ADHD and ASD

Question 1

What are the triad of difficulties seen in ADHD

Answer 1

Inattention
Hyperactivity
Impulsivity

Question 2

Do symptoms of ADHD change in different environments

Answer 2

No

They should be pervasive across all settings

Question 3

When does ADHD usually become apparent

Answer 3

From age 5

May become more noticeable later on but should have signs from this age

Question 4

What is the impact of childhood ADHD

Answer 4

Increased level of home stress
Emotional dysregulation leads to difficulties in peer relationships and reckless and dangerous behaviour
Poor problem solving ability
Struggle at school - can affect learning/education
Higher likelihood of antisocial behaviours
Low self-esteem - always getting told off

Question 5

What is the impact of adult ADHD

Answer 5

There is an increase in the frequency of psychiatric comorbidity
Higher levels of criminality, antisocial behaviour
Higher level of substance misuse
Poor impulse control
Occupational difficulty

Question 6

Can people grow out of ADHD

Answer 6

Kind of
Thought that some can compensate better for the cognitive deficit as they mature
Still have the disorder just cope better

Question 7

What causes ADHD

Answer 7

Genetic predisposition
Perinatal precipitants
Psychosocial adversity

This lead to neuroanatomical brain changes and the symptoms

Question 8

Is there a genetic component to ADHD

Answer 8

Yes
ADHD shows familial clustering
Strong increased risk for ADHD in the offspring of those with ADHD

Question 9

What perinatal factors can increase chance of ADHD

Answer 9

ADHD is common in kids with foetal alcohol syndrome
Alcohol and tobacco in pregnancy
Significant prematurity and perinatal hypoxia
Stressful birth

Question 10

Which area of the brain is underactive in ADHD

Answer 10

Frontal lobe
This leads to trouble reasoning, decision making, controlling impulses etc
Also affects long term memory - without this you can’t learn from mistakes

Question 11

How does ADHD affect your neurochemistry

Answer 11

Seems to be an excessively efficient dopamine-removal system - lose interest or pleasure faster
May also have reduced serotonin and norepinephrine

Question 12

What are the diagnostic criteria for ADHD in children

Answer 12

6 or more symptoms of inattentiveness; and/or
6 or more symptoms of hyperactivity and impulsiveness
Present before age 5 years
Reported by parents, school and seen in clinic
Symptoms get on the way of daily life

Question 13

What are the diagnostic criteria for ADHD in adults

Answer 13

In general, 5 or more of the symptoms of inattentiveness; and or
5 or more of hyperactivity and impulsiveness
Still look for inattentive and risk taking in adults – speeding, sexual behaviour etc
Historical concerns since early age
Affect several areas of daily life

Question 14

When is pharmacological treatment used in ADHD

Answer 14

Only in moderate and severe cases

Question 15

List some psychosocial intervention used to treat ADHD

Answer 15

Parent training and education
Social skills training
Sleep and Diet: eliminations and supplements
Behavioural classroom management strategies - reward charts or traffic like system
Specific educational interventions

Question 16

List the drugs used in the treatment of ADHD

Answer 16

1st Line = stimulants
Methylphenidate 
Dexamfetamine
2nd Line = SNRI
Atomoxetine
3rd Line = alpha agonist
Clonidine 
4th Line = 
Antidepressants (imipramine)
Antipsychotics (Risperidone)

Question 17

How effective is medication for ADHD

Answer 17

EXTREMELY

NNT is only 4

Question 18

What 5 disorders come under the umbrella of ASD

Answer 18

Asperger’s Syndrome
Rett’s Syndrome 
Childhood Autism
Pervasive Developmental Disorder
Pervasive Developmental Disorder NOS

Question 19

What are the triad of impairments seen in ASD

Answer 19

Social communication
Social interaction
Social imagination

(Repetitive behaviours are non-essential for diagnosis but very very common)

Question 20

How do autistic people struggle with social communication

Answer 20

Good language skills but struggle to pick up underlying meanings
Difficulty with jokes, sarcasm etc
They often have narrow interests which dominate their conversation
Can be very pedantic – will correct grammar
Difficulty expressing emotion

Question 21

How do autistic people struggle with social interaction

Answer 21

Difficulties picking up non-verbal cues
Appear self-focused and lacking in empathy - not really the case
Continually struggle to make and sustain personal and social relationships

Question 22

How do autistic people struggle with social imagination

Answer 22

Difficulties thinking flexibly and in abstract ways
Inability to understand other people’s points of view, taking things literally
Difficulties applying knowledge and skills across settings with different people
Difficulties projecting themselves into the future

Question 23

Which sex is more likely to have ASD

Answer 23

Males (5:1)

May be because girls are easier to miss – better at coping socially

Question 24

What is the link between autism and gender identity

Answer 24

Higher than population rate of ASD in those accessing gender identity clinics

In females it is common in those with CAH - higher testosterone

Question 25

What causes autism

Answer 25

Currently unknown - genetics, biological and environmental factors

Could be triggered by rubella in pregnancy, Fragile X, encephalitis, untreated PKU

Question 26

Is there a genetic component to ASD

Answer 26

Yes
Strongly heritable
identical twins have 90% chance of having ASD if the other one does

Question 27

What perinatal factors could increase risk of autism

Answer 27

Umbilical-cord complications
Foetal distress
Birth injury or trauma
Multiple birth and maternal haemorrhage 
Low birth weight/small for gestational age
Congenital malformation, 
Meconium aspiration

Question 28

Which areas of the brain are affected in autism

Answer 28

Frontal lobes, amygdala and cerebellum appear pathological
Amygdala is larger - leads to anxiety and worse social skills
Also object recognition areas are underactive – may lead to confusion and stress in unfamiliar situation

Question 29

Which NT’s are affected in autism

Answer 29

Glutamate receptors = dysregulation can lead to neuronal damage
GABA = allows us to relax
Serotonin = regulation of crucial steps of neuronal development

Question 30

Which area of development is commonly delayed in those with autism

Answer 30

Speech delay is common

Often repeat others or repeat the same words over and over

Question 31

What are the essential diagnostic criteria for autism

Answer 31

Symptoms must be present in the early developmental period
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
Disturbances are not better explained by other mental health problems, intellectual disability or global developmental delay

Mainly a subjective clinical diagnosis

Question 32

Which emotional disorders are commonly seen alongside ASD

Answer 32

Depression
Anxiety
Eating Disorders

Question 33

Which neurodevelopmental disorders are commonly seen alongside ASD

Answer 33

Tourette's
OCD
ADHD 
Dyspraxia 
Sensory processing disorder 
Dyslexia

Question 34

List some non-pharmacological management strategies for ASD

Answer 34

Assist with communications – speech and language
Social skills training – limited evidence but worth a try
Teach them how they should behave in certain situations – repeat this often so that they learn
Family and school support
Diet works for some people

Question 35

Which drugs can be used in ASD

Answer 35

Risperidone – licensed for management of severe aggression and significant self-injury
Otherwise it is just treating comorbidities :
e.g. anti-epileptics, SSRI for social anxiety, melatonin for insomnia