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Behavioral Dynamics > Autism Spectrum Disorder and ADHD - Exam 3 > Flashcards

Autism Spectrum Disorder and ADHD - Exam 3 Flashcards

1
Q

What is ADHD characterized by? What age of must the s/s start before?

A

Characterized by a persistent pattern of diminished sustained attention and high levels of impulsivity or hyperactivity

present before age 12

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2
Q

What are the 3 different types?

A

Predominantly Hyperactive/Impulsive

Predominantly Inattentive

Combined

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3
Q

excessive fidgeting and restlessness, hyperactivity, difficulty remaining seated and waiting turns, impulsivity is which kind of ADHD?

A

ADHD, Predominantly Hyperactive/Impulsive

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4
Q

disorganization, forgetful, easily distracted, daydreamers, difficulty completing tasks is which kind of ADHD?

A

Predominantly Inattentive

previously ADD

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5
Q

ADHD- Hyperactive is ratio male to female is _____. ADHD-Inattentive it is ____

A

4:1 in males

2:1 in males

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6
Q

ADHD is believed to be due to a combo of _____ and ____factors. What is the chemical imbalance in the brain?

A

biological and environmental

impaired catecholamine (norepinephrine and dopamine) metabolism in the brain

genetics

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7
Q

**What is the DSM criteria for ADHD?

A

6+ symptoms from one category (inattentive or hyperactive), or 6+ from each, for 6+ months

Maladaptive and inconsistent with developmental level

**Clear functional impairment from symptoms present in 2+ settings

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8
Q

What is the non-pharm treatment of ADHD?

A

behavioral interventions
cognitive therapy
dietary modifications

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9
Q

**______ is the preferred treatment for preschool ADHD pts. What are common ways to help small children?

A

behavioral intervention

Daily schedule
Using charts and checklists
Minimal distractions
Limiting choices
Specific and logical storage places
Rewarding positive behaviors
Using calm discipline, such as time-out

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10
Q

What is the tx for ADHD?

A

non-preschool aged kids answer is meds and therapy!

preschool aged kids is behavioral interventions

cognitive therapy may be useful as adjunct!

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11
Q

What is the videogame therapy for ADHD?

A

Endeavor Rx

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12
Q

What are stimulants for ADHD? Non-stimulant options?

A

Methylphenidate (Ritalin, Focalin, Concerta, Quillivant)

Amphetamines (Adderall, Vyvanse)
__________

Atomoxetine (Strattera)
Alpha-2 Adrenergic Agonists:
-Clonidine (Kapvay)
-Guanfacine (Intuniv)
Antidepressants

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13
Q

What are the criteria for starting therapy in children with ADHD?

A
  • Full diagnostic assessment and dx confirmed
  • Child is at least 6!
  • school will be compliant with medication
  • pharm is first line tx**
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14
Q

______ generally considered first-line for children 6 yo and up with functional impairment due to ADHD.

A

Stimulants

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15
Q

_______ known to increase intrasynaptic levels of catecholamines (______ and _______)

________ blocks reuptake

________ blocks reuptake and stimulate dopamine release

A

Stimulants

norepinephrine and dopamine

Methylphenidate - blocks reuptake
Amphetamines - blocks reuptake, stimulate dopamine release

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16
Q

_____ can help reduce adverse SE, reduce crash and reduce _____.

A

Extended release forms

reduce tachyphylaxis

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17
Q

**Do stimulants help with emotional problems?

A

These medications do not treat emotional problems, defiant behavior, learning impairment, reduced social skills

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18
Q

______ must be activated by stomach acid aka cannot be crushed or snorted

A

Vyvanse

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19
Q

What is the dosing schedule for stimulants? How do you discontinue?

A

start at lower doses and gradually titrate up

May reassess need for stimulants over time
If discontinued, taper down on dose

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20
Q

______ may be able to miss doses on weekends, vacations

A

drug holidays

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21
Q

What are common SE of stimulants?

A

Reduced appetite
Insomnia or nightmares
Feeling “on-edge” or “jittery”
Emotional lability
Weight loss and/or decreased height
Routine monitoring of growth in pediatric pts
Development of tics
Usually mild and correctable with dose adjustments

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22
Q

Peripheral vasculopathy is also known as _____

A

Raynaud’s

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23
Q

priapism is very rare but is associated with ______

A

methylphenidate

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24
Q

What do you do if your patient develops a tic with a stimulant?

A

trial of different dose or changing medication to non-stimulant

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25
Q

What do you do if your patient develops mood lability?

