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Psychiatry Year 3 Dundee > ADHD and ASD > Flashcards

ADHD and ASD Flashcards

1
Q

What are the triad of core symptoms that are up ADHD?

A

Inattention
Hyperactivity
Impulsivity

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2
Q

What other symptoms co-occur with the core triad in ADHD?

A

Developmentally inappropriate
Impairs function
Pervasive across all settings
Longstanding from the age of 5

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3
Q

List some impacts ADHD has.

A

Emotional dysregulation- difficult family and peer relations
Poor problem solving
Learning barrier as often excluded from education

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4
Q

ADHD in adults often leads to…

A

Increased frequency of psychiatric comorbidity
Higher levels of criminality/antisocial behaviour
Higher levels of substance abuse
Impaired occupational function

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5
Q

Why do symptoms of ADHD decrease over time?

A

As the brain matures the thickness of the cortices increases allowing for the compensation of cognitive deficit.

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6
Q

List some perinatal factors that can increase the risk of a child developing ADHD.

A

Tobacco and alcohol use in pregnancy
Significant hypoxia - prematurity and perinatal
Eclampsia

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7
Q

Neurobiologically how do ADHD patients present?

A

Underactive frontal lobe

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8
Q

Neurochemically how do ADHD patients present?

A

Excessive dopamine removal

Reduction in norepinephrine and seretonin

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9
Q

How are children assessed with ADHD?

A

Parent or school referral and observation

Screening or diagnostic questionnaire

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10
Q

How are adults assessed with ADHD?

A

Referred by patient

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11
Q

What do children need to have in order to be diagnosed with ADHD?

A

6 or more hyperactivity and impulsions
+ 6 symptoms of innattentivness
Presenting before the age of 5
Reported and seen by both school and home.

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12
Q

What do adults need to have in order to be diagnosed with ADHD?

A 
5 or more of hyperactivity and impulsiveness 
\+ 5 or more innatentivness
Historical concerns
Underachieving 
Reckless behaviour
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13
Q

Treatments for in mild ADHD

A

Psychosocial
Parent training
Sleep and diet modification and elimination
Behavioural classroom management

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14
Q

Treatments for moderate to severe ADHD.

A

Psychosocial

Pharmacological

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15
Q

List the pharmacological treatment for ADHD

A

1st line - Stimulants
2nd line - SNRIs
3rd line - Alpha agonists
4th line - Antidepressants or Antipsychotics

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16
Q

What Stimulants are used in ADHD?

A

Methyphenidate

Dexamfetamine

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17
Q

What SNRIs are used in ADHD?

A

Atomoxetine

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18
Q

What Alpha Agonists are used in ADHD?

A

Clonidine

Guanfacine

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19
Q

What Antidepressants or Antipsychotics are used in ADHD?

A

Antidepressants - Imipramine

Antipsychotics - Risperidone

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20
Q

How does Methyphenidate reduce the symptoms of ADHD?

A

Increases Dopamine by blocking its transporters

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21
Q

How does dexamfetamine reduce the symptoms of ADHD?

A

Increases dopamine

Increases extracellular norepinephrine and seretonin

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22
Q

How do SNRIs reduce the symptoms of ADHD?

A

Increase Norepinephrine by blocking its transporters

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23
Q

How do Alpha Agonists reduce the symptoms of ADHD?

A

Reduce sympathetic stimulation

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24
Q

What is the role of Norepinephrine in ADHD?

