ASD/ADHD Tutorial

Question 1

Nursery info to gain re social skills

Answer 1

• What are his social skills?
• Does he initiate social interactions?
• Does he play alongside others?
• Does he struggle in bigger groups or on peripheries?
• Does he stand out from others socially?
• Any aggressive behaviours - triggers? ABC (antecedent, behaviour, consequence)

Question 2

What do you need for adequate communication?

Answer 2

• Intact auditory system
• Intact visual system
• Ability to articulate back - speech and language skills

Be aware of children as English as second language - esp if dominant language not english, can be behind, ask about additional language

Question 3

Normal speech for 2 year olds

Answer 3

2 words together

Question 4

What is joint attention?

Answer 4

• Triangulate - use eye contact, gestures and expressions to show item of interest and enjoyment
• Share it for that persons enjoyment/interest (not just for functional need, needs to be social need)
• Eg if just take you to things that they want and then don’t interact this is just functional

Question 5

Questions to ask re play

Answer 5

• Does he show variety in play?
• Is there evidence of imagination?
• Signs of small world play? Roleplay? Take on role of characters? - after 18 months eg tea party play, feed horse
• Play skills repetitive? Unusual?

Question 6

What happens if children don’t play?

Answer 6

• Don’t develop neurodevelopmental pathways
• Brain does not develop properly
• Good for stimulating brain

Question 7

Questions to ask for paeds history?

Answer 7

• Antenatal history
• Birth - trauma, resus, premature?
• Illness post natally eg CNS infections, head trauma
• FH - ASD, ADHD, LDs
• SH - adverse childhood experiences

Question 8

Examination for ?developmental problem, ASD, ADHD

Answer 8

• Growth - height, weight, head circumference
• Dysmorphic features
• General system exam
• Skin manifestations
• Interaction
• Eye contact - quality and quantity
• Check if fixated on toy and if will swap toy, non-verbal gestures, facial expressions

check verbal matches with non-verbal

Question 9

What to say to parents re ASD diagnosis?

Answer 9

• Gauge parents understanding
• Gain concerns
• Anything specific in their mind they are worried about?
• Explain impression, state assessment takes time, need input from MDT

Question 10

Management plan for ?ASD, developmental delay

Answer 10

• Gather information from nursery/school
• Hearing test referral
• Speech and language referral
• Referral to Early years team/educational psychology
• Check for causes of broader developmental delay - eg metabolic tests (blood and urine) and genetics test (microarray takes months) - ONLY if needed
• Follow up appt - allow for more time if needed

Question 11

How is diagnosis for ASD done?

Answer 11

• Multi agency assessment
• MDT meeting if doubt present eg - parental, school

Question 12

Diagnosing ASD DSMV

Answer 12

• Triad of social interaction, social communicattion and restricted repetitive behaviours

FINISh

Question 13

Management of ASD

Answer 13

• Behavioural and educational management
• Chronic condition but needs can change as time progresses
• Can have implications on certain careers

Question 14

Co-morbid issues with ASD

Answer 14

• ADHD
• Anxiety
• Learning difficulties
• OCD
• Depression
• Sensory issues
• Restricted diet
• Fits/seizures
• Sleep related problems - behavioural approach/melatonin

Question 15

Triad of ADHD

Answer 15

• Impulsivity
• Hyperactivity
• Inattention

Question 16

What to ask re hyperactivity?

Answer 16

• Is he always on the go?
• Does he struggle to sit still?
• Fidgeting/fiddling with something always?
• Does he rock/swing his legs when sat down?

Question 17

What to ask re inattention?

Answer 17

• Does he seem to not listen to instructions?
• Does he struggle with sequential instructions?
• Does information need breaking down?
• Is he forgetful?
• Does he lose things?
• Can he organise himself for school?

Question 18

Questions to ask re impulsivity?

Answer 18

• Can he stop himself getting into dangerous situations? eg road safety
• Does he lash out easily?
• Can he mend relationship difficulties easily?

Question 19

Main RF for neurodevelopmental disease

Answer 19

Prematurity
Even week 37-40 there are differences between 37 and 40 weeks

Question 20

Differential for brown irregular patches on legs and back with ADHD

Answer 20

Neurofibromatosis type 1
Need 6 or more cafe au lait spots for significance
If in doubt, refer for genetic testing

Question 21

Management for ADHD

Answer 21

• Conners screening questionaires - parent and school
• Hearing test
• Check no underlying understanding issues eg consider SALT
• Get clear indication from school levels of learning and performance - may need to consider psych assessment
• Bloods

Question 22

What bloods for ?ADHD?

Answer 22

• FBC - anaemia
• Ferritin - low attention
• U&E - for med
• LFT - for med
• Bone profile
• TSH

Question 23

First line management ADHD

Answer 23

• Behavioural and psychoeducation (parents and school)
• Healthy diet and sleep (could be chronic sleep deprivation)
• If moderate/severe or impairment despite lifestyle measures - consider medication (aged 6 and above)

Question 24

Pre medication checks for ADHD medication

Answer 24

• What is functional benefit? - be clear
• Check for cardiac problems, murmur, FH early onset cardiac death/arrhythmias, any other drugs, mental health, seizures, thyroid problems, glaucoma
• Check height, weight and blood pressure

Question 25

How do ADHD medications work?

Answer 25

* Noradrenaline and dopamine reuptake inhibitor * Can be short dutation - 4hr or long duration - 8-12hr * All may need to be titrated/adjusted as child grows * Consider reducing dose/other class if side effect * First line = methylphenidate

Question 26

Other stimulant drugs

Answer 26

* Lysdexamfetamine

Question 27

Non stimulant drugs

Answer 27

* Atomoxetine * Guanfacine hydrochloride Need to build up levels in blood, take for a while then works Guanfacine increases appetite, can make more sleepy, lowers BP

Question 28

Side effects ADHD meds

Answer 28

* Reduced appetite * Low mood * Stunted growth (from low appetite) * Raised BP

Question 29

Differentials for behavioural issies

Answer 29

* Secondary to environment * ADHD * Both

Question 30

Management for behavioural issues secondary to environment

Answer 30

* Acknowledge concerns * Write to school for information * Consider screening questionaire for ADHD * Signpost - online parenting info * If no findings from school/questionaires - emphasize positives * Ensure no safeguarding concerns * Consider discharge at next appt if no evidence of ND problems - if school have concerns, get referred back