Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Behavioral dynamics > Autism/ADHD > Flashcards

Autism/ADHD Flashcards

1
Q

Characterized by a persistent pattern of diminished sustained attention and high levels of impulsivity or hyperactivity

A

Attention-Deficit/Hyperactivity Disorder (ADHD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

at what age does ADHD must be present by?

A

12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 major specifiers for ADHD

A
  1. ADHD, Predominantly Hyperactive/Impulsive (ADHD-PH)
  2. ADHD, Combined Type
  3. ADHD, Predominantly Inattentive (ADHD-PI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which ADHD type is excessive fidgeting and restlessness, hyperactivity, difficulty remaining seated and waiting turns, impulsivity

A

ADHD, Predominantly Hyperactive/Impulsive (ADHD-PH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which ADHD type is disorganization, forgetful, easily distracted, daydreamers, difficulty completing tasks

A

ADHD, Predominantly Inattentive (ADHD-PI) aka Attention Deficit Disorder (ADD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the epidemiology of ADHD

A
  1. 2-18% of children; 3-5% of adults*
  2. males MC
    - 4:1 for ADHD-PH, 2:1 for ADHD-PI*
  3. Comorbidities - conduct disorders, anxiety, depression, learning disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

biological causes of ADHD

A
  • Impaired catecholamine (norepinephrine, dopamine) metabolism in the brain
  • Genetics - increased risk in pts with (+) family history of ADHD, up to 92% for monozygotic twins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

environmental causes of ADHD

A
  • Intake of food additives or refined sugar
  • Deficiency of fatty acids, iron or zinc
  • Prenatal tobacco or alcohol exposure
  • Screen time exposure
  • Prematurity, low birth weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

criteria for ADHD

A

6+ symptoms from one category (inattentive or hyperactive), or 6+ from each, for 6+ months
1. Maladaptive and inconsistent with developmental level
2. Some symptoms must have been present before age 12
3. Clear functional impairment from symptoms present in 2+ settings
4. Symptoms not better accounted for by another disorder
5. symptoms
- inattentiveness
- Hyperactivity
- Impulsivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the non-pharm tx for ADHD

A
  1. Behavioral Interventions
  2. Cognitive Therapy
    (Psychotherapy)
  3. Dietary Modifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the preferred tx over medication for preschool ADHD pts

A

Behavioral Interventions
Reported to improve behavior in preschool-age pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what tx is an adjunct for older children and teens and alone, does not improve core ADHD s/s in school-age pts

A

Behavioral Interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

common interventions of behavioral interventions

A
  1. Daily schedule
  2. Using charts and checklists
  3. Minimal distractions
  4. Limiting choices
  5. Specific and logical storage places
  6. Rewarding positive behaviors
  7. Using calm discipline, such as time-out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

common interventions of behavioral interventions

A
  1. Daily schedule
  2. Using charts and checklists
  3. Minimal distractions
  4. Limiting choices
  5. Specific and logical storage places
  6. Rewarding positive behaviors
  7. Using calm discipline, such as time-out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is not recommended as monotherapy

A

cognitive therapy
No major improvement in core symptoms of ADHD
Any improvement noted is unlikely to transfer to practical settings (ex. school, home)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are 3 dietary modifications that could help ADHD

A
  1. Elimination Diets
    - not recommended
  2. Fatty Acid Supplementation
    - not recommended
  3. Other Alternative Therapies
    - Megavitamins, chelation, “detox”, herbal or mineral supplements
    - No solid evidence to support efficacy
    - Can have harmful side effects and setback in improvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which dietary modifications must you closely monitor to ensure adequate nutrition for children when tx ADHD?