A

XR formulations; evaluation for comorbid psych disorders

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26
Q

What are some CI to stimulants?

A

**History of substance abuse
Hyperthyroidism
Glaucoma
moderate to severe hypertension
arrhythmias or heart failure
motor tics/Tourette syndrome
anxiety
agitated states
use within 14 days of MAOI

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27
Q

______ is the methylphenidate transdermal patch. When is the drug class preferred?

A

Daytrana

methylphenidate:
**Preferred for preschool-age children requiring meds
Generally better tolerated with regard to side effects
Associated with slightly less weight loss

28
Q

_______ blocks catecholamine reuptake (norepinephrine, dopamine) → increased intrasynaptic levels

A

Methylphenidate

29
Q

What are the brand names for methylphenidate?

A

Ritalin, Focalin, Concerta, Methylin

30
Q

______ prodrug of dextroamphetamine that only becomes activated after orally ingested

A

Lisdexamfetamine (Vyvanse)

31
Q

______ blocks catecholamine reuptake (norepinephrine, dopamine); also increases dopamine release → increased intrasynaptic levels

A

amphetamines

32
Q

_____ has more SE and is associated with more weight loss. NOT associated with priapism

A

amphetamines

33
Q

______ is a selective norepinephrine reuptake inhibitor. Not controlled substance. When is it mainly used? Is it first line? How long does it take to go into effect?

A

Atomoxetine (Strattera)

Used mainly if stimulants can’t be used (need to avoid stimulants, hx of tic disorder, abuse of stimulants)

not first-line

May see delay of 1-2 weeks to clinical efficacy

34
Q

What are the CI for Atomoxetine (Strattera)?

A

use within 14 days of MAOI; glaucoma; pheochromocytoma; severe cardiovascular disease (heart failure, arrhythmia, etc.)

35
Q

______ stimulation of alpha-2 adrenergic receptors in the central nervous system. When are they commonly used? Is it controlled? What are the 2 names?

A

Alpha-Adrenergic Agonists

Mainly used for pts who fail to respond to or cannot tolerate stimulants or atomoxetine

not controlled :)

XR Clonidine (Kapvay)
XR Guanfacine (Intuniv)

36
Q

What is important to remember about Alpha-Adrenergic Agonists?

A

only the XR version is approved for ADHD the IR version is NOT!!

would not use in PCP setting, only psych

not first line!

37
Q

____ and ____ are 3rd-line monotherapy or adjunct to stimulants

A

XR Clonidine (Kapvay) and XR Guanfacine (Intuniv)

38
Q

What is a SE of XR Clonidine (Kapvay)? What do you need to do in order to d/c?

A

Sedating side effects

may be helpful in agitated, aggressive or highly active pts

If discontinued, taper to avoid rebound HTN

39
Q

Of the Alpha-Adrenergic Agonists, which ones works better?

A

XR Guanfacine (Intuniv) works better than XR Clonidine

40
Q

____ are used for 4th line therapy. ______ blocks reuptake of norepinephrine and dopamine; stimulant SE. What is it shown to help reduce?

A

TCAs (concerned about cardiotoxicity)

Bupropion (Wellbutrin)

shown to help reduce aggressiveness and hyperactivity

41
Q

What is autism spectrum disorder characterized by?

A

Deficits in social interaction
and communication
Restricted repetitive patterns of behavior, interests, and activities
Must be present in early development

42
Q

What is the pt population for autism? Pt with autism have a higher risk of _____ is more severe intellectual disability

A

males

seizures

43
Q

What are 3 genetic and metabolic conditions that as associated with autism?

A

Angelman syndrome, mitochondrial abnormalities, Fragile X syndrome

44
Q

What is the thought process behind autism?

A

Genetic etiology alters brain development → abnormal social and communication development → restricted interest and repetitive behavior

45
Q

Name some ASD brain/head abnormalities

A

Accelerated head growth in infancy
Increased overall brain size (2-10%)
Different patterns of connectivity, cognitive strategies and brain areas during social tasks or with visual/audio stimuli
Abnormal serotonin synthesis
Abnormal brain structure and organization

46
Q

ASD has been shown to increase risk with what 3 pregnancy related states?

A

Increased parental age (mother or father)
Overall poorer perinatal/neonatal health
-Preterm delivery
-Low birth weight
Maternal metabolic conditions (DM, HTN)

47
Q

What age does autism typically present at? What are some signs? Is older onset better or worse?

