Autism Spectrum Disorders

Question 1

Define ADHD according to Sir Alexandra Crichton

Answer 1

Attention and its diseases: A distraction of
attention does not have to be pathological; can
be “born with a person”
-Can also be caused by new disease and
generally diminished with age
-Hyperactivity not described

Question 2

Define ADHD according to Sir George Still

Answer 2

Motor agitation
Attention problems
Difficulty controlling impulses
Deficit of moral control

Question 3

WHO defined ADHD as hyperkinetic disease of infancy

Answer 3

Kramer and Pollnow in 1934

Question 4

WHO introduced the first treatment of ADHD with Benzedrine

Answer 4

Bradley in 1937

Question 5

WHO introduced Ritalin (Methylphenidate) as ADHD treatment

Answer 5

Panizzoni in 1944

Question 6

What’s the most effective and widely used medication in ADHD

Answer 6

Ritalin

Question 7

Describe the prevalence of ADHD in children and adults

Answer 7

3-10% in children and adolescents
2-5% in adults

Question 8

Outline the aetiology of ADHD (4)

Answer 8

’ Very strong biological contributions
‘ Genetic / hereditary (genes DAT1, DRD4 etc)
‘ Peri-natal problems (prem & low birth weight)
‘ In utero exposure to tobacco smoke

Question 9

How long should one have symptoms before ADHD diagnosis is made

Answer 9

At least 6months

Question 10

When should ADHD symptoms be present for ADHD diagnosis to be made according to DSM5 (which age)

Answer 10

Symptoms present before age 12

Question 11

List Symptoms of hyperactivity/impulsivity

Answer 11

Fidgety
Can’t sit still
Runs or climbs
Unable to play quietly
Talks excessively
Difficulty waiting turn
Interups
Impaired response inhibition, impulse control
Inability to stop and think before acting or doing

Question 12

How is INATTENTION diagnosed

Answer 12

6 or more of the ff

Careless/Fails to give close attention
Can’t sustain attention
Does not listen
Cannot follow through/ tasks incomplete
Difficulty organising tasks
Avoids mental effort
Often loses things
Easily distracted
Forgetful

Question 13

How does INATTENTION change over the years from Preschool to Preschool, Adolescence then Adulthood?

Answer 13

In Preschool: Have short play, do not complete activities, don’t listen

In Preeschool: Do brief activities, changes activity, forgetful, disorganised and distracted

Adolescents: lacks focus on details, less persistent, poor planning

Adulthood: incomplete details, forgets appointments, lack of foresight

Question 14

How does OVERACTIVITY change over the years from Preschool to Preschool, Adolescence then Adulthood?

Question 15

How does IMPULSIVITY change over the years from Preschool to Preschool, Adolescence then Adulthood?

Question 16

Which conditions are necessary to exclude before ADHD diagnosis

Answer 16

Cardiac history

Question 17

Which test do you do to check selective attention

Answer 17

Strooptest
-Measures attention. It takes advantage of our ability to read words more quickly and automatically than naming colors.
-Cognitive mechanism in this task is directed/selected
attention: one has to manage one’s attention, inhibit or
stop one response in order to say or do something else.

Question 18

Outline the treatment for ADHD

Answer 18

PHARMACOLOGY
-stimulants
-non stimulants

NON PHARMACOLOGY
-Psychosocial management
-Dietary interventions
-Psychological interventions

Question 19

Outline the psychosocial management of ADHD

Answer 19

• Psycho-education: parent/child/school
• Develop therapeutic alliance
• Promote consistent parenting
• Parent-child relational work
• Address parents’ ADHD etc
• Behavioural intervention (+ve reinforcement etc)
• Group therapy (social skills
• O.T. and S.A.L.T

Question 20

What does psychological treatment ifADHD aim to do

Answer 20

• Cognitive training
➢ Attention and working memory training
• Behavioural interventions
➢ Parent training
➢ Parent-child training
➢ Parent-child plus teacher training
➢ CBT with child

Question 21

Dissadvantages of dietary treatment in ADHD

Answer 21

CAUTIONS about lack of concrete evidence:
• It discourages removal of artificial food colourants and
additives from the diet
• If link seen need a food diary and dietician referral
• Opposes fatty acid supplementation

Question 22

What is the stimulant medication for ADHD

Answer 22

Methylphenidate
SHORTACTING/IMMEDIATE
RELEASE
Ritalin (3-4 hours)

INTERMEDIATE RELEASE
Ritalin LA (8 hours)

LONG ACTING/MODIFIED
RELEASE
Concerta XL (12 hours)

Question 23

What is the non stimulant medication used to treat ADHD

Answer 23

atomoxetine,
• extended-release
guanfacine ER
clonidine ER

Question 24

What is the main limitation of atomoxetine

Answer 24

Slower onset of action compared to stimulants

Question 25

Choice of treatment for ADHD depends on what factors

Answer 25

Co-morbid conditions (eg tics/epilepsy)
Tolerability, adverse effects
Convenience of dosing (compliance/schools)
Potential for diversion
Pt preference

Question 26

Outline the side effects of ADHD medication

Answer 26

-Loss of appetite (measure weight before and every 3-4mon)
-Growth delay (measure height before and every 3-4months)
-Insomnia
-CVS side effects
-Hepatotoxicity, incr in hepatic enzymes, bili and jaundice
-Emergent suicide behaviours

Question 27

When do you refer patients with ADHD to psychiatry

Answer 27

If unsure of diagnosis
Pt requesting a 2nd opinion
Complex diagnosis present (ADHD with tics/OCD/ non responding depression)
Pt not responding to treatment
More than 6 years of age GO: max 1mg/kg/d methylphenidate

Question 28

How to manage sleep disturbances in ADHD

Answer 28

Sleep diary
Monitor
Stop meds
Add small dose f rebound
Add melatonin
Change stimulant
Polysomnography if suspect sleep breathing
disorder episodic nocturnal phenomena, limb
movements