Week 4 - C - ADHD - Triad, Co-morbidities and Treatment, ASD - Core features (mainly triad), Co-morbidities and treatment

Question 1

What is the most common neurobehavioural disorder?

Answer 1

This would be ADHD

Question 2

What does ADHD stand for?

Answer 2

Stands for attention deficit hyperactive disorder

Question 3

What is the diagnostic triad of ADHD?

Answer 3

In ADHD, there is the tirad of impulsivity, inattention and hyperactivity

Question 4

ADHD is a A co-occurring cluster of impairing symptoms relating to self regulation (‘executive functioning’) There is no diagnostic test for ADHD but what may be seen on positron emission tomography? (PET scan)

Answer 4

Might see decreased function of frontal lobes

Question 5

What is the most common type of ADHD?

Answer 5

This is combined type ADHD (also known as hyperkinetic syndrome) The children have the triad of inatention, hyperactivity and impulsivity * It is developmentally inappropriate * impairing * pervasive and * longstanding

Question 6

How do the three core symptoms of ADHD often present?

Answer 6

Often presents with a childhood problems such as remaining focussed in tasks, as well as difficulties in organizing and planning taks for long periods

Question 7

ADHD is a spectrum disorder How can having a family member with ADHD impact on the home?

Answer 7

It can impact on the home as it can cause * Complicated stress to the parents * Raised family stress levels * Increased anger and upset * Increased risk of harm

Question 8

How can having ADHD affect schooling?

Answer 8

There is usually a barrier to learning The children are usually in trouble There is frequent disorganization, tendency to lose things, and forgetting things

Question 9

Comorbid symptoms of ADHD are common What are some comorbid symptoms that may present alongside ADH? What is the triad inn ADHD again?

Answer 9

Comorbid symptoms * Learning diffficulties * Social communication difficulties * Attachment difficulties * Mood and anxiety problems * Behavioural disorders * Substance use Triad for ADHD - imuplsivity, inattention, hyperactivity

Question 10

ADHD * High rates of crime * High rates of substance misuse * High rates of psychiatric disorder What causes ADHD?

Answer 10

It is a multifactorial disease Environmental factors, genetics, brain structure and function, cognition

Question 11

How would you go about diagnosing ADHD?

Answer 11

History * Screening questionnaires * Structural diagnostic questionnaires * Background risk factors- family history, male gender, socioeconomic status * Careful review of differentials Examination * School observation * Examination in clinic room * Cognitive impairment

Question 12

Do symptoms of ADHD ever stop?

Answer 12

The symptoms of ADHD commonly remain throughout childhood The core symptoms of ADHD can persist into adulthood with the manifestation of symptoms changing as the child progresses into adulthood Some however will grow out of ADHD as part of the brains normal development

Question 13

The different treatments for ADHD include psychological therapies and pharamcological therapies How would you treat ADHD psychologically? (1st and 2nd line)

Answer 13

1st line is parent training - this includes behavioral classroom training 2nd line is social sills training and importance of sleep and diet

Question 14

If psychological training fails for the management of ADHD - ie parent training, then pharmacological training is attempted What is the 1st line pharmacological treatment?

Answer 14

1st line = METHYLPHENIDATE - ritalin Dexamfetamine Lisdexamfetamine

Question 15

What is the 2nd line and 3rd line pharmacological management of ADHD?

Answer 15

Atomexetine is the 2nd pharmacological line management of ADHD (cn also use guanfacine) 3rd line - antidepressants, antihypertensives, antipsychotics

Question 16

What is the first, second and third line medication treatment for ADHD? (used if parent training or social skills training has failed) What are the side effects of stimulant drugs?

Answer 16

* 1st line - methylphenidate (ritalin) * Dexamfetamine * Lisdexamfetamine 2nd line - atomoxetine or guanacine 3rd line - antidepresant, antipsychotic (atypicals), antidepressant Side effects of these stimulant drugs -Dysphoria, anxiety, tics

Question 17

How do stimulants work in the treatment of ADHD? What do they affect in ADHD?