A

elimination diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the pharm tx of ADHD

A
  1. Stimulants
    - Methylphenidate
    - Amphetamines
  2. non-stimulants
    - Atomoxetine (Strattera)
    - Alpha-2 Adrenergic Agonists
    - antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ritalin

A

Methylphenidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Focalin

A

Methylphenidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Concerta

A

Methylphenidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Quillivant

A

Methylphenidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

adderall

A

amphetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lisdexamfetamine

A

amphetamine
(vyvanse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Clonidine (Kapvay)

A

Alpha-2 Adrenergic Agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Guanfacine (Intuniv)

A

Alpha-2 Adrenergic Agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the criteria for pharm tx of ADHD

A
  1. Full diagnostic assessment has been completed and confirms dx
  2. Child is at least 6 years old¹
  3. School will cooperate in administration and monitoring of rx
  4. No concerns about substance use in household members
  5. No history of…
    - Sensitivity or allergy to chosen medication
    - Uncontrolled tachycardia
    - Uncontrolled hypertension
    - Uncontrolled anxiety
    - Seizures
    - Pervasive developmental delay
    - Tourette syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the 1st line tx for ADHD?

A

pharm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Generally considered first-line tx for children 6 yo and up with functional impairment due to ADHD

A

Stimulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what schedule are Stimulants

A

schedule II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

which pharm tx is known to increase intrasynaptic levels of catecholamines (norepinephrine, dopamine)

A

stimulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which stimulant blocks reuptake of catecholamines

A

Methylphenidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

which stimulant blocks reuptake and stimulate dopamine release?

A

amphetamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

benefits of extended release forms of stimulants

A

helpful due to need to treat ADHD in multiple settings
1. Reduce adverse SE at peak levels of drug
2. Reduce “crash” SE when drug is cleared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Many stimulants come with special release formulations to manage symptoms and what else?

A

reduce tachyphylaxis
Partial immediate-onset, partial delayed-onset
Some have capsules that can be opened, some must be swallowed whole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what medications do not treat emotional problems, defiant behavior, learning impairment, reduced social skills

A

stimulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

may be able to miss doses on weekends, vacations

A

drug holiday

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how do you adjust dosing schedules?

A

based on symptoms, activities and functional impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Start at lower doses and gradually titrate up until:

A

40-50% improvement in symptoms
SE become intolerable or max dose reached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

common SE of stimulants

A
  1. Reduced appetite
  2. Insomnia or nightmares
  3. Feeling “on-edge” or “jittery”
  4. Emotional lability
  5. Weight loss and/or decreased height
    - Routine monitoring of growth in pediatric pts
  6. Development of tics
  7. Usually mild and correctable with dose adjustments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

less common SE of stimulants

A
  1. CV - Increased HR, increased BP, palpitations; peripheral vasculopathy (Raynaud’s)
  2. Priapism - seen with methylphenidate; very rare
  3. Neuro - Headache, dizziness
  4. GI - N/V/D
  5. Psych - psychotic symptoms, manic symptoms
  6. Diversion or Misuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

pt is experiencing decreased appetite while on stimulants, how could you fix this?

A

dose at or following a meal; emphasize nutrient-dense foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

pt is experiencing poor growth while on stimulants, how could you address this?

A

drug holiday or change in therapy if substantial deceleration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

pt is experiencing dizziness while on stimulants, what can you do?

A

monitor BP and HR; adequate fluids; XR formulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

pt is experiencing sleep disturbances, what could you do?

A

normal bedtime routine; earlier dosing or decrease/omit last dose of day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

pt is experiencing mood lability while on stimulants, what could you do?

A

XR formulations; evaluation for comorbid psych disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

pt is experiencing rebound while on stimulants, what could you do?

A

Increased dose or adding another dose later in the day

48
Q

pt is experiencing tics while on stimulants, what could you do?

A

trial of different dose or changing medication to non-stimulant

49
Q

pt is experiencing psychosis while on stimulants, what could you do?

A

discontinue stimulant; psych referral if needed

50
Q

you discover your pt is misusing/diversion stimulants, what could you do?

