Autism and ADHD Flashcards
Which questionnaire is used in the assessment of ADHD?
CONNERS Questionnaire
What is the ADOS-2?
0 ADOS-2: Autism Diagnostic Obversation Schedule, used for diagnosing and assessing autism
- Structured tasks that involve social interaction with the examiner to observe the patient
- Examines the patient using play and social interaction
What is the DISCO?
DISCO: Diagnostic interview for Social and Communication Disorders
- Clinical and research instrument for ASD in patients of any age
What is the ADI?
ADI: Autism Diagnostic Interview-revised (ADI-R)
- Structured interview conducted with parents of those referred
- Examined for ASD or related disorders
What characteristics in a developmental history may indicate ASD?
- Delay in speech development
- Sensory sensitivity
- Delay in social development
What are school observations useful for?
They give a truer impression of the child in their own environment
What signs may be seen at school that can indicate ASD?
- Not obeying commands
- Not responding to name
- Poor concentration or disinterest
- Focusing better in smaller groups
- Little interest in interacting with other children
- Poor eye contact
- Poor engagement in conversations
- Strong dislike if events are not to their liking/distress
- Flapping hands when over-stimulated
- Slower academic progression
What does ASD pertain to?
Autism Spectrum Disorder (ASD) pertains to:
- Autism
- Asperger’s
- Childhood Disintegrative Disorder
- Pervasive Developmental Disorder
This was produced by the DSM-V
- Social communication disorders alone are diagnosed when behaviours/interests are not restricted
What is the epidemiology of Autism?
Autism is more frequent in boys than girls in the ratio of 4:1, but this may be due to being under-diagnosed in females
Are there any genetic or congenital associations with autism?
- The risk of developing ASD if a sibling is affected - recurrence sate is 2-8%
- If a patient has 2 autistic siblings, this increases to 25-30%
- Phenylkentinuria and congenital rubella are associated with autism
- Chromosomal disorders: 2, 4, 7, 13, 15 and 19
- Fragile X syndrome or Tuberous sclerosis
What signs are indicative of a good prognosis in autism?
- Communicative speech 6 years old and above
- Higher IQ (>50)
- Skills that can be used to secure employment
What comorbidities are often seen in ASD?
- Depression
- BPAD
- Schizophrenia
- Learning disabilities (80%)
- Seizure disorders
- 3/5 patients will be unable to lead independent lives
What is the management for ASD?
- Early intervention at school and with parents
- Needs-led bases, functional assessment
Psychotherapy for both parents and the patient
- CBT
- Behaviour management programmes
- Applies behavioural analysis program (operant conditioning)
- TEACCH (Treatment and educations for Autistic and related Communication Handicapped Children programme) enhances life skills and reduces self-harming behaviour
- Educational psychology
Social - led by functional assessment
- Carers
- Respite care
- Education of peers in school
- Educational support (learning support, SENCOs, special schools)
Medication, adjuncts to psychological intervention:
- SSRIs, mainstay of treatment
- Second generation antipsychotics - first line pharmacological treatment for children/adolescents with ASD and irritability
(Risperidone is used)
- Melatonin can help reduce sleep latency (time taken to fall asleep)
What areas does the ADI-R assess?
Three functional domains:
- Language and communication
- Reciprocal Social interactions
- Restricted, repetitive and stereotyped behaviours and interests
What is the DISCO used for?
- Used in ASD
- Determines the patient’s individual behaviours and needs
- Assists clinicians in assessing patient’s development, disabilities and specific needs
What are the modules included in the ADOS-2?
- Toddler module (12-30 months, do not consistently use phrase speech)
- Module 1 (31mo+, do not consistently use phrase speech)
- Module 2 (any age, using phrase speech but not verbally fluent
- Module 3 (verbally fluent children and young adolescents
- Module 4 (verbally fluent older adolescents and adults)
Scores are then entered into the ADOS-2 algorithm form
The difference between autism and autism spectrum is severity.
What initial recommendations can be made following a diagnosis of ASD?
- Access information provided by the National Autistic society
- Educational psychology for the patient and their family
- Referral to SALT if needed
How should a diagnosis of Autism be explained?
- What it is
A communication and language disorder which changes the way a patient interacts with other people
Sensory aspects, learning disabilities etc - How autism is likely to affect the patient’s development and function
They may find it more difficult than their peers to work well in a classroom environment, so additional support or a special school may be advised
They may have difficulty making friends and communicating their needs with others, so CBT/psychotherapy is provided that can help
What should be provided to families and patients following a diagnosis of Autism?
- Written report of diagnostic assessment
- Share information with GP (with assessment)
- Share information, with consent, with key professionals involved in the patient’s care, including teachers etc
- Make the patient profile visible (with consent) to other professionals involved in care and education
- Follow-up appointment with autism team within 6 weeks of end of autism assessment for further discussion
- Discuss with parents the risk of autism occurring in siblings and future children
What can be seen on an MRI in patients with ASD?
MRI scans show brain enlargement:
- Occipital
- Parietal
- Temporal lobes
This could be due to reduced neuronal death, increased neurogenesis, or increased production of glial cells/vasculature
What is the theory of mind?
A lack of a theory of mind:
- Deficits in empathy and understanding what others may think
- Tested using the Sally-Anne test
Which medication is licensed to treat challenging aggressive behaviour in autistic children?
Risperidone
- NICE suggests that psychosocial interventions are tried and a physical cause for the aggressive behaviour is ruled out/treated first
What is Atomoxetine?
Atomodetine is an alternative to Methylphendate (Equasym) in the treatment of ADHD