Answer 17

The stimulants improve dopaminergic neurotransmission involved in executive functioning - this directly improves the core symptoms

Question 18

Which drug to treat ADHD is a non stimulant?

Answer 18

Atomoxetine - noradrenergic and dopaminergic agonist Guanfacine also - alpha 2 agonist

Question 19

What is ASD? What is ASD a triad of?

Answer 19

This is autism spectrum disorder It is a triad of Impaired social interaction Impaired imagination - +/- abnormal non verbal and verbal communication Restricted repetitive patterns of behavior and interests

Question 20

What is the ADHD and the autism triad?

Answer 20

ADHD * Hyperactivity * Inattention * Impulsivity ASD * Imparied social interaction * Impaired imagination (+/- verbal and non verbal communication) * Restricted repetitive patterns of behaviour and interests

Question 21

Autism is a spectrum * ‘Spectrum’ implies a range of types and severities of presentations unified by overlying symptom themes * As with ADHD: continuum into normal population * Cut off for diagnosis can be subjective and subject to social constructionism Which gender is more commonly effected by ASD?

Answer 21

Boys are more commonly affected by autism than girls

Question 22

What is the DSM 5 criteria for autism spectrum disorder? (it combines the triad basically into 2 core symptoms)

Answer 22

There is a persistent deficit in social communication and interaction (combined the impaired social interaction and impaired imagination (=/- verbal and non verbal communication) There is also restricted and repetitive patterns of behaviour, interests or activities

Question 23

Even thought there are the core symptoms of autism, for diagnosis, when must symptoms be present and what other 2 key points are relevant from the history?

Answer 23

The symptoms must be present in the early developmental period They must cause clinically significant impairment in social, occupation or other important area of current functioning The disturbances cannot be better explained by intellectual disability or global developmental delay

Question 24

How are those with ASD described socially? What social norms to people with ASD have difficulty in interpreting?

Answer 24

* They are often described as aloof - not friendly or forthcoming * They are described as having ‘lack of theory of mind’ * Only interested in people to meet needs * Happy being alone They have difficulty in interpreting social cues and irony in social norms

Question 25

What is meant by inflexible patterns of thinking and repetitive behaviours in ASD?

Answer 25

Changes in things is very distressing for the person - eg changing a vases place on the counter They have a need for routine and repetition This leads them to having very logical thinking -hence the path for IT maths engineering

Question 26

What co-morbidities are common in ASD?

Answer 26

* Learning disability * Anxiety * Depresssion * ADHD * Dyspraxia * Specific language delay and impairments * Sensory differences/sensory defensiveness

Question 27

What language deficits can be seen in autism spectrum disorder?

Answer 27

No speech - language delay Confuse pronouns Off prosody (patterns of rythtm) Echolalia - echoing another persons spoken words

Question 28

What is stimming? May be one of the first signs seen in autism

Answer 28

Self-stimulatory behavior, also known as stimming and self-stimulation, is the repetition of physical movements, sounds, or repetitive movement of objects common in individuals with developmental disabilities, and most prevalent in people with autism spectrum disorders. Stimming when repeating words is known as echolalia

Question 29

What sensory differences might be present in someone with ASD?

Answer 29

Sound and texture differences are most commonly seen sensory differences Pain and temperature may also be observed

Question 30

What causes ASD?

Answer 30

It is strongly inheritable however there is no single causative gene that has been found

Question 31

Assessment screening tools are often used to help aid with the diagnosis of ASD What is the ASD non-pharamacological management?

Answer 31

Early intensive behavioural interventions +/- speech therapy +/- special schooling There is no non-medication intervention that treats the core symptoms of Autism.

Question 32

What can be given in ASD in patients who are very aggressive, extreme tantrums and self harm? What can be given to manage the ADHD type symptoms?

Answer 32

What can be given in ASD in patients who are very aggressive, extreme tantrums and self harm - can try giving atypical antipsychotics- eg rispridrone or aripiprazole What can be given to manage the ADHD type symptoms - can try giving methylphenidate (ritalin)

Question 33

Autism spectrum disorder is associated with learning difficulties, what percentage of LD are due to ASD?

Answer 33

30% of LD are due to ASD