Lecture 26, 27 - ADHD, Autism

Question 1

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

Describe some of the characterisitc features

which category decreases with age

Answer 1

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)

Question 2

ADHD
when do symptoms have to present by?

where does the impairment have to be observed?

Answer 2

age 12

in greater than 1 setting

Question 3

ADHD

challenges of the dx?

Answer 3

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

need multiple sources of data (teachers, parents)

Question 4

ADHD Co-occurring conditions

Answer 4

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

Question 5

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

what are some predictors of this

Answer 5

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

Question 6

ADHD – environmental risk factors?

Answer 6

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

Question 7

ADHD Neuro imaging –

Answer 7

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

Question 8

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

Answer 8

• Rate of cortical thinning:

(slowest) ADHD < ADHD symptoms < no sx

Question 9

ADHD Treatment

Answer 9

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

Question 10

DMS Criteria for Autism Spectrum D/o

Answer 10

• 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

Question 11

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

Answer 11

early development

Question 12

Gender differences in ASD

Answer 12

Males > Females 4:1

But females will have more severe intellectual disability

Question 13

Risk factors for ASD

Answer 13

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

Closer spacing of pregnancies

Question 14

What method is used for screening of ASD?

Gold standard for dx ?

Answer 14

MCHAT Questionnaire @ 18 and 24 mo

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

Question 15

What is inclusive in the interdisciplinary assesment of ASD?

Answer 15

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

Question 16

Common co-morbidities in ASD?

Answer 16

Co-occurring seizures

intellectual disability -

Question 17

Criteria for Intellectual disability

Answer 17

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

• Deficits in adaptive functioning
• Onset during development

Question 18

Domains of severity of Intellecual disability?

Answer 18

Conceptual (academic)

Social – empathy, social judgement, interpersonal

Practical – personal care, job, money,

Question 19

ID

Possible etiologies (general)

Co-occurring lllness (general)

Answer 19

Inborn errors of metabolism, Genetics

Psychiatric Illness - 10 to 39% of individuals with ID

Question 20

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

Answer 20

Self-Injurious Behaviors –

Question 21

what 2 antipsychotics are approved for irritability due to autism ?

what drugs may worsen symptoms?

Answer 21

ariprprazole and risperidone

SSRIs