topic 10 - autism, asperger's and adhd 2010

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Autism, Asperger’s & ADHD (6PS048)ADHD, Autism & Asperger’s (6PS052)

Simon BignellPsychology, School of Science

Autism, Asperger’s & ADHD

Simon Bignell – Module Leader

Lecture 10

Spring 2010 (6PS048 & 6PS052)

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Outline.

• Summary Lecture of the module content.– Draw your own conclusions based on evidence.– Most importantly, to have an opinion you can

defend.• Recap the lecture content with recommended reading.• Draw out themes.• Try to reach some conclusions about the relations

between ASD and ADHD.• More time for questions.

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Learning Outcomes Of This Lecture.On completion of the lecture and with independent study

you should be able to: 1. Give an overview of the key issues covered in the

module. 2. Express an opinion on the multiple relations

between Autism, Asperger’s and ADHD .

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Lectures.Lecture 1 – Module Introduction.Lecture 2 – ADHD and Hyperkinetic Disorder.Lecture 3 – Autistic Disorder (Classic Autism).Lecture 4 – Asperger's Disorder.Lecture 5 – Classification, Assessment & Diagnosis.Lecture 6 – Aetiology.Lecture 7 – Comorbidity.Lecture 8 – Treatment For ADHD.Lecture 9 – Treatment For Autism.Lecture 10 – Autism, Asperger's and ADHD.Lecture 11 – Revision & Exam Tips.

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Lecture 2 – ADHD and Hyperkinetic Disorder.Content:• Symptoms of ADHD.

– Inattention.– Hyperactivity/Impulsivity.

• Prevalence.• Comorbidity.• Developmental course of ADHD.• Consequences of ADHD.• Lifespan.• Controversy.

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Lecture 2 – ADHD and Hyperkinetic Disorder.Key Points from Lecture:• First described around 100 years ago.• Problems with Attention, Hyperactivity & Impulsivity.• Affects 2-5% of school age children in UK.• Exists on a degree of severity.• Boys are six times more likely to be referred for help than girls.• Almost always occurs with other disorders/problems.

Reading• Barkley, R.A. et. al. (2002). International Consensus Statement

(January 2002). Clinical Child and Family Psychology Review, 5(2). p.89-111.

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Lecture 3 – Autistic Disorder (Classic Autism).Content:• What is Autism?• Symptoms of Autism.• Prevalence of Autism.• How Autism was first recognised.• Assessment.• Diagnosis.

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Lecture 3 – Autistic Disorder (Classic Autism).Key Points from Lecture:• First described around 65 years ago.• Exists as a spectrum, a continuum, a syndrome with various

degrees of impairment • Affects communication, social interactions, and strange behaviour

that impair education performance.• Generally evident before age 3.• A life-long pervasive developmental disorder with genetic

susceptibility.

Reading• Frith, U. & Happe, F. (1994) Autism: Beyond Theory of Mind.

Cognition, 50, pp.115-132.

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Lecture 4 – Asperger's Disorder.

Content:• What is Asperger’s Disorder?• Symptoms of Asperger’s.• How Asperger’s was first recognised.• Characteristics of Asperger’s Disorder.• How is Asperger’s different from Classic

Autism.

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Lecture 4 – Asperger's Disorder.Key Points from Lecture:• A higher-functioning form of Autism characterised by

impairments in the social domain, some impairment in the behaviour/interests domain.

• No significant delays in cognitive or language skills.• Motor clumsiness, especially in younger children.• Asperger’s tend to desire to interact with others, but don’t know

how to in an appropriate way.• May live very successful independent lives in appropriate job

settings. • Not so easy to spot Asperger’s Disorder.Reading• Baron-Cohen, S. (1999). The Extreme-Male-Brain Theory of

Autism. In Tager-Flusberg, H, (ed) Neurodevelopmental Disorders. MIT Press (1999).

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Lecture 5 – Classification, Assessment & Diagnosis.Content:• What is Classification?• DSM-IV-TR / ICD-10.• How does assessment happen in the UK?• How is a diagnosis of Autism, Asperger’s or

ADHD made?

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Lecture 5 – Classification, Assessment & Diagnosis.Key Points from Lecture:• Diagnosis has to be made on a behavioural basis.• Variations in symptoms and severity of impairments.• DSM-IV (APA, 1994) & ICD-10 (WHO, 1994).

• ‘Pervasive Developmental Disorder’.• ‘Attention-Deficit and Disruptive Behavioural Disorders’.• Missed diagnosis and misdiagnosis.

– Multiple referral routes.– Pressures on LEA resources.– Multiple assessment protocols and diagnostic tools.

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Lecture 6 – Aetiology of ADHD & Autism.Content:• What is ADHD?• Theories of ADHD.

– Response Inhibition Theory.– Diet.

• Scepticism towards ADHD.• What is Autism?• Theories of Autism.

– Theory of Mind deficit.– Executive Function (Dysfunction) deficit.– Weak Central Coherence.

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Lecture 6 – Aetiology of ADHD & Autism.Key Points from Lecture:• The causes of ADHD are not fully known.

