ADHD and autism spectrum disorder (spring) Flashcards
define Attention Deficit Hyperactivity Disorder
“persistent pattern of inattention or hyperactivity—impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development
diagnosis of ADHD
Diagnosis is done through assessment of information collected from parent and school and the young person themselves if old enough (e.g. Conner’s Comprehensive Behavior Rating Scales assessment)
Computerised testing of core symptoms is also possible hyperactivity, impulsivity and inattention/distractibility (e.g. QbTest)
what are each of these involved in?
Frontoparietal circuits
Dorsal frontal parietal circuits
Mesocorticolimbic circuits
Frontoparietal circuits- alerting atention, orienting response.
Dorsal frontal parietal circuits- inhibitory control, response selection, executive functions.
Mesocorticolimbic circuits- motivation, reward processing, frustration and aggression.
risk factors for ADHD
Genetic dysfunction in ADHD: dopamine transporter, D4 receptor, dopamine beta-hydroxylase, MAOA, catecholamine-methyl transferase, SLC6A4, 5-HT2A, 5HT1B, DAT1 gene, DRD4 gene.
Environmental/Social factors: E.g. Lead exposure, smoking/alcohol in pregnancy
why are animal models used?
To model behavioural characteristics
To test therapeutic compounds, genetic associations, and identify novel ADHD candidate genes
treatment for ADHD
Stimulant drugs - ADHD children require more stimulation to maintain attention.
- Methylphenidate (Ritalin)
- Dexamfetamine (Dexedrine)
- Atomoxetine (Strattera)
Where there may be concern about the potential for drug misuse and diversion (for example, in prison services), atomoxetine may be considered as the first‑line drug treatment for ADHD in adults
For adults with ADHD and drug or alcohol addiction disorders there should be close liaison between the professional treating the person’s ADHD and an addiction specialist
Antipsychotics are not recommended for the treatment of ADHD in adults
what is the Mechanism of action of Methylphenidate?
Norepinephrine–dopamine reuptake inhibitor
was does NICE recommend as treatment for young people and children with ADHD?
Drug treatment is not indicated as the first‑line treatment for all school‑age children and young people with ADHD. It should be reserved for those with severe symptoms and impairment or for those with moderate levels of impairment who have refused non‑drug interventions, or whose symptoms have not responded sufficiently to parent‑training/education programs or group psychological treatment.
Moderate levels of impairment: psychological interventions
was does NICE recommend as treatment for adults with ADHD?
Drug treatment is the first‑line treatment for adults with ADHD with either moderate or severe levels of impairment.
Methylphenidate is the first‑line drug. Psychological interventions without medication may be effective for some adults with moderate impairment, but there are insufficient data to support this recommendation. If methylphenidate is ineffective or unacceptable, atomoxetine or dexamfetamine can be tried.
If there is residual impairment despite some benefit from drug treatment, or there is no response to drug treatment, CBT may be considered. There is the potential for drug misuse and diversion in adults with ADHD, especially in some settings, such as prison, although there is no strong evidence that this is a significant problem.
define autism
Autism is a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them
diagnosis of Autism Spectrum Disorder
No objective diagnostic test. Assessment based on information from:
- parents (through structured interview about developmental history)
- school where possible (via observation and questionnaires from teachers)
- direct observation of the individual using a semi-structured ( e.g. the Autism Diagnostic Observation Schedule – ADOS)
- Self-report questionnaires can be useful for adults as a screen (e.g. Autism Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale (RAADS)
Symptoms/presentation of autism spectrum disorder
Difficulties with social communication (e.g. poor eye contact, monotone voice, difficulties reading social cues like body language or gestures, difficulty with ”unwritten rules”, knowing how to start a conversation, knowing when to stop talking)
Pattern of interests/behaviours (repetitive behaviours, obsessive interests in hobbies or topics that can be all encompassing, difficulties with change, high dependence on routines and predictability)
Other common issues
- sensory interests or sensitivity (e.g. may find lights too bright, can’t tune out from background noises like a fan going or someone else talking – these can be experienced as “physically painful”
- Emotional dysregulation – experiencing very strong emotional reactions to things and difficulties with managing those feelings
- Motor mannerisms
Adulthood
- Outcome in adulthood is generally poor
- Often need daily support
- Generally studies find: 75% ‘able’ (no ID) adults not living independently, low employment etc.
- Bullying/Peer Victimisation – Social Vulnerability.
risk factors of autism spectrum disorder
Environmental/Social factors
- parental – maternal and paternal – age at time of conception
- Non-specific factors during pregnancy (maternal metabolic conditions, weight gain)
- Specific factors (maternal bacterial or viral infections)
- Maternal medication use (Valproic acid use associated with increased risk of ASD)
Genetic factors
- Heterogenous, individual genetic variants associated with ASD risk
- Autism like symptoms are observed in monogenic developmental disorders such as Rett syndrome and Fragile X.
- (This has led to the development of mouse models for these disorders, which display some autism like characteristics)
treatment for autism spectrum disorder
Non-pharmacological treatments recommended by NICE
Psychosocial interventions (under 19s)
- social-communication intervention for the core features of autism in children and young people that includes play-based strategies with parents, carers and teachers to increase joint attention, engagement and reciprocal communication in the child or young person. Strategies should:
- be adjusted to the child or young person’s developmental level
- aim to increase the parents’, carers’, teachers’ or peers’ understanding of, and sensitivity and responsiveness to, the child or young person’s patterns of communication and interaction.
- include techniques of therapist modelling and video-interaction feedback.
- include techniques to expand the child or young person’s communication, interactive play and social routines.
- The intervention should be delivered by a trained professional. For pre‑school children consider parent, carer or teacher mediation. For school‑aged children consider peer mediation.
In complex cases, antipsychotics may be used
how does treatment for ADHD and ASD differ in children and adults?
pharmacological treatments are not recommended as a first-line treatment in children. treatment focuses on non-pharmacological approaches.
