learning difficulties - ASD, ADHD, cerebral palsy Flashcards
autism spectrum disorder (ASD)
neurodevelopmental condition
qualitative impairment in -
- social interaction
- communication
repetitive stereotyped -
- behaviour
- interests
- activities
usually presents early childhood
what % of ASD have intellectual disability
50%
ASD clinical features
typically evident before 2-3yrs
- impaired social - play alone, lack of social cues (eye gaze, expression), form + maintain relationships
- repetitive behav, interests + activities - motor mannerisms, nonfunctional routines/rituals
- intellectual/language impairment
assoc with higher head circumference to brain volume ratio
phamacological interventions for ASD
SSRIs - reduce repetitive sterotyped behaviour, anxiety, aggression
antipsychotics - reduce sx like agression, self-injury
methylphenidate - for ADHD
no evidence to demonstrate much improvement
goal in management of ASD
- learning + development
- improve social skills + improved comms
- decreased disability + comorbitity
- aid families
Drug therapy in ADHD
methylphenidate
- must be 5+years old
- give for 6wks trial
lisdexamfetamine
drug therapy is seen as a last resort
methyphenidate MoA
CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor
methyphenidate + lisdexamfetamine side effects
abdo pain
nausea
dyspepsia
Cardiotoxic
- baseline ECG before starting
- refer to cardio is signif PMH/FH
diagnostic criteria for ADHD
features relating to inattention +/- hyperactivity/impulsivity that are persistent
<=16 - 6 features
>=17 - 5 features
inattention - easily distracted, forgetful, loses thing, reluctant to engage ….
hyperactivity/impulsivity - talks excess, always on the go, interupts, answer premature …
cerebral palsy
disorder of movement + posture due to a non-progressive lesion of the motor pathways in developing brain
causes of cerebral palsy
antenatal (80%)
- cerebral malformation
- congenital infection (rubella, toxoplasmosis, CMV)
intrapartum (10%)
- birth asphyxia/trauma
postnatal (10%)
- intraventricular haemorrhage
- meningitis
- head trauma
early manifestations of cerebral palsy
- abnormal tone early infancy
- delayed motor milestones
- abnormal gait
- feeding difficulties
cerebral palsy assoc non-motor problems
learning difficulties (60%)
epilepsy (30%)
squints (30%)
hearing impairment (20%)
4 classifications of cerebral palsy
spastic - 70%
dyskinetic
ataxic
mixed
spastic cerebral palsy
increased tone resulting from damage to upper motor neurons
subtypes include -
- hemiplegia
- diplegia
- quadriplegia
dyskinetic cerebral palsy cause + features
caused by damage to basal ganglia and substantia nigra
- athetoid movements (slow, twisting/squirming)
- oro-motor problems
ataxic cerebral palsy cause
by damage to cerebellum with typical cerebellar signs (DANISH)
(intention tremor, hypotonia, nystagmus, dysdiadochokinesia)
management of cerebral palsy
MDT
tx for spasticity = oral diazepam, oral + intrathecal baclofen
anticonvulsants + analgesia as required