– Likely to have multiple causes and complex interactions.– Good evidence for genetic component.– Evidence of structural and functional brain abnormality.

• Barkley’s Theory of Response Inhibition in ADHD.• Theory of Mind deficit. Executive Dysfunction. Weak Central

Coherence.Reading• Barkley, R.A. et. al. (2002). International Consensus Statement (January 2002).

Clinical Child and Family Psychology Review, 5(2). p.89-111. • Rajendran, G. & Mitchell, P. (in press). Cognitive Theories of Autism.

Developmental Review.• Frith, U. & Hill, E. (2004) Understanding Autism: Insights From Mind and Brain

In Autism: Mind and Brain, ed. Frith, U. & Hill, E. Oxford, Oxford University Press, pp.1-19.

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Lecture 7 – Comorbidity in ADHD and Autism.Content:• A refresher: DBDs & PDDs.• Why is comorbidity important?• Are ADHD And Autism Really That

Different?• Comorbid conditions.• What might this overlap of symptoms

suggest?

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Lecture 7 – Comorbidity in ADHD and Autism.Key Points from Lecture:• A large number of medical conditions are very often

associated with ADHD and/or Autism.• High overlap between ADHD and ASD symptoms.• ADHD and Autism are generally described as

separate disorders with separate genetic aetiologies.

• Most genetic studies exclude cases of Autism from studies on ADHD and vice versa.

Reading• Gillberg, C., & Billstedt, E. (2000). Autism and Asperger syndrome:

Coexistence with other clinical disorders. Acta Psychiatrica Scandinavica, 102, 321–330.

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Lecture 8 – Treatment For ADHD.

Content:• Clinical Symptoms.• Intervention Development.• Considerations for interventions in ADHD.• Non-pharmacologic Treatments.• MTA.• Medication

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Lecture 8 – Treatment For ADHD.

Key Points from Lecture:• Conduct problems and symptoms of ADHD may hinder treatment

and/or assessment.• All strategies do not fit all children.• Medication is the ‘treatment of choice’ for ADHD following MTA.• The MTA studies suggest that there’s very little benefit from any

psychotherapeutic treatment on core symptoms.• Stimulant treatment is easily available in the community and

behavioural treatment is not. But opinion remains divided.Reading• The MTA Cooperative Group. (1999). A14 Month Randomized Clinical

Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Archives of General Psychiatry, 56. p.1073-1086.

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Lecture 9 – Treatment For Autism.

Content:• Autistic Disorder.• Treatment for Autism Spectrum Disorder.

– Medication.– Behavioural Interventions.– Other Treatments.

• Problems of treatment.• Parent advocacy groups.• Prognosis.

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Lecture 9 – Treatment For Autism.

Key Points from Lecture:• Many different types of behavioural interventions for ASD.• Early intervention is most beneficial.• Treatment depends on the individual.• Most effective treatment for the disorder is highly structured and

intensive ‘Applied Behavioural Analysis’ (ABA).• Problems treating people with Autism, communication, non-

compliance, comorbidity, intellectual/emotional immaturity.Reading• Lovaas, O. I. (1987) Behavioral treatment and normal

educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

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Themes.• Misdiagnosis vs. Missed diagnosis.• Behavioural/Cognitive vs. Pharmacological treatment.• Normal vs. Pathological behaviour.• Continuum vs. Categorical classification.• Academia & Parental viewpoints.• Aetiological vs. Symptomatological. • Evidence-based vs. Anecdotal-based methods.• Acceptance vs. Rejection of Disorder.• Mild vs. Severe degrees of impairment.• Increasing incidence vs. Better awareness.

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Relation between ASD & ADHD.

ADHD

• Usually spotted in school.

• Normal IQ.• Often pragmatic

language problems.• High comorbidity

with other problems.

• Often mistaken for bad behaviour.

Classic Autism

• Early onset• IQ tends to be lower• Often fail to develop

spoken language• Problems with non-

verbal communication

• Tend to be adept at basic motor skills

Asperger’s

• Later onset• Higher range of IQ• No language

deficit• Non-verbal

communication problems less severe

• Clumsiness in basic motor skills

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Conclusions.

• Autism and ADHD : No single cause; no single cure. Hence: A spectrum, a continuum, a syndrome. (…debatable?)

• It’s easier to ‘spot’ Autism at the low-functioning end of the spectrum.

• ADHD is often diagnosed because of ODD/CD.• Although poor parenting does not cause ADHD (or

Autism) it can make things worse.• ADHD is a ‘preferable’ diagnosis to Autism.• Behavioural (ASD) and Pharmacological (ADHD)

treatments can be effective but may not address cause.

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"We are not born to suffer. We are born to thrive. If you live in a dry area and your garden receives

little water, you plant plants which like dry soil. But when you are given a plant that likes wet soil, you

don't kill it, you water it, you spend one of your 1440 minutes each day watering that plant.

Because you know, that given the right care, that little bit of effort can produce spectacular blooms.

And so it should be with children like us." Joshua Muggleton, age 17

Accessed at http://mugsy.org/josh/

topic 10 - autism, asperger's and adhd 2010

Education