A

Affects the concentration

Leads to hesitation Obsession and doubt

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25
What is the role of Dopamine in ADHD?
Affects Alertness | Working memory Compulsions Foggy clarity
26
What is the role of seretonin in ADHD?
Affects Satisfaction | Restlessness Confusion Anxiety
27
ASD
Autism Spectrum Disorder
28
What disorders come under ASD?
``` Asperges Retts Childhood autism Pervasive Developmental Disorder PDD NOS ```
29
What are the core features of ASD?
Social communication Social Interaction/Imagination Repetitive Behaviours
30
Social Communication in ASD
Generally good language skills but miss underlying meaning Jokes Idioms Metaphors Sarcasm - taken literally Often sound monotonous Pedantic and idiosyncratic language Narrow interest which dominate their conversation
31
Social Interaction in ASD
Difficulty in picking up non verbal cues Appear self focused an apathetic - usually just struggling to process social situations Difficulty finding and maintaining personal and social relationships.
32
Social Imagination in ASD
Difficulty in thinking outside of the box Inability to see others POV Difficulty in projecting themselves in to future plans or goals
33
Repetitive Behaviours in ASD
Stereotyped or repetitive motor movements Inflexibility to change in their routine Highly restricted interests Hyper or Hypo reactive to sensory input
34
ASD epidemiology
5:1 M:F | 1 in 56
35
Why is ASD more common in Men?
Sex hormones wide involved in brain development and organisation of brain circuits. Poor specificity of diagnostic tests in females
36
What hormone is linked to ASD and why?
Testosterone Sex Hormone Binding Globulin is reduced in females with autism, as such they have much higher levels of free testosterone.
37
What is 3 to 4x more likely in a child with ASD?
Gender Identity issues
38
What can trigger autistic behaviour in children?
``` Rubella as a foetus Tuberous Sclerosis Fragile X Syndrome Encephalitis Untreated Phenylketonuria ```
39
What perinatal factors can lead to ASD?
``` Umbilical chord complications Foetal distress Injury or trauma during delivery Low birth weight Meconium aspiration ```
40
What environmental factors can lead to ASD?
Teratogenic exposure during first 8 weeks post conception
41
How does the brain of someone with ASD appear?
Frontal lobe Amygdala and Cerebellum are all pathological | Amygdala is enlarged - sever anxiety
42
What are all receptors and neurotransmitters are reduced in ASD?
Glutamate receptors GABA Seretonin
43
How can a reduction in GABA result in ASD?
GABA helps in the developmental stages of cell migration and neuronal differentiation and maturation.
44
How can a reduction in Serotonin result in ASD?
Helps in cellular and brain maturation
45
How can blocking of Glutamate receptors lead to ASD
Glutamate dysregulation can lead to neuronal damage
46
What should be looked at in the investigation into a child with ASD?
Speech and language Social Skills Sensory
47
What could be observed in a child with ASD? | Speech and Language
Doesn't babble or make other vocal sounds Parrot- repeat or mimic words or phrases without developing their own language Older children have trouble using non verbal behaviours e.g. maintaining eye contact facial expressions body language and gestures
48
What could be observed in a child with ASD? | Social skills
``` Lack awareness of interest in other children Gravitate to older or younger children Play alone Little or no imaginative play Change to routine triggers tantrums Flap hand or twist fingers when excited ```
49
What could be observed in a child with ASD? | Sensory
Taste - restricted diet as sensitive to textures Sound - inability to filter out background noise concentration is impaired Touch - often painful or uncomfortable brushing or cutting hair Sight- Poor depth perception and increased clumsiness Focused in on details not whole thing Sensitive to light - difficulty sleeping
50
What could be observed in an adult with ASD? | Communication
Difficulty seeing others perspective, picking up non verbal cues, making eye contact Shows compassion but confused by social signals Problems initiating and continuing a conversation - small talk is difficult Difficulty seeing peoples intentions
51
What could be observed in an adult with ASD? | Social
Appear blunt Take things literals Difficulty fitting in as doesn't follow norms Appear shy or avoid interaction
52
What is a good diagnostic tool in ASD?
ADOS | Autism Diagnostic Observation Schedule
53
What neurodevelopment disorders are common comorbidities with ASD?
``` Tourettes OCD ADHD Dyspaxia Dyslexia Language Impairment ```
54
What percentage of ASD patients have Tourettes?
7%
55
What percentage of ASD patients have OCD?
30%
56
What percentage of ASD patients have ADHD?
65%
57
What percentage of ASD patients have Dyspraxia ?
17%
58
What percentage of ASD patients have Dyslexia?
70%
59
What percentage of ASD patients have a language impairment?
70%
60
What percentage of patients with ASD and a learning disorder have an IQ <70
65%
61
What percentage of patients with ASD and a learning disorder have an IQ <50
35%
62
What is the main management of ASD?
Psychosocial | No real pharmacological treatment
63
What psychosocial management is given to ASD patients?
``` Self and family psychoeducation Speech and language therapy Social skills training Family and school based support Diet - Conflicting evidence diet has an influence ```
64
What medication is used in ASD?
Risperidone - antipsychotic | Used acutely for severe aggression and self injury

Psychiatry Year 3 Dundee (21 decks)

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