ASD and ADHD Flashcards by Laurence Forsyth

state some neurodevelopmentla disorders 6

ADHD

ASD

tourettes

learning difficulties

dyslexia

dyspraxia

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define ADHD

syx of inattention and/or hyperactivity/impulsviity significantly interfere with daily function

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prevalanece of ADHD

5.2% in US

3.45% europe

2.8% worldwide

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gender bias of ADHD

M:F 4:1

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developmental impact of ADHD at the following age:
pre-school 1

behaviour disturbance

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developmental impact of ADHD at the following age:
school age 4

behavioural distrubance

academic impairment

poor social interaction

peer acceptance

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developmental impact of ADHD at the following age:
adolescent 5

academic impairment

social skills learning

self-esteem

smoking/alcohol/drugs

antisocial behaviour

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developmental impact of ADHD at the following age:
college age 5

academic failure

occupational difficulties

self esteem

alcohol and substance abuse

injury/accidnet

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developmental impact of ADHD at the following age:
adult 6

not coping with daily tasks

unemployment

relaitonship problems

motor accidents

alcohol and substance abuse

mood instabi.ity

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presentation of ADHD in adults

chaotic

disorganised

always late

restless

fidgeting

and more

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diagnosis of ADHD 4

2-3 sessions,. no rush

detailed psychatirc and developmental assessment

collateral history
-school reports
-parental reports
-sbiling report

Neuropsychatirc assessment

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inattentive syx of ADHD 9
-*mneomic

*-mneomonic -DADMOMLFC
(mom taught me ABC dad taught me LFC)

Difficulty sustaining attention
Avoids sustaining attention
Distracted easily
Misplaces things
Organisation problems
Mistakes made
Listening difficult
Forgetful in daily activities
Completing tasks or jobs

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hyperactive/impulsive syx of ADHD 9
*-mneominc

*-LFROST/WIB

Loud in quiet situations
Fidgetiness
Restless or overactive
On the go all the time
Seating difficult
Talks excessively

Waiting difficult
Interrupts or intrudes
Blurts out prematurely

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other syx of ADHD 5

affective instability

ceasless mental acitivty

mind wandering

initial insomnia

hyperfocus

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differenital diagnosis for ADHD

normal behaviour

malingering or seeking stimulant medications

hyperthyroidism, susbtance abuse, mania

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important point abotu differntials for ADHD

could also be a co-morbidiity
-check other syx
-check response to treatment

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what happens after someone is diagnosed with ADHD 2

delineate ADHD syx from comorbid syx and normal behaviour

inform:- employer, university/college, DVLA, car insurers

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medication for ADHD

suppress syx
-treatmetns increase neurotransmission of dopamine and/or noradrenaline

1st line- stimulants
2nd line- non-stimulants

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pros and cons of stimulant ADHD medications 2v1

pro- immediate action
-controlled drugs

cons
-more potential for diversion

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pros and cons of non-stimulant ADHD medication 1v2

pros
-preferable if concern about diversion

cons
delayed onset of action
-similar to antidepressants

-non-controlled drugs

First line treatement for ADHD in adults

methylphenidate

moa of methylphenidate

DA and NA reuptake inhibitor

types of preparations of methylphenidate and why is this beneficial

immeidate release preparations
-cheaper
-can allow more fine tuning of dosing

slow release preparation
-allow once daily AM dosing

*-can be combined to fine tune syx control at certain times of day

dose titration of methylphenidate 3

increment- smallest available

interval- at least 2 weekly

until-adequate resonpnse or intolerable side effects or increase in BP and HR

examples of methyphenidates 5

ritaline/medikinet - immediate release slow release: -concerta medikinet XL equasym

side effects of methylphenidates 7

reduced appetite insomia headache irritability tachycardia tics seziures

alternative stimulant medication to methylphenidate for ADHD

dexamfetamine

MOA and use of dexametamine for ADHD

DA and NA releaser and reuptake inhibitor USE -worth trial if poor response to methylphenidate *watch as considered more abuse/diversion potential than methylphenidate

first line non-stimulant medication for ADHD

atomoxetine

MOA and use of atomoxetine for ADHD

MOA- NARI USE -when stimulant not tolerated or risk of diversion *remember has delayed onset several weeks

severe side effects of atomoxetine 2 common side effects -5

acute liver failure suicidality *-both rare -can be avoided by gradual dose titrations common: -reduced appetite -nausea -insomia -dizziness -constipation -sweating -sexual dysfunction -seizures

contraindications to atomoexteine 1

phaechromocytoma

other options for ADHD medication 4

guanfacine/clonidine buproprion modafinil nortriptule or desipramine

assessing repsonse in ADHD 4

core syx assoc syx functionig patient report/ collateral

points on prescirbing in ADHD when co-morbidity is present

treat most severe condition first optimise exisitng treatment Examples: Psychosis - non-stimulant preferable, antipsychotic cover Depression – careful with side effects if already on antidepressant with NA effect Mania - mood stabiliser/antipsychotic cover Anxiety - stimulants may exacerbate, atomoxetine preferable Addiction – depends on substance, 6/12 abstinence Tourette’s syndrome – stimulants make tics worse

duration of treatment for ADHD

6 monthly BP/HR drug holiday -period without meds -considered annual -assess whether grown out of ADHD

how does aspergers differ to ASD

similar to autism bu no general delay in language or cognigitev development -tend to have normal intelligence

triad of core syx of ASD

abnormal reciprocal social interactions communciation/langage impairemnt resitricted and repetitive interests/activties

incidence of ASD and gender bias -*IQ spread

M:F 4:1 prevalence- 0.5-1% *-80% have low IQ ( learning disability) -20% normal IQ (high functioning autism) -aspergers syndrome (normal language)

aetiology of ASD 4

tendency to run in families genetic mutations -many assoc w development of brain non-genetic factors -parental age -birth complications -

charactersitics of abnormal social interactions for ASD 6

indiffernce minimal shared nejoyment reciprocal interction only early life friends limited empathy, insensitive lack of intuition

charactersitics of communcation/ langugae impairemnt for ASD 6

delayed or lack of speech prolonged or avoidant eye contact awkward posture or body language unusual speech volume misinterpreationof literal or implied meaning advanced voacb- poor convo skills

charactersitics of resistricted and repeitive intererst/behaviours for ASD 6

obsessive fixed intrests motor mannerisms- hand flapping, body rocking compulsive/repeitive behaviours preference for smaeness increased sensory responsiveness change unsettling

other featuers of ASD 3

clumsiness difficulites expressing emotion increased pain threshold

assessment of ASD 2

whos involved: -doctors -speech and langue therapy -occupational therapy -psychology standardised tools -autism behaviour checklist childhood autism rating scales autism diagnostic observation schedule

principles of ASD management 3

structue routine predicatbility

general points about ASD managment 5

adapt enviornemt -reduce complex social interactions -use routine/timetabling communication aids -use of pictures or objects social skills training CBT, OT family support -parenting programmes

use of medciation for ASD 3

symptomaitc -antipsychotic for stereotyped or aggressive hevioaurs SSRIs for compulsive behaviours melatoinin for insomnia