ASD and ADHD Flashcards
what are the 5 disorders that come under the umbrella of ASD
Asperge's Rett's Childhood autism Pervasive developmental disorder Pervasive developmental disorder NOS
what is the most common disorder on the ASD spectrum
Asperge’s
what is the triad of impairments people with ASD have
social communication
social interaction
social imagination
ASD also has the feature of ______ behaviours
repetitive
describe ASD social communication impairment
good with language but find it hard to grasp the underlying meaning of conversation - difficulty understanding jokes etc
ASD often has narrow interesting which dominates conversation - this is known as
lack of reciprocity
describe ASD social interaction impairment
difficulty picking up non-verbal ques - appear self-focused and lacking in empathy but they are just trying to figure out social situations
do people with ASD find it easy to share their thoughts and feelings
no
do people with ASD find it easy to make friends
no - struggle to make and sustain personal and social relationships
describe people with ASD social imagination impairment
difficulty thinking flexibly - inability to understand peoples views and take things literally
difficulty projecting themselves into the future or making goals sensibly
describe the repetitive movements in ASD
stereotyped or repetitive motor movements, uses of objects or speech
insistance on sameness
is ASD more common in boys or girls
boys
____ levels are reduced in females with asperge’s, pointing to higher levels of free ______
SHBG
testosterone
true/false
gender identity problems are higher in people with ASD
true
is ASD inheritable
yes very
what chromosomal abnormalities are involved in ASD
deletion, duplication and inversion
what is the most common form of inherited intellectual disability
fragile X syndrome
____ in pregnant mother may cause ASD
Rubella
name 3 other things that may cause ASD
Tuberous sclerosis
Encephalitis
Untreated PKU
what are some perinatal complications that may cause ASD
umbilical cord complications foetal distress birth injury or trauma multiple birth maternal haemorrhage LBW/SGA congenital malformation meconium aspiration neonatal anaemia, ABO or Rh incompatibility and hyperbilirubinaemia
what 3 brain areas appear pathological in autism
frontal lobes, amygdala and cerebellum
the ______ in boys with autism appears larger leading to more severe ____ and worse _____
amygdala
anxiety
worse social and communication skills
what 3 neurotransmitters are implicated in autism
Glutamate
GABA
serotonin
what are some signs you would look for in children for a diagnosis of ASD
- speech and language difficulties
- lack of awareness of and interest in other children - play alone
- sticking to same routine
- repetitive activity
- sensory processing difficulty
what kind of speech and language difficulties are seen in children with ASD
- dont babble or use other vocal sounds
- repeat words or phrases spoken by others without forming or developing their own language
- difficulty with non-verbal interactions e.g. eye contact
if a child with ASDs routine is changed slightly what might happen
tantrum
what is an example of a repetitive activity seen in ASD
watching the same movie over and over again
describe the sensory difficulties seen in children with ASD
any of the senses may be over or under sensitive e.g. some foods too strong or noises too loud
how is ASD diagnosed in adults
same as children but better adjusted to social conventions
are there any biological markers for diagnosing ASD
no
how can ASD be diagnosed
subjective clinical assessment - good developmental history and collateral history
+ assessment tools
name 2 screening questionnaires
3DI (The Developmental, Dimensional and Diagnostic Interview)
DISCO (Diagnostic Interview for Social and Communication Disorders)
what is the standardised assessment tool for diagnosing ASD
Autism Diagnostic Observation Schedule - ADOS
what is the essential criteria for a diagnosis of ASD
symptoms must
- be present in early developmental period
- cause significant impairment in social, occupational or other important areas of current functioning
- not be better explained by other mental health problems/intellectual disability/global developmental delay
people with ASD commonly have what comorbidities
depression and anxiety ADHD, tourettes, OCD dyslexia, language impairment learning disability epilepsy hearing / visual impairment
what are some non-pharmacological managements of ASD
- self and family psychoeducation
- applied behaviour analysis
- speech and language therapy
- social skills training
- social care
- dietician
what drug is licensed for management of severe aggression and significant self injury in ASD