A

2 years old

no eye contact
sitting in abnormal position
limited verbal capacity
impaired social skills

older onset is harder social skills

48
Q

Autism usually presents with _____ in other

A

unaware of other children

uninterested in imitating others

Little/no desire to share enjoyment, interests, or achievements with other people
prefer solitary play, little interest in friendships

49
Q

What are some stereotyped behaviors for ASD? ______ can be seen in ASD with cognitive impairment

A

Hand flapping or twisting, rocking, swaying
Lining toys up in an exact manner, counting

self- injurious

50
Q

ASD has major difficulty with _____ and do better with???

A

difficulty with change

need identical daily routines and struggle with transitions

51
Q

ASD pts have ____ interests or persistent preoccupation with inanimate objects

A

narrowed interest

52
Q

Intellectual impairment often stronger in _____ and markedly deficient in _____

A

nonverbal tasks and verbal cognition

53
Q

Pts with ASD abilities improve with _____ and ____. Verbal abilities are relatively intact in ______

A

early detection and intervention

Asperger disorder

54
Q

What are some screening important early indicators for ASD?

A

No babbling by 9 months
No pointing or gestures by 12 months
Lack of orientation to name by 12 months of age
No single words by 16 months
Lack of pretend or symbolic play by 18 months
No spontaneous, meaningful (not repetitive or echolalic), two-word phrases by 24 months
Any loss of any language or social skills at any age

55
Q

What are the screening tools for ASD?

A

M-CHAT-R/F - young children (16-30 mo)
One of the most universally used tests for ASD

56
Q

(Earlier/Later) detection → better outcomes. Why?

A

earlier detection has better outcomes

Earlier education planning
Provisions of family support
More appropriate medical care

57
Q

What happens next after a child screens positive for ASD?

A

Be referred to a specialist who is familiar with autistic disorders

Undergo a hearing screening and serum lead level screen

Possibly undergo genetic testing

58
Q

What is the tx for ASD?

A

Educational and Behavioral Interventions
-social, language and adaptive skills
Routine Screening and Preventative Care
Complementary and Alternative Medicine: Melatonin, omega-3 fatty acids, probiotics, hyperbaric oxygen, IVIG, music therapy, yoga, massage, horseback riding
Psychopharmacologic Interventions
Do NOT treat ASD but can help behaviors

59
Q

What stimulant is used to treat ASD symptoms? What two antipsychotics are used to treat ASD symptoms?

A

Methylphenidate

**risperidone or aripiprazole

60
Q

_____ is an SSRI that is helpful in ASD pts with anxiety or repetitive behaviors

A

fluoxetine

61
Q

What are good prognosis factors for ASD? What are poor prognosis factors?

A

higher cognitive abilities, less severe symptoms, early identification, functional play skills

IQ <70, lack of joint attention by age 4 or functional speech by age 5, seizures or other comorbid conditions, severe symptoms

62
Q

What is Rett disorder? What gender? What gene mutation? What age do they survive to?

A

born normal and slowly lose social and verbal skills

almost exclusively in FEMALES

sporadic mutation in MECP2 gene

typically survive to 45 years old

63
Q

What is the classic presentation of Rett disorder?

A

uneventful pregnancy and delivery, normal development for first part of life (about 6 months)

Deceleration of head growth - can appear as early as 2-3 mo

12-18 months - loss of acquired fine motor, intellectual and communication abilities

64
Q

What is the initial presentation of Rett disorder? What does later present like?

A

loss of interest in surroundings, little purposeful hand movements (may persist with stereotypic movements)

some recovery of nonverbal communication with improved eye contact, followed by slow deterioration of gross motor functioning

65
Q

What are some additional common findings of Rett disorder?

A

Loss of expressive language
Motor dysfunction (stereotypic hand movements, gait disturbance, bruxism, drooling, rigidity, dystonia)
Scoliosis (50-85% by age 16)
Growth failure
Epilepsy
Bone mineral deficit and increased fracture risk
Cardiac abnormalities
Disordered wakeful breathing patterns
Sleep disorders

66
Q

What is the tx of Rett disorder?

A

**no specific treatment

Good nutrition (high-calorie, balanced diet)
Assess oral motor function, GERD, delayed gastric emptying
High index of suspicion of fractures
Antiepileptic drugs for seizure patients
Monitor QT interval
Physical therapy for scoliosis
Sleep hygiene and medication if needed
PT and OT for motor dysfunction

67
Q
A

Behavioral Dynamics (16 decks)

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