ASD and ADHD Flashcards
state some neurodevelopmentla disorders 6
ADHD
ASD
tourettes
learning difficulties
dyslexia
dyspraxia
define ADHD
syx of inattention and/or hyperactivity/impulsviity significantly interfere with daily function
prevalanece of ADHD
5.2% in US
3.45% europe
2.8% worldwide
gender bias of ADHD
M:F 4:1
developmental impact of ADHD at the following age:
pre-school 1
behaviour disturbance
developmental impact of ADHD at the following age:
school age 4
behavioural distrubance
academic impairment
poor social interaction
peer acceptance
developmental impact of ADHD at the following age:
adolescent 5
academic impairment
social skills learning
self-esteem
smoking/alcohol/drugs
antisocial behaviour
developmental impact of ADHD at the following age:
college age 5
academic failure
occupational difficulties
self esteem
alcohol and substance abuse
injury/accidnet
developmental impact of ADHD at the following age:
adult 6
not coping with daily tasks
unemployment
relaitonship problems
motor accidents
alcohol and substance abuse
mood instabi.ity
presentation of ADHD in adults
chaotic
disorganised
always late
restless
fidgeting
and more
diagnosis of ADHD 4
2-3 sessions,. no rush
detailed psychatirc and developmental assessment
collateral history
-school reports
-parental reports
-sbiling report
Neuropsychatirc assessment
inattentive syx of ADHD 9
-*mneomic
*-mneomonic -DADMOMLFC
(mom taught me ABC dad taught me LFC)
Difficulty sustaining attention
Avoids sustaining attention
Distracted easily
Misplaces things
Organisation problems
Mistakes made
Listening difficult
Forgetful in daily activities
Completing tasks or jobs
hyperactive/impulsive syx of ADHD 9
*-mneominc
*-LFROST/WIB
Loud in quiet situations
Fidgetiness
Restless or overactive
On the go all the time
Seating difficult
Talks excessively
Waiting difficult
Interrupts or intrudes
Blurts out prematurely
other syx of ADHD 5
affective instability
ceasless mental acitivty
mind wandering
initial insomnia
hyperfocus
differenital diagnosis for ADHD
normal behaviour
malingering or seeking stimulant medications
hyperthyroidism, susbtance abuse, mania
important point abotu differntials for ADHD
could also be a co-morbidiity
-check other syx
-check response to treatment
what happens after someone is diagnosed with ADHD 2
delineate ADHD syx from comorbid syx and normal behaviour
inform:- employer, university/college, DVLA, car insurers
medication for ADHD
suppress syx
-treatmetns increase neurotransmission of dopamine and/or noradrenaline
1st line- stimulants
2nd line- non-stimulants
pros and cons of stimulant ADHD medications 2v1
pro- immediate action
-controlled drugs
cons
-more potential for diversion
pros and cons of non-stimulant ADHD medication 1v2
pros
-preferable if concern about diversion
cons
delayed onset of action
-similar to antidepressants
-non-controlled drugs
First line treatement for ADHD in adults
methylphenidate
moa of methylphenidate
DA and NA reuptake inhibitor
types of preparations of methylphenidate and why is this beneficial
immeidate release preparations
-cheaper
-can allow more fine tuning of dosing
slow release preparation
-allow once daily AM dosing
*-can be combined to fine tune syx control at certain times of day
dose titration of methylphenidate 3
increment- smallest available
interval- at least 2 weekly
until-adequate resonpnse or intolerable side effects or increase in BP and HR
examples of methyphenidates 5
ritaline/medikinet - immediate release
slow release:
-concerta
medikinet XL
equasym
side effects of methylphenidates 7
reduced appetite
insomia
headache
irritability
tachycardia
tics
seziures
alternative stimulant medication to methylphenidate for ADHD
dexamfetamine
MOA and use of dexametamine for ADHD
DA and NA releaser and reuptake inhibitor
USE
-worth trial if poor response to methylphenidate
*watch as considered more abuse/diversion potential than methylphenidate
first line non-stimulant medication for ADHD
atomoxetine
MOA and use of atomoxetine for ADHD
MOA- NARI
USE
-when stimulant not tolerated or risk of diversion
*remember has delayed onset several weeks
severe side effects of atomoxetine 2
common side effects -5
acute liver failure
suicidality
*-both rare
-can be avoided by gradual dose titrations
common:
-reduced appetite
-nausea
-insomia
-dizziness
-constipation
-sweating
-sexual dysfunction
-seizures
contraindications to atomoexteine 1
phaechromocytoma
other options for ADHD medication 4
guanfacine/clonidine
buproprion
modafinil
nortriptule or desipramine
assessing repsonse in ADHD 4
core syx
assoc syx
functionig
patient report/ collateral
points on prescirbing in ADHD when co-morbidity is present
treat most severe condition first
optimise exisitng treatment
Examples:
Psychosis - non-stimulant preferable, antipsychotic cover
Depression – careful with side effects if already on antidepressant
with NA effect
Mania - mood stabiliser/antipsychotic cover
Anxiety - stimulants may exacerbate, atomoxetine preferable
Addiction – depends on substance, 6/12 abstinence
Tourette’s syndrome – stimulants make tics worse
duration of treatment for ADHD
6 monthly BP/HR
drug holiday
-period without meds
-considered annual
-assess whether grown out of ADHD
how does aspergers differ to ASD
similar to autism bu no general delay in language or cognigitev development
-tend to have normal intelligence
triad of core syx of ASD
abnormal reciprocal social interactions
communciation/langage impairemnt
resitricted and repetitive interests/activties
incidence of ASD and gender bias
-*IQ spread
M:F 4:1
prevalence- 0.5-1%
*-80% have low IQ ( learning disability)
-20% normal IQ (high functioning autism)
-aspergers syndrome (normal language)
aetiology of ASD 4
tendency to run in families
genetic mutations
-many assoc w development of brain
non-genetic factors
-parental age
-birth complications
-
charactersitics of abnormal social interactions for ASD 6
indiffernce
minimal shared nejoyment
reciprocal interction
only early life friends
limited empathy, insensitive
lack of intuition
charactersitics of communcation/ langugae impairemnt for ASD 6
delayed or lack of speech
prolonged or avoidant eye contact
awkward posture or body language
unusual speech volume
misinterpreationof literal or implied meaning
advanced voacb- poor convo skills
charactersitics of resistricted and repeitive intererst/behaviours for ASD 6
obsessive fixed intrests
motor mannerisms- hand flapping, body rocking
compulsive/repeitive behaviours
preference for smaeness
increased sensory responsiveness
change unsettling
other featuers of ASD 3
clumsiness
difficulites expressing emotion
increased pain threshold
assessment of ASD 2
whos involved:
-doctors
-speech and langue therapy
-occupational therapy
-psychology
standardised tools
-autism behaviour checklist
childhood autism rating scales
autism diagnostic observation schedule
principles of ASD management 3
structue
routine
predicatbility
general points about ASD managment 5
adapt enviornemt
-reduce complex social interactions
-use routine/timetabling
communication aids
-use of pictures or objects
social skills training
CBT, OT
family support -parenting programmes
use of medciation for ASD 3
symptomaitc
-antipsychotic for stereotyped or aggressive hevioaurs
SSRIs for compulsive behaviours
melatoinin for insomnia