A

formulations with decreased abuse potential; discussion with patient and parents; changing to non-stimulant therapy

51
Q

CI for stimulants

A
  1. Allergic
  2. hx of substance abuse
  3. Hyperthyroidism
  4. Glaucoma
  5. CV
    - Symptomatic CV disease
    - Moderate-severe HTN
    - Arrhythmias or HF
  6. Neuro/Psych
    - Motor tics or Tourette syndrome
    - Agitated states
    - Anxiety
    - Use within 14 days of MAOI
52
Q

which stimulant is a transdermal patch?

A

daytrana - methylphenidate

53
Q

which stimulant is preferred for preschool-age children requiring meds

A

Methylphenidate

54
Q

which stimulant is generally better tolerated with regard to side effects
Associated with slightly less weight loss
Rarely associated with priapism

A

Methylphenidate

55
Q

which stimulant is not preferred for preschool-age children requiring meds

A

Amphetamines

56
Q

which stimulant is less tolerated with regard to side effects
Associated with slightly more weight loss
Not associated with priapism

A

Amphetamines

57
Q

which medication is a Selective norepinephrine reuptake inhibitor

A

Atomoxetine (Strattera)

58
Q

which medications are not a controlled substance for ADHD

A
  1. Atomoxetine (Strattera)
  2. Alpha-Adrenergic Agonists
    - XR Clonidine (Kapvay)
    - XR Guanfacine (Intuniv)
59
Q

which medicaiton is used mainly if stimulants can’t be used - not first-line

A

Atomoxetine (Strattera)
- Intolerable SE to stimulants
- Desire to avoid stimulant therapy
- History of tic disorder or development of tics
- Risk of diversion/abuse of stimulants

60
Q

SE of atomoxetine (strattera)

A
  1. GI - decreased appetite, N/V, abdominal pain, dyspepsia, weight loss
  2. CV - rare; may see increased BP and HR, arrhythmias, peripheral vasculopathy
  3. Priapism
  4. Neuro/Psych - psychosis, suicidal thoughts, tics
  5. Liver Injury
61
Q

CI for atomoxetine (strattera)

A

allergy to drug; use within 14 days of MAOI; glaucoma; pheochromocytoma; severe cardiovascular disease (heart failure, arrhythmia, etc.)

62
Q

which drug is responsible for the stimulation of alpha-2 adrenergic receptors in the central nervous system
May take up to 2 weeks to see response

A

Alpha-Adrenergic Agonists

63
Q

which medication is mainly used for pts who fail to respond to or cannot tolerate stimulants or atomoxetine

A

Alpha-Adrenergic Agonists

64
Q

which medications are 3rd-line monotherapy or adjunct to stimulants

A

XR Clonidine (Kapvay)
XR Guanfacine (Intuniv)

65
Q

which medication has sedating SE
helpful in agitated, aggressive, or highly active pts
help offset some SE of stimulants

A

XR Clonidine (Kapvay)

66
Q

SE of XR Clonidine (Kapvay)

A

sedation, depression, bradycardia, low BP, HA

67
Q

CI for XR Clonidine (Kapvay)

A

hypersensitivity

68
Q

which medication Improves ADHD symptoms, but not as effective as stimulants
Once-daily dosing
Fewer side effects than XR clonidine

A

XR Guanfacine (Intuniv)

69
Q

SE of XR Guanfacine (Intuniv)

A

sedation, HA, fatigue, abdominal pain

70
Q

CI for XR Guanfacine (Intuniv)

A

hypersensitivity to drug

71
Q

4th line therapy for ADHD

A

TCAs
Concern over SE, especially cardiotoxicity
May be helpful in children with comorbid mood disorders

72
Q

which medication blocks reuptake of norepinephrine and dopamine; stimulant SE

A

Bupropion (Wellbutrin)

73
Q

which medication is Shown to help reduce aggressiveness and hyperactivity
SE of insomnia, anorexia, tics, seizures
Not extensively studied for ADHD

A

Bupropion (Wellbutrin)

74
Q

Group of neurodevelopmental disorders characterized by:

A
  1. Deficits in social interaction
    and communication
  2. Restricted repetitive patterns of behavior, interests, and activities
  3. Must be present in early development
75
Q

ASD is 3-4x more common in ?

