ADHD and Autism

Question 1

Define ADHD

Answer 1

Developmentally inappropriate hyperactivity, impulsivity and/or inattention, leading to impairment in social, behavioural and/or academic function

Question 2

What are the 3 subtypes of ADHD?

Answer 2

Hyperactive
Inattentive
Combined

Question 3

What are inattention symptoms of ADHD?

Answer 3

Does not attend 
Fails to finish tasks
Can't organise
Avoids sustained effort
Loses things
Easily distracted

Question 4

What are the 3 symptom groupings for ADHD?

Answer 4

Inattention
Hyperactivity
Impulsivity

Question 5

What are hyperactivity symptoms of ADHD?

Answer 5

Fidgets
Leaves seat in class
Runs/climbs excessively 
Cannot play/work quietly 
Always 'on the go'

Question 6

What are impulsivity symptoms of ADHD?

Answer 6

Talks excessively 
Blurts out answers
Cannot await turn 
Interrupts others 
Intrudes on others

Question 7

What are some of the psychiatric comordbidities of ADHD?

Answer 7

Disruptive behaviour disorders e.g. conduct disorder, oppositional defiant disorder
Anxiety and mood disorders

Question 8

What are the functional impairments of ADHD relating to self?

Answer 8

Low self-esteem
Accidents and injury
Smoking/substance abuse
Delinquency

Question 9

What are the functional impairments of ADHD relating to school/work?

Answer 9

Academic difficulties and underachievement

Employment difficulties

Question 10

What are the functional impairments of ADHD relating to home?

Answer 10

Family stress

Parenting difficulties

Question 11

What are the functional impairments of ADHD relating to social?

Answer 11

Poor peer relationships
Socialisation deficit
Relationship difficulties

Question 12

What is the global prevalence of ADHD?

Answer 12

5%

Question 13

What is the prevalence of the different subtypes of ADHD?

Answer 13

Hyperactive - 15%
Inattentive - 20-30%
Severe combined - 75%

Question 14

Why is the prevalence of ADHD in Scotland so low?

Answer 14

Underdiagnosed disorder

Question 15

What is high prevalence of ADHD linked to?

Answer 15

Low socioeconomic class

Question 16

What evidence is the surrounding the heritability of ADHD?

Answer 16

Estimated heritability of 75%
Chr 4, 5, 6, 8, 11, 16, 17
Linkage with dopamine receptors and transporter genes, serotonin transport genes also

Question 17

What are ante/peri-natal factors that may contribute to the causation of ADHD?

Answer 17

Pre-term delivery
Smoking 
Alcohol
Maternal stress
Intrapartum asphyxia

Question 18

What are post-natal factors that may contribute to the causation of ADHD?

Answer 18

Brain trauma
Epilepsy
Deprivation/attachment

Question 19

Which structures in the brain are thought to be involved in the pathphysiology of ADHD?

Answer 19

Frontal lobes
Cingulate gyrus
Basal ganglia
Locus coeruleus
Cerebellum

Question 20

What have imaging studies shown about the pathophysiology of ADHD?

Answer 20

Reduced volume of key brain structures

Reduced activation of key brain areas, particular frontostriatal pathways (fMRI, SPECT)

Question 21

What have neuropharmacology studies shown about the pathphysiology of ADHD?

Answer 21

ADHD symptoms improved by medications that modify the release and reuptake of key neurotransmitters (DA, NA) which are concerned with self regulation and attention

Question 22

What have neuropsychology studies shown about the pathophysiology of ADHD?

Answer 22

Deficiencies in frontal lobe mediated functions such as working memory, executive function, focus, distractibility

Question 23

What are the prefrontal regions associated with impulsivity, hyperactivity and inattention?

Answer 23

Impulsivity - orbital frontal cortex
Hyperactivity - prefrontal motor cortex
Inattention - dorsal anterior cingulate, dorsolateral prefrontal

Question 24

What is the role of dopamine and noradrenaline in information processing?

Answer 24

Optimum processing requires distinguishing signals form noise
DA and NA tune the prefrontal cortex to make information processing more efficient
Too much DA and NA input can be as disruptive as too little input in regulating cortical information processing

Question 25

Define ASD

Answer 25

Triad of impairment affecting social communication, social interaction and social imagination

Question 26

Describe the social communication impairments seen in ASD

Answer 26

Inappropriate eye contact, facial expression, gesture and prosody
Taking turn in conversation
Interpret language in literal matter

Question 27

Describe the social interaction impairments seen in ASD

Answer 27

Lack of empathy and reciprocity

Failure to adapt behaviour according to others

Question 28

Describe the social imagination impairments seen in ASD

Answer 28

Poor imagination skills leading to restricted, repetitive patterns of behaviour
Preoccupation with structure and routine

Question 29

Why has there been a rise in ASD diagnosis?

Answer 29

Increased detection
Accompanied by a fall in prevalence of other neurodevelopmental disorder that implies there may have been misdiagnosis in the past

Question 30

What is the prevalence of ASD?

Answer 30

1-2%

Question 31

How many ASD children have an intellectual disability?

Answer 31

50%

Question 32

Which gender is ASD more common?

Answer 32

4 times more common in males

Question 33

Name 4 syndromes associated with ASD

Answer 33

Fragile X
Tuberous Sclerosis
Downs syndrome
Angelman’s syndrome

Question 34

What are other co-morbidities associated with ASD?

Answer 34

Sleep disorders
Child onset epilepsy
Motor function e.g. dyspraxia, toe walking
Sensory function e.g. hypo ro hyperresponsiveness

Question 35

What is the main cause of ASD?

Answer 35

Genetic

Question 36

What is the pathphysiology og ASD?

Answer 36

Brain volume enlarged
Macrocephaly
Reduced size and distortion of neurones
Reductio in white mater volume and connectivity

Question 37

What are the suggested deficits in psychological processing and functioning in ASD?

Answer 37

Impairment of frontal lobe mediated executive function and working memory

Deficiencies in theory of mine

Problems in achieving central coherence