risperidone
when is pharmacological intervention appropriate in ASD
to treat co-morbidity
what can be given to treat chronic insomnia
melatonin
_____ may be a blood based biomarker for social functioning
oxytocin
what is the triad of difficulties in ADHD
inattention
hyperactivity
impulsivity
ADHD is more common in males/females
males
is ADHD as common in adults as it is in children
no but almost
the triad of difficulties in ADHD are …. (4)
- developmentally inappropriate
- impairing function
- pervasive across settings
- longstanding from age 5
the triad of difficulties in ADHD are frequently co-occurring with what cluster of symptoms
impairing symptoms relating to self regulation
is ADHD a disorder or a spectrum
spectrum
how do adult and child ADHD differ
adult ADHD has less obvious symptoms of hyperactivity or impulsivity and more obvious inattentive symptoms
how does childhood ADHD impact lives
- difficult to parent
- emotional dysregulation leads to difficulties in friendships and reckless and dangerous behaviour
- exclusion from education and antisocial behaviours
in adults with ADHD there is increased rates of ____ and ______
criminality and substance misuse
what causes ADHD
perinatal precipitants, genetic predisposition and psychosocial adversity lead to neuroanatomical brain changes which lead to the cognitive and behavioural features of ADHD
what neurotransmitter genes are mainly involved in ADHD
dopamine and serotonin
there is ____ clustering in ADHD
familial
what are some perinatal factors that lead to ADHD
tobacco and alcohol
prematurity and perinatal hypoxia
unusually short or long labour/foetal distress/forceps
eclampsia
exposure to what in the 1st trimester can lead to ADHD
viral infection
what kind of parenting is assoc. with ADHD
inconsistent parenting (psychosocial adversity)
what other psychosocial adversities is ADHD assoc. with
severe marital discord, big family, low social class, paternal criminality, maltreatment
genetic risk is an important precursor that may be compounded or turned on by ______
psychosocial factors / perinatal factors
in ADHD there is ______ function in the frontal lobe
underactive
in ADHD there is a ____ concentration of dopamine uptake transporters
higher - excessively efficient dopamine removal system
symptoms in ADHD may also be caused by reduction of ____ and _____
NA and serotonin
assessment of childhood ADHD is mainly driven by
parents / school
assessment of adult ADHD is mainly driven by
patient
how is childhood ADHD assessed
screening questionnaires and structured diagnostic questionnaires
background info regarding RFs
early history and attachment
what is common in adult ADHD
comorbidities
what is the diagnostic criteria for childhood ADHD
6 or more symptoms of inattentiveness and/or 6 or more symptoms of hyperactivity and impulsiveness
present before age 5
reported by parnets/school/seen in clinic
symptoms get in the way of daily life
what is the diagnostic criteria for adult ADHD
5 or more symptoms of inattentiveness and/or 5 or more of hyperactivity and impulsiveness
historical concerns since early age
symptoms have a moderate effect on different areas of their life such as work/driving/relationships
what are the psychosocial interventions for mild moderate and severe ADHD in children
parent training (New Forest Parenting programme) social skills training behavioural classroom management strategies
what is a good tactic for children with ADHD in the classroom
sit at the front
what can be given to improve sleep cycle
melatonin (controversial)
when can pharmacological managements be used in ADHD
moderate and severe
what is the 1st line pharmacological treatment of ADHD
stimulants
give 3 examples of stimulants
methylphenidate
dexamfetamine
lisdexamfetamine
what is 2nd line pharmacological treatment of ADHD
SNRI
give an example of an SNRI used in ADHD
atomoxetine
what is 3rd line pharmacological treatment of ADHD
alpha agonist
name 2 alpha agonists
clonidine
guanfacine
what is 4th line pharmacological treatment of ADHD
antidepressants - imipramine
antipsychotics - risperidone
how does methylphenidate work
stimulant
- increases dopamine by blocking transporter
what are some side effects of methylphenidate
head ache
poor appetite
insomnia
how does dexamphetamine work
stimulant - increase dopamine by blocking transporter
also increases NA and serotonin
how do alpha agonists work in ADHD
increase NA by reducing sympathetic stimulation
what neurotransmitter is responsible for alterness
dopamine
what neurotransmitter is responsible for concentration
norepinephrine
what neurotransmitter is responsible for satisfaction
serotonin
