Lecture 26, 27 - ADHD, Autism Flashcards Preview

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Flashcards in Lecture 26, 27 - ADHD, Autism Deck (21):
1

ADHD -- what are the two categories of symptoms for ADHD ?

Describe some of the characterisitc features

which category decreases with age

Inattentive symptoms -- careless errors, can't sustain attention, don't seem to listen when spoken to directly, doesn't follow through on tasks, difficulty organizing tasks, loses things, easily distracted, forgetful in daily activity

Hyperactive-impulsive - fidgets, squirms, leaves seat, runs or climbs inappropriately, can't play quietly, on the go, talks excessively, blurts out, difficulty awaiting turn, interrupts symptoms
(decreases with age)

2

ADHD
when do symptoms have to present by?

where does the impairment have to be observed?

age 12

in greater than 1 setting

3

ADHD
challenges of the dx?

all kids have some of these characaterisitcs
have to identify what is outlier behavior

need multiple sources of data (teachers, parents)

4

ADHD Co-occurring conditions

Disruptive Behavior Disorders
Anxiety Disorders
Mood Disorders
Substance Abuse in Teens --- Impulsivity control

5

ADHD -- course in adulthood --what % of kids have the DSM criteria into adulthood?

what are some predictors of this

50%
combined hyperactive and inattentive symptoms
severity of symptoms
Comorbid depression
Parental Anxiety mood disorders

6

ADHD -- environmental risk factors?

Maternal smoking, alcohol, substance
Maternal stress
Low birth weight
Nutritional deficiencies
Nutritional excess --- sugar

7

ADHD Neuro imaging --

Functional Imaging -- hypo activity during reward anticipation; hyper-responsiveness to reward; Prefer immediate rewards over delayed

not able to suppress activity as well in the frontal cortex


Poor time perception: -- affected ability to wait/delay response and make predictions about their environment

8

Rates of cortical thickening in adhd, adhd sx vs non adhd dx?

• Rate of cortical thinning:
(slowest) ADHD < ADHD symptoms < no sx

9

ADHD Treatment

• Psychoeducation
• Parenting skills training/behavior management
• Stimulants are first line medication
○ Methylphenadate based --
○ Amphetamine based

10

DMS Criteria for Autism Spectrum D/o

• Deficits in social communication/interaction -- Social reciprocity, nonverbal communications, developing/maintaining and understand relationship


Restricted, repetitive patterns of behavior, interests or activities -- Stereotypic repetitive movements, rigid adherence to routine; hyper or hypoactive to sensory input


must cause functional impairment

11

ASD -- when do these symptoms present in order to make the dx?

early development

12

Gender differences in ASD

Males > Females 4:1

But females will have more severe intellectual disability

13

Risk factors for ASD

• Familial recurrence among siblings -- 2-10%; up to 18%
• Advanced maternal or paternal age
• Extreme prematurity

Closer spacing of pregnancies

14

What method is used for screening of ASD?

Gold standard for dx ?

MCHAT Questionnaire @ 18 and 24 mo

ADOS -- autism diagnostic observation schedule (assessment of communication, social interaction, play)

15

What is inclusive in the interdisciplinary assesment of ASD?

• Audiology, speech, occupational, physical exam (screen for sz)
• Genetic testing is now standard of care (G Band karyotyping, fragile X, chromosomal microarrays)

16

Common co-morbidities in ASD?

Co-occurring seizures

intellectual disability -

17

Criteria for Intellectual disability

Deficits in intellectual functions (by clinical eval and standardized testing)

• Deficits in adaptive functioning

• Onset during development

18

Domains of severity of Intellecual disability?

Conceptual (academic)

Social -- empathy, social judgement, interpersonal

Practical -- personal care, job, money,

19

ID

Possible etiologies (general)

Co-occurring lllness (general)

Inborn errors of metabolism, Genetics

Psychiatric Illness - 10 to 39% of individuals with ID


20

what behaviors is observed in 50% of kids with ASD or ID?

Self-Injurious Behaviors --

21

what 2 antipsychotics are approved for irritability due to autism ?

what drugs may worsen symptoms?

ariprprazole and risperidone


SSRIs