Autism and ADHD Flashcards
What are some language disturbances that may accompany autism
-deficits in development/use
-may express more than they understand
-echolalia or stereotypy phrases
-odd voice quality/rhythm
-total lack of speech
what are some signs of irritability in children with autism
aggression
self-injurious behavior
severe tantrums
may emerge w/o trigger
what are some other common associated features of autism
-instability of affect
-hyperactive/inattentive
-precocious skills
-insomnia
-minor infections/GI sx
what are the two medications approved to treat irritability in autism
risperidone
aripiprazole
core symptoms of autism
-persistent deficits in social communication/interaction
-restrictive/repetitive behaviors/interests
possible manifestations of social communication/interaction deficits in autism
-poor eye contact
-disrupting routine can cause extreme anxiety
-atypical attachment behavior
-impaired ability to infer feelings/empathy
-poor social skills
possible manifestations of restricted/repetitive behaviors/interests in autism
-Restricted/muted exploratory play
-rigid, repetitive, monotonous play
-ritualistic and compulsive behaviors
-increased self-stimulation and self-injury when intellectual disability is present
-
physical characteristics associated with autism
-ear malformations
-ambidextrous
-abnormal fingerprints
Possible disturbances in language usage associated with autism
-may express more than they understand
-echolalia or stereotypic phrases out of context
-peculiar voice quality and rhythm
is it common for autism to have deficits in language development
No but it can happen
typically lack prosody and inflection
How can irritability be manifested in autism
-aggression
-self-injury
-severe temper tantrums
-may emerge unexpectedly w/o trigger
possible responses to sensory stimuli in autism
-may over/under respond
-not uncommon to appear deaf
-heightened pain threshold and altered response to pain
-particular enjoyment of vestibular stimulation (spinning, up-and-down, etc.)
hyperactivity and inattention in autism
ADHD is often comorbid
minor infections that are more frequent in autism
-URIs
-febrile seizures
standardized assessment tool for autism
autism diagnostic observation schedule-generic
(ADOS-G)
Targets for autism treatment
-core behaviors
-social interaction/communication
-strategies for school integration
-development of peer relationships
-independent living skills -
psychosocial interventions for autism treatment
-early intensive behavioral/developmental interventions
-social skills training
-tx comorbid symptoms
-educational interventions
early behavioral/developmental intervention for autism: UCLA/LOVAAS-based model
–given one-on-one for several hours weekly in the home
-focuses on social skills, language usage, play skills
early behavioral/developmental interventions for autism: ESDM
-parents/educators trained as cotherapists to deliver interventions in natural settings (school, daycare, home)
-focus on play and relationship skills
social skills training in autism
-typically in group setting w/ varying ages
-guided practice in initiating conversation, greetings, initiating games, and joint attention
-includes emotional identification and regulation
interventions for insomnia in autism
-change parental behavior towards child at bedtime to reduce reinforcement for being awake
-massage
educational interventions for children with autism: TEACCH method
-structured teaching based on idea that children have a problem with perception
-uses visual aides to teach academic and social skills
what is the use of medications in autism
to treat behavioral symptoms rather than core symptoms
medications approved to treat irritability in autism
risperidone
aripiprazole
what is risperidone/aripiprazole mainly used for in autism
1st line for aggression and self-injurious behavior
0.5-1mg
typical dosage of aripiprazole in autism patients
5-15mg
weight gain not as bad as risperidone
medications used to treat hyperactivity, impulsivity, and inattention in autism
methylphenidate (moderate)
atomoxetine (better than placebo)
how to treat repetitive/stereotypic behavior in autism
risperidone may help by reducing irritability
prenatal risk factors for autism
-advanced maternal age
-gestational bleeding
-gestational diabetes
-first born baby
perinatal risk factors for autism
-umbilical complications
-birth trauma/fetal distress
-small for gestational age
-low birth weight
-low 5-minute APGAR
-congenital malformations
-Rh factor incompatibility
-hyperbilirubinemia
frequent ADHD comorbidities
-learning disorders
-anxiety disorders
-mood disorders
-disruptive behavior disorders
what is the age requirement for ADHD dx
sx must be present before age 12
most common ADHD characteristics
-hyperactivity
-attention deficit
-impulsivity
-memory/thinking deficits
-learning disabilities
-speech/hearing deficits
medical problems with symptoms that overlap ADHD
-petit mal epilepsy
-hearing/vision impairments
-thyroid abnormalities
-hypoglycemia
what is considered first line therapy for ADHD
stimulants
stimulants for the treatment ADHD
-methylphenidate
-amphetamine-D
-amphetamine D,L
brand names for amphetamine D
-dexedrine spansule
-zenzedi
-procentra
brand names for amphetamine D.L
-adderall
-evekeo
-adzenys
-dyanavel
-mydayis
what kind of agonists are methylphenidate and amphetamine
dopamine
what is the ER formulation of methylphenidate
Concerta
what is good abount the methylphenidate patch
it stops working 1 hour after removal
nonstimulant medications for ADHD
-atomoxetine
-clonidine
-guanfacine
drug class of atomoxetine
norepinephrine reuptake inhibitor
half-life and dosing of atomoxetine
half-life 5 hours and typically given BID
drug class of clonidine
norepinephrine receptor agonist
drug class of guanfacine
norepinephrine receptor agonist
clonidine dosage range for ADHD
0.1-0.2mg typically dosed BID
clonidine taper
increase by 0.1mg weekly
do not taper any faster than q3-7 days
are ER and IR formulations of clonidine interchangeable
No
dosage of guanfacine in ADHD treatment
-start 1mg and titrate up by 1mg at weekly intervals to max dose of 4mg daily
dc taper of guanfacine
taper by 1mg q3-7 days
guanfacine and meals
do not take with high fat meal
what is best option for depression comorbid with ADHD
SSRIs
what may work for ADHD in adults
modafinil
what should be checked quarterly in children taking stimulants
height, weight, BP, P
psychosocial interventions for ADHD
-psychoeducation
-academic organization skills
-parent training
-behavior modification
-CBT
-social skills training
which neurotransmitter is the focus of treatment for ADHD
dopamine
main treatment for ADHD in adults
long-acting stimulants
