Neurodivergence in Adults

Question 1

Autism Spectrum Disorder (ASD) definition

Answer 1

A complex neurodevelopmental disorder, characterised by a spectrum of social communication impairment, with restrictive behaviours and interests. It spans a wide range of symptoms, skills, and levels of disability, with a lifelong impact.

Question 2

ASD epidemiology

Answer 2

• 1-2% worldwide prevalence of autism
• males > females although there is a reported gender bias in autism diagnosis.

Question 3

ASD risk factors

Answer 3

• advanced parental age at the time of conception
• preterm birth
• certain genetic mutations and chromosomal abnormalities e.g. Down’s syndrome, fragile X, tuberous sclerosis
• maternal exposure to specific drugs or infections during pregnancy
• learning disability or neurodevelopmental disorders
• family history

Question 4

ASD investigations

Answer 4

• multidisciplinary assessment by CAMHS or a local autism team
• childhood and here and now
• DSM-5 and ICD-11
• no biological marker or test
• screening tools - autism quotient AQ-10 or AQ-50

Question 5

ASD diagnostic criteria

Answer 5

• difficulties in social communication and interaction
• difficulties in routines, repetitive behaviours, rigidity (includes sensory)
• must be present from early childhood
• impact/impairment on functioning

Question 6

what is the most heritable mental health condition?

Answer 6

ADHD

Question 7

what are asome common co-occurring issues that happen along side ADHD?

Answer 7

• neurodevelopmental conditions
• mental health condition (especially anxiety and depression)
• neurological or genetic presentations (epilepsy, brain injury, FAS)
• insomnia

Question 8

What should a referral letter for ADHD contain?
Describe the 3 appointment process following referral for suspected ADHD.

Answer 8

• Referral should contain symptomatology, description of disablement, confirmation symptoms present in childhood and an ASRS-1.

3 appointment process:
1. full mental state exam & elimination of co-morbid psychopathology which may better explain symptoms
2. psychometric testing and developmental history
3. diagnosis (or otherwise) with discussion with patient

Question 9

ADHD epidemiology

Answer 9

• common condition in children, with an estimated prevalence of 5% worldwide
• often persists into adulthood
• 2-5 times more prevalent in boys than girls

Question 10

ADHD presents with two main symptom domains: inattention and hyperactivity/impulsivity. According to the DSM-5, the following symptoms should be present for a diagnosis:

Answer 10

Criteria A, 5 or more symptoms of:
- inattention: difficulty focusing on and completing tasks, disorganisation, forgetfulness and losing possessions, careless mistakes.
- and hyperactivity and impulsivity: excessive movement and activity, decisions or actions which are not thought through and have potention risk associated e.g. interrupting others, temper outbursts.

Criteria B: several symptoms present by age 12.

Criteria C: several symptoms present in 2 or more settings.

Criteria D: symptoms interfere with or reduce equality of social, educational or occupational functioning.

Criteria E: symptoms are not better explained by another condition, such as a mood disorder.

Question 11

ADHD conservative management strategies

Answer 11

• behavioural techniques: CBT, behavioural therapy, psychoeducation and social skills training.
• extra support at school
• sleep support: sleep hygiene advice should be trialled, and melatonin can be considered if it fails.

Question 12

Outline the medical management of ADHD

Answer 12

Stimulants:
- Methylphenidate: typically 1st-line
- Lisdexamphetamine

Non-stimulants:
- Atomoxetine
- Guanfacine