ASD, ADHD and Disorders of Intellectual Development

Question 1

Define neurodevelopment disorders?

Answer 1

multifaceted conditions characterized by impairments in cognition, communication, behavior and/or motor skills resulting from abnormal brain development

Question 2

Define adaptive functioning?

Answer 2

skills necessary to cope in environment with greatest success and least conflict with others e.g. grooming, getting dressed, avoiding danger, safe food handling

Question 3

What is the triad of impairments in ASD?

Answer 3

social communication, social interaction and social imagination

Question 4

ICD 11 classifications for autism?

Answer 4

Autism spectrum disorder can be classed as:
* Without or with disorders of intellectual development
* With impairment/ absence or no impairment of functional language

ASD no longer includes Rett’s syndrome under classifications

Question 5

How does ASD differ from disorders of intellectual development?

Answer 5

• ASD diagnosis is based on social functioning, disorders of intellectual development are based on intellectual and adaptive functioning

Question 6

Specific Criteria for ASD?

Answer 6

• Persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the expected range of typical functioning given the individual’s age and level of intellectual development. Manifestations may include limitations in the following:
  o Understanding of, interest in, or inappropriate responses to the verbal or non-verbal social communications of others.
  o Eye contact, body language, facial expressions
  o Understanding and use of language in social contexts and ability to initiate and sustain reciprocal social conversations
  o Social awareness, leading to behaviour that is not appropriately modulated
  o Ability to imagine and respond to the feelings, emotional states, and attitudes of others.
  o Mutual sharing of interests.
  o Ability to make and sustain typical peer relationships.
• Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. These may include:
  o Lack of adaptability to new experiences and circumstances, with associated distress
  o Inflexible adherence to particular routines
  o Excessive adherence to rules (e.g., when playing games).
  o Excessive and persistent ritualized patterns of behaviour (e.g., preoccupation with lining up or sorting objects in a particular way) that serve no apparent external purpose.
  o Repetitive and stereotyped motor movements e.g. hand flapping
  o Persistent preoccupation with one or more special interests
  o Sensory sensitivities

Question 7

Is ASD more common in girls or boys?

Answer 7

boys
ratio 5:1

Question 8

Essential criteria for ASD?

Answer 8

• Symptoms must be present in the early developmental period
• Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning (regardless of age) - or functioning is only maintained through an exceptional amount of effort
• Disturbances are not better explained by other mental health problems, intellectual disability or global developmental delay

Question 9

Management of ASD?

Answer 9

• Self and family psychoeducation
• Applied behavior analysis, SALT, social skills training
• Family and school based supports
• There is no medication for ASD but it may be used for co-morbidities

Question 10

What is the triad of difficulties in ADHD?

Answer 10

inattention, hyperactivity and impulsivity

Question 11

ADHD must be _____

Answer 11

pervasive (across settings i.e. home and school) and long standing from age 5

Question 12

Classifications of ADHD?

Answer 12

predominantly inattentive subtype, predominantly hyperactive/ impulsive subtype or combined subtype

Question 13

Management of ADHD Psychosocial?

Answer 13

• Parent training (New Forest parenting program)
• Social skills training
• Behavioural classroom management strategies
• Specific educational interventions

Question 14

Management of ADHD pharmacological?

Answer 14

• 1st line – stimulants e.g. methyphenidate, dexamfetamine, lisdexamfetamine- these are all highly effective
• 2nd line- SNRI e.g. atomoxetine
• 3rd line- alpha agonist e.g. clonidine, guanfacine
• 4th line- antidepressants, antipsychotics – imipramine, risperidone

Question 15

Define disorders of intellectual development?

Answer 15

• Deficits in intellectual functioning defined as an IQ less than 70
• Deficits in adaptive functioning (how well a person handles the common demands of life and how independent they

Question 16

Disorders of intellectual development must have _____

Answer 16

a developmental aetiology

Question 17

What is a borderline disorder of intellectual development? (IQ, mental age, level of ability?)

Answer 17

• IQ range 70-84, mental age 12- <15 years
• Not a DSM or ICD category
• Can generally cope on their own

Question 18

What is a mild disorder of intellectual development? (IQ, mental age, level of ability?)

Answer 18

• IQ range 50-69, mental age 9 to < 12 years
• Most common ID
• Delayed speech but uses everyday speech
• Full independence in every day activities but struggles to read or write
• Often has other relatives with a low IQ

Question 19

What is a moderate disorder of intellectual development? (IQ, mental age, level of ability?)

Answer 19

• IQ range 35-49, mental age 6- <9 years
• Slow with comprehension and language
• Limited achievements
• Delayed self care and motor skills
• Simple practical tasks can be done under supervision
• Usually fully mobile and physically active

Question 20

What is a severe disorder of intellectual development? (IQ, mental age, level of ability?)

Answer 20

• IQ range 20-34, mental age 3 to < 6 years
• Marked impairment

Question 21

What is a profound disorder of intellectual development? (IQ, mental age, level of ability?)

Answer 21

• IQ < 20 (this is difficult to measure using a test), mental age < 3 years
• Severe limitation in ability to understand or comply with requests or instructions
• Little or no self care
• Often severe mobility restriction
• Basic or simple tasks may be acquired

Question 22

Aetiology of disorders of intellectual development?

Answer 22

• ID refers to an outcome caused by disparate disease process (this is a really fancy way of saying that ID is caused by diseases that don’t have the same effect on everyone who gets them, diseases that cause of a range of outcomes in people such as cerebral palsy where some people are severely disabled and others only slightly disabled)

Some examples:
* Chromosomal abnormalities e.g. Prader Willi, Turners, Downs, Edwards, Klinefelter
* Genetic e.g. phenylketonuria, tuberous sclerosis, congenital hypothyroidism
* CNS malformations of unknown aetiology e.g. microcephaly, macrocephaly
* Prenatal factors e.g. maternal infection such as rubella, CMV, toxoplasmosis, maternal exposure to drugs, alcohol or poor diet
* Perinatal factors e.g. neonatal septicaemia, pneumonia, meningitis, birth injury, respiratory distress, hypoglycaemia
* Postnatal factors e.g. CNS infections, vascular accidents, head injury, cerebral palsy, epilepsy

Question 23

People with an intellectual disability are _____ more likely to die of an avoidable cause than the general population?

Answer 23

4x

Question 24

Side effect of methylphenidate used in ADHD?

Answer 24

stunted growth (because it suppresses appetite)
should only give to children > 5 years old where ADHD is still causing significant impairment after trying environmental modifications

need weight and height monitored regularly