adhd and autism

8/7/2019 ADHD and Autism

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Types of PDD (ICD-10)

Childhood autism

autistic ds, infantile autism, infantile psychoseKanners syndrome

Atypical autismRetts syndrome

Childhood disintegrative ds

Overactive ds associated with MR

Aspergers syndrome

PDD- not otherwise specified


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Diagnosis: 3 main areas of

impairment in PDD or ASDDelay and abnormal quality in:

reciprocal social interaction

language and communication

imaginative thinking - restricted,repetitive activities and interests

&early onset: before age 3

***Prediagnosis

Infant-good baby

6-8/12 no regards mother

2/3 trait f/u diagnosis change


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Social impairmentQualitative impairment in reciprocalsocial relationships

non-verbal cues: poor eye contact, facial

expressions, body postures, gesturesfailure to develop peer relationship

fail to share enjoyment or seek comfortwhen hurt (lack of pointing, requesting)

difficulties with understanding socialcues

lack of social empathy (difficulty to

recognise others emotions)


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Language &

communicationDelay in receptive and expressivelanguage

stereotyped or repetitive use of languageidiosyncratic use of words

unable to initiate or sustain aconversation (those with speech)

echolalia, pronoun reversal, inventedreduced gestures or poorly co-ordinated

(abnormal pointing)

lack of social imitative or pretend play


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Repetitive stereotyped

activities and interestsRigid and inflexible thought processes

resistance to change, insist on same

routines, ritualistic behaviours (lengthymealtime ritual)

repetitive activities and interests(complex or simple)- hand flapping,

twirling objects, fascinated with unusualparts of objects, same segment TV show)

persistent preoccupation with parts ofobjects


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Other features: not

required for diagnosisUnusual responses to sensory stimuli egcertain sounds, fascination by certainvisual stimuli, dislike gentle touch, butenjoys firm pressure

poor motor co-ordination

over or underactivity

food fadserratic sleeping patterns

abnormalities of mood- excitement/misery


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Age of OnsetDelay or abnormal functioning in at

least one area must be before age 3

years


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PrevalenceChildhood autism:

3-4 per 10,000 population

20 per 10,000 (broader definition)

Asperger Syndrome

36 per 10,000

Male preponderance


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Dif ferent ia l d iagnoses of

c h i ldhood aut ismDeafness

Developmental language disorder

Mental retardation with autistic featuresMental retardation without autisticfeatures

Intense early deprivation

Pervasive developmental disorders:Asperger Syndrome, Retts syndrome,Degenerative disorder, atypical

autism, PDD-not otherwise specified


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Treatment plan Establish goals for educational purposes

Establish target symptoms for

intervention

Co-morbid conditions

Monitoring

Multiple domains of functioning

Medication


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? Die t m odi f ic a t ion

No gandum

Milk

Vanilla


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The l i t t le Rasc a ls @

Attention Deficit Hyperactive Disorder

(ADHD)

Dr. Fauzi IsmailDepartment of Psychiatry


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Hyperk ine t i c c h i ldren


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Hyperactive parents

all manner of behaviour e.g. frequent night awakenings, talking loudly,

naughtiness, exuberance

depends on attitudes and tolerance ofparents

MUST always pay attention to the stage ofdevelopment when deciding normality and abnormality


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Hyperactive Children

Hyperactive psychiatrists

more restrictive definition restlessness

inattentiveness

impulsiveness


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Hyperactive Children

Overactive : increase in amount and tempo of purposeful

activity increase in number of purposeless minor

movements irrelevant to tasks

e.g. wriggle and squirm in seatfidget with objectsrestless

unable to suppress activity when stillness isrequired e.g. in classroom or at meal table


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Core

symp tomsHyperactivity More active than children their age

Inattentive Short attention span

Impulsive

Poor impulse controlPervasive Symptoms occur across all situations

Lit tle Rascals


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Hyperac t i v i t y

Fidgets with hands or feet

Squirms in seat

Runs about or climbs excessivelyDifficulty playing or engaging in leisureactivities quietly

Talks excessivelyAlways on the go

Described as if driven by a motor

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Ina t ten t i vene

ss

Fails to give attention to details

Makes careless mistake

Do not follow through instructionsFails to complete schoolwork, chores orduties

Reluctance to engage in tasks requiring

sustain mental effortsDifficulty organizing tasks & activities

Easily distracted

Often forgetful for their age

Lit tle Rascals


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Impuls ive

Blurts out answers before questioncompleted

Difficulty awaiting their turn

Interrupts or intrudes on others

Makes poor judgement

Accident prone

Lit tle Rascals


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Do you fit these criteria

Lit tle Rascals


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Epidemio logy

Prevalent in 1-3% of children

Male : Female

3:1Hyperactivity dates back to pre-schoolyears

Referral delayed until primary school Present with inattentiveness, learning

difficulties & disruptiveness

Lit tle Rascals


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Et io logy

Unknown

Unlikely to be a single etiological factor

Most likely an interplay

psychosocial & biological factors

Lit tle Rascals


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Dif ferent ia l

d iagnos is

Normality Consider parents expectations & level of

tolerance

Situational hyperactivity Symptoms occur only in certain situations

Mental retardation Poor attention and activity control

Specific learning disability

Lit tle Rascals


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Management

Requires a multi-disciplinary approach

Pharmacological treatment - etarline

Psychological intervention

Educational support

Lit tle Rascals


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PrognosisHyperactivity wanes in adolescence

30% have residual symptoms in adulthood

Restless & inattentive30% have no symptoms with good

functioning

Choose job which allow freedom of movement30% continuous display of symptom

Develop other psychopathologies

E.g. substance abuse & anti-social personality

Lit tle Rascals


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adhd and autism

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