Peds MNTH Flashcards
Key features of Autism
Social communication and interaction behavior
No diagnostic biomarker for ASD
Autism Etiology
Inherited or occur de novo
Older maternal or paternal age
Maternal obesity, short interval from prior pregnancy, premature birth, rubella or cytomegalovirus
Changes in brain volume
Symptoms of ASD?
Reduced response to name and unusual use of objects
Symptoms before age 12 months not as reliably predictive
Easy baby.
What are comorbid conditions of ASD?
Intellectual disability
Nonverbal status to age appropriate speech
GI problems
Epilepsy in 35%
ADHD
Anxiety 40%
Sleep problems 50-80%, abnormalities in melatonin secretion
Restrictive feeding patterns and food selectivity
Disruptive behaviors
DSM-5 for ASD (Autism Spectrum Disorder)
Unusual or Restricted Interests or repetitive behavior
Reduced eye contact, reduced facial expressions or gestures
Reduced awareness of personal space, reduced initiation of social play or sharing.
Absent response to name being called and social smiling
Language delay (using less than 10 words by age 2yr), odd or flat intonation.
When should you Screen for ASD, and what do you use?
18-24 months
MCHAT R/FU
ASD Tx
Intensive behavioral therapies
Individualized
Applied behavioral analysis
Augmentative communication
Meds:
Melatonin, Stimulants (Hyperactivity), Anxiety (SSRI’s)
ADHD Prevalence and risk factors?
5-9% of school-aged children, 2-6 adolescents, 2% adults
Several inattentive symptoms before age 12 years
Male more than females
2-8 fold higher with genetics. Monozygotic twins in 92%, Multifactorial
Causes of ADHD
Decrease DA and serotonin
Aberrant catecholamine metabolism of dopamine and NE
DMS-5 ADHD Inattention
6 core symptoms of the disorder for at least 6 months in 2 or more settings and must be before age 12.
Not a sudden diagnosis
- Lack of attention to detail
- Difficulty sustaining attention
- Difficulty with listening skills
- Difficulty with task completion
- Difficulty with organizational skills
- Difficulty with tasks requiring sustained attention
- Frequently loses belongings
- Easily distracted
- Forgetful
Clinical presentation of ADHD
Younger kids
Adolescents and Adults
Symptoms appear by age 4 years and by age 7 or 8 years
Motor restlessness and disruptive behavior
Typically inattention, less motor hyperactivity
Continues in up to 40% of affected children
What are some diagnosis of exclusion for ADHD?
CNS disease Hyperthyroidism High lead levels Congenital genetic syndromes Sudden manifestation Primary sleep disorders Evaluate for substance use disorder
DSM-5 ADHD Hyperactivity and Impulsivity
6 core symptoms of the disorder for at least 6 months in 2 or more settings and must be before age 12.
Not a sudden diagnosis
- Fidgeting and squirming
- Stands when sitting is expected
- Runs around inappropriately
- Difficulty with quiet play
- Inability to relax and remain still
- Excessive talking
- Blurts out answers
- Difficulty waiting for turn
- Interrupts
Comorbid disorders with ADHD
Oppositional defiant disorder 69% Mood disorder 50% Anxiety disorder Language or learning disability Conduct disorder Autism spectrum disorder Depressive disorders
Emotional lability (38% to 75% of children)
Clumsiness
Learned helplessness
Tx of ADHD in:
Preschool 4-5
6-11
12-18
Behavior Therapy
Methylphenidate (Ritalin)
Stimulantslike amphetamine, methylphenidate , atomoxetine, guanfacine and clonidine
Medications are first line and consider behavior therapy; preferably both.
