dyspaxia Dyslexia Language Impairment
What percentage of ASD patients have Tourettes?
7%
What percentage of ASD patients have OCD?
30%
What percentage of ASD patients have ADHD?
65%
What percentage of ASD patients have Dyspraxia ?
17%
What percentage of ASD patients have Dyslexia?
70%
What percentage of ASD patients have a language impairment?
70%
What percentage of patients with ASD and a learning disorder have an IQ <70
65%
What percentage of patients with ASD and a learning disorder have an IQ <50
35%
What is the main management of ASD?
Psychosocial
No real pharmacological treatment
What psychosocial management is given to ASD patients?
Self and family psychoeducation Speech and language therapy Social skills training Family and school based support Diet - Conflicting evidence diet has an influence
What medication is used in ASD?
Risperidone - antipsychotic
Used acutely for severe aggression and self injury
