Autism and ADHD

Question 1

What is Autism characterised by?

Answer 1

lifelong neurodevelopment condition

• persistent difficulties in social interaction and communication
• stereotypical, rigid and repetitive behaviours
• resistance to change or restricted interest

Question 2

What is the prevalence of Autism?

Answer 2

1 in 100

Male: Female –> 3 to 5 : 1

Question 3

What are some risk factors of Autism?

Answer 3

genetics: fragile X syndrome, Down’s syndrome, siblings with ASD
parental age over 40
sodium valproate in pregnancy
rubella infection in mother
obstetric complications like hypoxia

Question 4

What are some diseases that occur alongside Autism?

Answer 4

intellectual disability
epilepsy
sensory problems
GI: IBD, coeliac
psychiatric: depression, bipolar, OCD

Question 5

What are some ways “asocial” manifests in those with autism?

Answer 5

few social gestures: nodding and pointing
lack of: eye contact, social smile, interest in others, emotional expression, awareness of social rules

Question 6

How does the characteristic “restricted behaviour” manifest in those with ASD?

Answer 6

restricted, repetitive behaviours like rocking
upset at any change to routine
may prefer same foods, same clothes, same games
obsessively pursued interests

Question 7

How might those with ASD be “communication impaired”?

Answer 7

distorted or delayed speech
echolalia (repetition of words)

Question 8

What are the ICD-10 criteria for the diagnosis of Autism?

Answer 8

• abnormal or impaired development before age of 3
• qualitative abnormalities in social interaction
• qualitative abnormalities in communication
• restrictive, repetitive behaviours, interests
• clinical picture not attributable to other developmental disorders

Question 9

How might ASD present in children?

Answer 9

before 3 years
- socio/ communication difficulties
- sensory processing problems
- lacks flexibility, social imagination, theory of mind, generalisation

*in over 1 environment

Question 10

What are the speech and hearing developmental milestones?

Answer 10

3m - turns towards sound
6m - double syllables eg: adah
9m - says mama and dada
12m - knows and responds to name
12-15m - knows about 2-6 words, simple commands understood
2y - combines 2 words
3y - talks in short sentences
4y - asked when? how? why?

Question 11

What are some social behaviour developmental milestones?

Answer 11

6w - smiles (refer if not by 10w)
6m - enjoys interaction
1y - waves bye
2y - interested other children
3y - make believe play
4y - plays with other children

Question 12

How might you manage Autism?

Answer 12

• diagnosis by specialist by age 3
• local autism teams, MDT, key worker to coordinate Tx
• CBT
• interventions for daily life skills, coping strategies
• family support, self help groups
• special schooling
• melatonin for sleep

Question 13

How might ASD be managed in children?

Answer 13

psychoeducation
stress reduction
environmental changes
treat comorbidities

Question 14

How might you deal with interventions for challenging behaviours?

Answer 14

treat co-existing physical and mental and behavioural problems
modify environmental factors like sensory input
antipsychotics

Question 15

How would you define ADHD?

Answer 15

early onset, persistent pattern of inattention, hyperactivity, and impulsivity that are more frequent and severe than peers.

*home or school difficulties but also adults who were undiagnosed

Question 16

What are the 3 subtypes of ADHD?

Answer 16

• Inattention
  (not listening, distractible, losing things)
• Hyperactive-impulsive
  (restless, reckless, energy, impatient)
• Combined *most common

Question 17

How might ADHD present in children?

Answer 17

poor attention and concentration
physical overactivity
impulsivity

*in over 1 environment
*diagnosis after 6, Sx since before then

Question 18

What is the prevalence of ADHD?

Answer 18

2.4% UK children
(1 in 20 children and 4% adults)

Question 19

What are some potential causes and risk factors?

Answer 19

genetic, low birth weights, maternal smoking, preterm delivery, epilepsy, alcohol in pregnancy, iron deficiency etc
males more at risk, FH, social deprivation

Question 20

What are some co-occuring disorders?

Answer 20

ODD
substance misuse
mood disorders
autism
dyslexia
dyscalculia
dyspraxia

Question 21

What are the ICD-10 criteria for ADHD?

Answer 21

• abnormality of attention, impulsivity at home and nursery
• directly observed abnormality of attention or activity
• no criteria for pervasive developmental disorder
• onset before 7y
• duration of at least 6m
• IQ over 50

Question 22

How might you approach assessing a child with potential ADHD?

Answer 22

observe
speak to child - try and involve them, be patient, spark their interests
speak to parents - collateral, offer support

Question 23

How might you manage ADHD?

Answer 23

*10w watch and wait from presentation then referral to secondary care paeds or CAMHS

• support from parents and teachers
• parent teaching and education programmes
• psychoeducation and CBT
• Medication as last resort
• DVLA informed if Sx or SE affect

Question 24

What is the role of medication in ADHD management?

Answer 24

*if severe in school aged
- methylphenidate
- lisdexamfetamine

SE: headache, insomnia, loss of apetite, weight loss

Question 25

How might you monitor the medication use in ADHD?

Answer 25

• height and weight as potential stunting with methylphenidate
• CVS: BP, tachycardia monitor
• tics: reduce dose
• seizures, sleep, sexual dysfunction etc