autism, hyperkinetic, LD Flashcards
define autism
pervasive developmental disorder
ASOCAIL Behaviuor restrircted Communication TRIAD - impairment in social interaction - impairment in communication - restricted, stereotyped interests and behaviours.
prenatal aetiology autism
genetics - fragile X syndrome, tuberous sclerosis
parental age - 40 years old
Drugs - sodium valporate
infection - prenatal viral infections - rubella
perinatal aetiology autism
obstetic complications
hypoxia during childbirth
- gestational age at birth
- low birthweight offer increased risk of autism.
postnatal aetiology autism
toxins - lead and mercury
- pesticide exposure
RFs of autism
Male
Males are 4 × more likely to be affected than females.
Genetics/Family history
There is an 88% concordance rate in monozygotic twins, indicating a strong genetic component.
Advancing parental age
Recent studies have suggested that advancing parental age is a significant risk factor for ASD.
Parental psychiatric disorders
Evidence suggests a link between parental psychiatric disorders such as schizophrenia and the child having autism.
Prematurity
Born before 35 weeks’ gestation.
Maternal medication use
with mothers receiving sodium valproate during pregnancy.
clinicla features of autism as seen in ICD-10
ABC
Asocial
Few social gestures, e.g. waving, nodding and pointing at objects.
Lack of: Eye contact (gaze avoidance), social smile, response to name,
interest in others, emotional expression, sustained relationships and awareness of social rules.
Behaviour restricted
Restricted, repetitive and stereotyped behaviour, e.g. rocking and twisting.
Upset at any change in daily routine.
May prefer the same foods, insist on the same clothes and play the
same games.
Obsessively pursued interests.
Fascination with sensory aspects of environment.
Communication impaired
Distorted and delayed speech (often the first sign which is noticed).
Echolalia (repetition of words).
onset is before 3 years of age
other features
- intellectual disability
- temoer tantrums
- impulsivity
- cognitive imapirment
Social difficulties Communication difficulties Lack of flexibility of thinking Needs to occur in more than one environment
Symptoms must be present before 3 years
other conditions ass w autism
Epileptic seizures: ~20% develop this.
Visual impairment.
Hearing impairment.
Infections.
Pica: Eating inedible objects.
Constipation.
Sleep disorders.
Underlying medical conditions: PKU, fragile X,
tuberous sclerosis, congenital rubella, CMV or
toxoplasmosis.
Psychiatric: Hyperkinetic disorder, depression, bipolar
affective disorder, anxiety, psychosis, OCD, DSH.
Ix of autism
Full developmental assessment including family history, pregnancy, birth, medical history, developmental milestones, daily living skills and assessment of communication, social interaction and stereotyped behaviours
- hearing tests if required
- screening tools including CHAT
checklist for Autism in Toddlers
DDx of autism
Learning disability Deafness Childhood schizophrenia - Asperger’s syndrome* Rett’s syndrome* Childhood disintegrative disorder*
what is Aspergers syndrome
Similar
to autism with abnormalities in social interaction and restricted, stereotyped, repetitive interests and behaviours.
NO IMPAIRMENT
in language, cognition or intelligence (IQ normal). It is more prevalent in boys.
What is Rett’s syndrome
Severe, progressive disorder starting in early life. Results in language impairment, repetitive stereotyped hand movements, loss of fine motor skills, irregular breathing and seizures. Almost exclusively seen in girls. The MECP2 gene’s role in Rett’s syndrome has been identified.
what is childhood disintegrative disorder (Heller’s syndrome)
Characterized by two years of normal development followed by loss of previously learned skills (language, social
and motor). Also associated with repetitive, stereotyped interests and behaviours as well as cognitive deterioration.
speech and hearing developmental milestones
3 months turns towards sound, quietens
to parent’s voice.
6 months double syllables e.g. ‘adah’.
9 months says ‘mama’ and ‘dada’.
12 months knows and responds to own name.
12–15 months knows about 2–6 words,
understands simple commands.
2 years combines two words.
3 years talks in short sentences
(e.g. 3–5 words), asks ‘what?’ and ‘who?’
questions.
4 years asks ‘when?’, ‘how?’ and ‘why?’
questions.
social behaviour developmental milestones
6 weeks smiles (refer at 10 weeks if not smiling).
6 months enjoys interaction.
1 year waves bye-bye.
2 years interested in other children.
3 years make believe play.
4 years plays with other children.
general Mx of autism
diagnosis by specialist
local autism teams
Interventions for life skills include support developing their daily living skills, their coping strategies and enabling access to education and community facilities such as those related to leisure and sports.
Ensure all physical health, mental health and behavioural issues are addressed
Families and carers should also be offered personal, social and emotional support. Self-help
groups such as the National Autistic Society (NAS) are available.
- special schooling
- melatonin maybe for sleep disorders
core features
- social-communication intervention
bio-psychosocial Mx for autism
biological
Treat co-existing disorders (e.g. methylphenidate for hyperkinetic disorder).
Antipsychotics for behaviour that challenges.
Melatonin.
psychological
Psychoeducation for families or carers.
Full assessment of the functions of behaviour, to understand the child fully.
CBT.
Social Modification of environmental factors. Social-communication intervention. Self-help groups such as the National Autistic Society. Special schooling.
define ADHD
early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development, and are present in more than one situation.
aetiology of ADHD
Genetic
- The DRD4 and DRD5 genes are thought to play a role.
Neurochemical - abnormality in the dopaminergic pathways
Neurodevelopmental - abnormalities of the pre-frontal cortex are hypothesized based on symptoms of recklessness, inattention and learning difficulties.
Social
- social deprivation
- family conflict
- prenatal cannabis and alcohol exposure
RFs of ADHD
age of onset 3-7 years
Male
Males are three times more likely to be affected than females.
Family history
Family history is a strong determinant of hyperkinetic disorder with twin studies reporting about 70% heritability.
Environmental risk factors
Social deprivation and family conflict as well as parental cannabis and alcohol exposure.
ICD-10 criteria for ADHS
A. Demonstrable abnormality of attention, activity and impulsivity at home, for the age and developmental level of the child.
B. Demonstrable abnormality of attention and activity at school or nursery (if applicable), for the age and developmental level of the child.
C. Directly observed abnormality of attention or activity. This must be excessive for the child’s age and developmental level.
D. Does not meet criteria for a pervasive developmental disorder, mania, depressive or anxiety disorder.
E. Onset before the age of 7 years.
F. Duration of at least 6 months.
G. IQ above 50.
- Poor attention and concentration
- Physical overactivity
- Impulsivity
- Needs to occur in more than one
environment - Diagnosis after 6 years, but symptoms
present before
define inattention
Not listening when spoken to.
Highly distractible (moving from one activity to the next).
Reluctant to engage in activities that require persistent mental effort, e.g. school work which contains careless mistakes.
Forgetting or regularly losing belongings.