A

males

76
Q

what is the general consensus of ASD etiology

A

Genetic etiology alters brain development → abnormal social and communication development → restricted interest and repetitive behavior

77
Q

what is the Epigenetic theory for ASD etiology

A

abnormal gene is “turned on” early in development that influences other genes

78
Q

what is the Epigenetic theory for ASD etiology

A

abnormal gene is “turned on” early in development that influences other genes

79
Q

brain abnormalities seen in ASD

A
  1. Accelerated head growth in infancy
  2. Increased overall brain size (2-10%)
  3. Different patterns of connectivity, cognitive strategies and brain areas during social tasks or with visual/audio stimuli
  4. Abnormal serotonin synthesis
  5. Abnormal brain structure and organization
80
Q

Increased ASD risk seen with what biological factors

A
  1. Increased parental age (mother or father)
  2. Overall poorer perinatal/neonatal health
    - Preterm delivery
    - Low birth weight
  3. Maternal metabolic conditions (DM, HTN)
81
Q

ASD most commonly recognized around age ?

A

2 yrs
- May be present earlier
- May manifest later, when social demands exceed limited capacities to cope

82
Q

what is considered severe vs mild ASD

A
  1. Severe - significant behavioral problems, often mute
  2. Mild - children have verbal capacity, may show unusual special interests

Common factor - impaired social skills

83
Q

what is a very common presenting complaint with ASD

A

Delays and deviations in language
- echolalia, pronoun reversal

84
Q

what is social reciprocity in ASD

A

impaired; often unaware of other children, lack empathy, uninterested in imitating others

85
Q

little/no desire to share enjoyment, interests, or achievements with other people in ASD

A

joint attention

86
Q

difficulty using and interpreting nonverbal cues in ASD

A

Nonverbal communication

87
Q

prefer solitary play, little interest in friendships is MC seen in what population of pts with ASD

A

younger

88
Q

lack understanding of behavior being appropriate in one scenario and not another, do not grasp needs of others is MC seen in what population of pts with ASD

A

older

89
Q

can involve complex or whole-body movements such as Hand flapping or twisting, rocking, swaying
is called what type of behavior

A

stereotyped behavior

90
Q

can involve complex or whole-body movements
is called what type of behavior

A

stereotyped behavior

91
Q

what % of ASD pts show stereotyped behavior

A

95

92
Q

what % of ASD pts show stereotyped behavior

A

95%

93
Q

lining toys up in an exact manner, counting is called what type of behavior in ASD

A

stereotyped rituals

94
Q

what stereotyped behavior in ASD is seen more with cognitive impairment, such as head-banging, face slapping, self-biting

A

Self-injurious

95
Q

major difficulty with changes; often need identical daily routines and struggle with transitions

A

Insistence on sameness

96
Q

Either abnormal intensity or focus on a narrow area or persistent preoccupation with unusual (usually inanimate) objects

A
  1. Restricted interests
    - Younger - peculiar sensory arousal
    - Older - weather, dates, schedules, phone numbers, license plates, etc.
97
Q

aberrant sensory processing in up to 99% of ASD patients
Hyposensitivity, hypersensitivity, or paradoxical responses

A

Sensory perception

98
Q

other common features of ASD

A
  1. Intellectual impairment - often stronger in nonverbal
    tasks and markedly deficient in verbal cognition
  2. “savant” skills
  3. Language impairment - delay in, or lack of, development of spoken language is common
  4. Motor deficits - may include abnormal gait, clumsiness, toe walking, hypotonia
  5. Macrocephaly - ¼ of children have head circumference > 97th percentile
99
Q

how can intellectual impairment in ASD improve?

