Autism and ADHD Flashcards
What is autism spectrum disorder?
A lifelong pervasive (home and school) developmental disorder with 2 core symptoms:
1. Persistent deficits in social communication and interaction across multiple contexts
• Social reciprocity – how child responds and reciprocates
• Joint attention – wanting to share an interest
• Non-verbal communications – using or interpreting
• Social relationships – developing and maintaining friends
2. Restricted, repetitive patterns of behaviour, interests, or activities
• Lining up toys, flapping hands, and imitating
• Fixed on certain routines (same school route)
• Restrictive thinking, specific knowledge
When does autism usually become apparent?
The symptoms are present from early life but may not become obvious until social demands exceed the capacity of the child. This results in clinically significant impairment in functioning and cannot be attributed to other conditions such as intellectual disability or global developmental delay. Commonly they will have sensory processing issues.
What genetic conditions are associated with Autism?
What physical condition often accompanies autism?
What is the sex ratio of autism?
Definite genetic component particularly fragile X and Rett’s syndrome
If affected sibling, then 5-10% increased risk with next child
Epilepsy associated 30% of the time
4:1 ratio of males to females
How is a diagnosis of Autism made?
Must be made by at least 2 clinicians usually occurring at an MDT meeting including parents, teachers, speech and language therapist, psychiatrist and psychologist.
ICD10 criteria
Before the age of 3 showing impaired or abnormal development in one of the following:
1. Receptive or expressive language as used in social communication
2. Development of selective social attachments or of reciprocal social interaction
3. Functional or symbolic play
After the age of 3 this diagnosis can be confirmed if they have a total of 6 symptoms from 3 categories with at least 2 in the first category and 1 in the other two
1. Impairment of social interaction manifesting as certain symptoms
2. Abnormalities in communication manifesting as certain symptoms
3. Restricted, repetitive and stereotyped behaviour manifesting as certain symptoms
What questionnaire can be used to aid diagnosis of autism?
GARS2 questionnaire for parents and school
How should autism be managed?
This is based around support for the child and parents once the diagnosis is made and should be targeted to the patients needs.
Parents should attend training classes and education on ASD as well as being encouraged to claim or apply for disability living allowance.
Direct parents and children to relevant national and local websites and groups.
Are there any pharmacological management option for symptoms of autism?
There are some drugs that help with specific symptoms
Risperidone for aggression
Melatonin for sleep
SSRIs for repetitive behaviour
What is ADHD?
Most common neurodevelopmental disorder of childhood. It has a strong genetic component and has 3 core diagnostic features: impulsivity, inattention and hyperactivity. No drugs are licensed until after the age of 6 and diagnosis is difficult before this age.
Thought to be due to low levels of dopamine and nor-adrenaline.
What differentials should be considered in a child showing signs of ADHD?
Hearing impairment, behavioural disorders, age appropriate behaviour and low or high IQ
What does ADHD put patient at increase risk of?
Self-harm, suicide and assault.
How is a diagnosis of ADHD made?
This is made using DMS5 criteria
Children up to 16yrs must have at least 6 pervasive Inattention symptoms and/or 6 hyperactivity/impulsivity symptoms, those older than 16 must have 5 and these symptoms must last for 6 months. Can be split into Inattentive or Hyperactive/impulsive subtype.
There must be clear evidence of clinically significant impairment in social, academic, and occupational function.
Can include computer attention test
Education psychology
GARS2 questionnaire for parents and school
How should children diagnosed with ADHD be managed?
Unless the need is immediate treatment shouldn’t start and there should be a 10 week watch and wait period.
Behavioural Psychotherapy
Time management and organisational skills as well as parent and teacher involvement helping with specific parenting techniques and help in the classroom.
What baseline and regular monitoring are required for/before drug treatment for ADHD
Prior to starting any medication, a baseline ECG, height, weight and BP should be undertaken as most of the medications used are cardiotoxic. These should also be measured at every follow up appointment.
Describe the common stimulant medications used in ADHD?
First line is Methylphenidate/Dexmethylphenidate (these act as Noradrenaline/dopamine reuptake inhibitors).
Second line are Amphetamines - Dexamphetamine/Lisdexamphetamine
Must be careful as the phenidates and amphetamines are controlled drugs and have a high street value.
When should stimulant medication be take and when shouldn’t it?
Medication shouldn’t be given over weekends and holidays as it suppresses appetite and may impair growth.
