ADHD and ASD

Question 1

What is the main diagnostic triad of ADHD?

Answer 1

Inattention
Hyperactivity
Impulsivity

Question 2

What do the symptoms of ADHD have to be to make a diagnosis?

Answer 2

Developmentally inappropriate
Impairing function
Pervasive across settings
Present for at least 6 months

Question 3

How is a diagnosis of ADHD in childhood made?

Answer 3

History
Observation at home and school
Diagnostic tools like the ADHD rating scale

Question 4

What are non-pharmacological options for management of ADHD?

Answer 4

Parent training
Social skills training
Sleep and diet changes
Psychoeducation

Question 5

What is the pathway of pharmacological treatments of ADHD?

Answer 5

First line: stimulants
Second line: SSRI - atomoxine
Third line: alpha agonist
4th line: antidepressants (imipramine) or antipsychotics (risperidone)

Question 6

What are examples of stimulants used in ADHD?

Answer 6

Methylphenidate
Dexamfetamine
Lisdexamfetamine

Question 7

What is the mechanism of methylphenidate as treatment for ADHD?

Answer 7

CNS stimulant associated that works primarily by improving dopamine signalling in the networks associated with executive functioning

Question 8

What are side effects of methylphenidate?

Answer 8

Headache
Poor appetite
Insomnia

Question 9

How do SSRIs work in ADHD?

Answer 9

Non-stimulant - work by inhibiting noradrenaline uptake

Question 10

What are side effects of SSRIs in ADHD?

Answer 10

Nausea
Dry mouth
Weight loss

Question 11

What alpha agonists are used in ADHD?

Answer 11

Clonidine

Guanfacine

Question 12

What are the domains in which people with ASD struggle?

Answer 12

Social interactions
Social imagination
Communication
Repetitive behaviours

Question 13

What is meant by social imagination?

Answer 13

Ability to imagine and understand what others are thinking or their point of view
Ability to imagine yourself in the future and plan for goals

Question 14

In what ways do people with ASD struggle with social interaction?

Answer 14

Find relationships difficult to establish and sustain
Struggle to figure out social situations so can appear self-focused and lacking in empathy
Lack interest in others

Question 15

In what ways do people with ASD struggle with communication?

Answer 15

Delay in receptive and expressive language
Struggle to make eye contact
Struggle to understand sarcasm, metaphors, underlying meanings of conversation
Struggle to initiate and sustain conversation
Stress, pitch or rhythm of speech may be odd or monotonous
Language can be pedantic and idiosyncratic

Question 16

What kind of repetitive behaviours do people with ASD exhibit?

Answer 16

Restricted, repetitive and stereotyped behaviour such as spinning or rubbing head
Routine orientated and struggle to cope with change in routine
Interested or fixated on one task or hobby

Question 17

How is diagnosis of ASD made?

Answer 17

Symptoms present in early developmental period
Symptoms cause significant impairment in social, occupational or other areas of functioning
Disturbances not better explained by other mental health problems, intellectual disability or developmental delay

Question 18

What are non-pharmacological options for management of ASD?

Answer 18

School interventions
Social skills training
Speech and language therapy

Question 19

What are pharmacological options for management of ASD?

Answer 19

Risperidone/aripiprazole short term for significant aggression, tantrums or self-injury
Methylphenidate for ADHD symptoms
Anti-anxiety, antidepressants, melatonin

Question 20

What are intellectual disabilities?

Answer 20

Conditions the cause a reduced intellectual ability and difficulty with everyday tasks, socialising or managing money - which affects someone for their whole life

Question 21

What criteria are needed for an intellectual disability?

Answer 21

IQ <70
Onset before age 18
Impairment in a wide range of functions

Question 22

What are the categories for severity of intellectual disability?

Answer 22

Mild: IQ 50-69
Moderate: IQ 35-49
Severe: IQ 20-34
Profund: IQ <20

Question 23

What are the features of a mild intellectual disability?

Answer 23

Most common
Delayed speech
Full independence
Difficulties reading + writing
Capable of unskilled or semiskilled work

Question 24

What are the features of a moderate intellectual disability?

Answer 24

Slow with comprehension and language
Limited achievements
Delayed self care and motor skills
Simple practical tasks (often with supervision)
Usually fully mobile
E.g. Down syndrome

Question 25

What are the features of a severe intellectual disability?

Answer 25

Mental age 3-6 years Require support throughout life Difficulty following instructions - may need information presented in a different way, e.g. hand gestures

Question 26

What are the features of a profound intellectual disability?

Answer 26

Mental age less than 3 years Severe limitation in ability to understand or comply with requests/instructions Little or no self care Often severe mobility restrictions

Question 27

What is borderline intellectual disability?

Answer 27

Not officially an ID IQ 70-84 Mental age 12-15

Question 28

What are pre-natal causes of intellectual disability?

Answer 28

Genetics Substance misuse Medications in pregnancy Infection in pregnancy - rubella, CMV

Question 29

What are perinatal causes of intellectual disability?

Answer 29

Prematurity Tumours Metabolic disorders (phenylketonuria, neonatal hypothyroidism, hyper bilirubinemia) Infection: meningitis, pneumonia

Question 30

What are examples of genetic conditions associated with intellectual disability?

Answer 30

``` Neurofibromatosis Tuberous sclerosis Down syndrome: trisomy 21 Patau syndrome: trisomy 13 Edwards syndrome: trisomy 18 Fragile X syndrome Prader-Willi syndrome Angelman syndrome DiGeorge syndrome Cri Du Chat syndrome Lesch-Nyhan syndrome ```

Question 31

How does Prader-Willi syndrome present?

Answer 31

Obesity, compulsive over eating and self injurious behaviour

Question 32

How does Angelman syndrome present?

Answer 32

Ataxia leading to puppet like movement and paroxysms of laughter

Question 33

How does DiGeorge syndrome present?

Answer 33

Small head, facial abnormalities, prominent nose, congenital heart disease and increased risk of schizophrenia

Question 34

How does Cri Du Chat syndrome present?

Answer 34

Microcephaly and characteristic cat like cry

Question 35

How does Lesch-Nyhan syndrome present?

Answer 35

Gout, renal stones and self injurious behaviour, which is characteristically by biting

Question 36

How are psychiatric symptoms different in people with intellectual disabilities?

Answer 36

Depression more likely to present with somatic symptoms Schizophrenia typically presents with negative symptoms or behavioural changes Autism is more common - 30%