A

early detection and intervention
- Earlier education planning
- Provisions of family support
- More appropriate medical care

100
Q

what are the important early indicators for ASD

A
  1. No babbling by 9 months
  2. No pointing or gestures by 12 months
  3. Lack of orientation to name by 12 months of age
  4. No single words by 16 months
  5. Lack of pretend or symbolic play by 18 months
  6. No spontaneous, meaningful (not repetitive or echolalic), two-word phrases by 24 months
  7. Any loss of any language or social skills at any age
101
Q

M-CHAT-R/F is for what? for what age?

A

screen tool for ASD
young children (16-30 mo)

102
Q

after a child is screened positive for ASD, what is the next step?

A
  1. Be referred to a specialist who is familiar with autistic disorders
  2. Undergo a hearing screening and serum lead level screen
  3. Possibly undergo genetic testing
103
Q

ASD tx

A
  1. Educational and Behavioral Interventions
    - Focus on social, language and adaptive skills
    - May use manual signing, picture exchange
  2. Routine Screening and Preventative Care
    - Especially be aware of dietary intake and physical activity
  3. Complementary and Alternative Medicine
    - Melatonin, omega-3 fatty acids, probiotics, hyperbaric oxygen, IVIG, music therapy, yoga, massage, horseback riding
  4. Psychopharmacologic Interventions
    - Do not treat ASD but can help behaviors
104
Q

what pharm tx can help with inattention/hyperactivity in ASD

A

stimulants
- Methylphenidate (most studied)
- other stimulants, alpha agonists, atomoxetine

105
Q

what pharm tx can help with maladaptive behavior in ASD

A

Antipsychotics - especially risperidone or aripiprazole
Stimulants, SSRIs, alpha-adrenergics may also help

106
Q

what pharm tx can help with anxiety or repetitive behavior in ASD

A

SSRIs (fluoxetine)

107
Q

what pharm tx can help with Depressive symptoms in ASD

A

SSRI/SNRI

108
Q

what pharm tx can help with dysregulated mood in ASD

A

atypical antipsychotic or SSRI

109
Q

good prognosis of ASD

A

higher cognitive abilities, less severe symptoms, early identification, functional play skills

110
Q

poor prognosis of ASD

A

IQ <70, lack of joint attention by age 4 or functional speech by age 5, seizures or other comorbid conditions, severe symptoms

111
Q

Neurodevelopmental disorder
Almost exclusively in females
Most cases - sporadic mutation in MECP2 gene

A

Rett disorder

112
Q

what is the classic presentation of Rett disorder

A
  1. uneventful pregnancy and delivery, normal development for first part of life (about 6 months)
    - Deceleration of head growth - can appear as early as 2-3 mo
    - 12-18 months - loss of acquired fine motor, intellectual and communication abilities - Can be gradual or rapid
113
Q

initial findings of Rett disorder

A

loss of interest in surroundings, little purposeful hand movements (may persist with stereotypic movements)

114
Q

later findings of rett disorder

A

some recovery of nonverbal communication with improved eye contact, followed by slow deterioration of gross motor functioning

115
Q

additional common findings of rett disorder

A

Loss of expressive language
Motor dysfunction (stereotypic hand movements, gait disturbance, bruxism, drooling, rigidity, dystonia)
Scoliosis (50-85% by age 16)
Growth failure
Epilepsy
Bone mineral deficit and increased fracture risk
Cardiac abnormalities
Disordered wakeful breathing patterns
Sleep disorders

116
Q

tx for rett disorder

A
  1. No specific treatment available
    - Good nutrition (high-calorie, balanced diet)
    — Assess oral motor function, GERD, delayed gastric emptying
    - High index of suspicion of fractures
    - Antiepileptic drugs for seizure patients
    - Monitor QT interval
    - Physical therapy for scoliosis
    - Sleep hygiene and medication if needed
    - PT and OT for motor dysfunction

Behavioral dynamics (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions