ADHD & Autism Spectrum Disorder PDF

Attention - deficit & hyperactivity Disorders Dr. Abel Perez  Introduction Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by age-inappropriate levels of motor hyperactivity, impulsivity, and inattention. ...

Attention - deficit & hyperactivity Disorders Dr. Abel Perez  Introduction Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by age-inappropriate levels of motor hyperactivity, impulsivity, and inattention.  introduction It is a common disorder of 10% of children and childhood and 4.5% of adults. adolescence and persists Males > females with into a adulthood in about 2:1 ratio. 50%.  Etiology The etiology of ADHD is multi-factorial and may include Genetic Factors; Increased rate in first degree relatives of affected individuals. Environmental; Potentially in utero exposure to neurotoxin, low birth weight or childhood abuse or neglect. Signs & symptoms The diagnosis A child with ADHD is characterized of ADHD is made by by a considerable degree of careful clinical inattentiveness, distractibility, history. impulsivity and often hyperactivity that is innapropiate for the development stage of the child. Adults with ADHD often present with marked inattention, distractibility, organization difficulties and poor efficiency which culminate in life histories of academic and occupational failure. ADHD through pictures  Diagnosis The diagnostic criteria for ADH by Diagnosis for ADHD requires the the DSM-V originally developed to criteria by the Diagnostic and diagnose ADHD in children, need Statistical Manual of Mental slight modifications for use with Disorders (DSM-5). adults.  dsm-5 criteria Onset prior to age 12. Two symptoms domains: Inattentiveness and hyperactivity/impulsivity. Symptoms more than 6 months and present in two or more settings (home, school).  dsm-5 criteria At least six inattentive symptoms Does not pay attention to detail or makes careless mistakes. Had difficulty sustaining attention Struggles to follow instructions. Is unorganized Avoids tasks requiring high cognitive demands. Misplaces/loses objects frequently Is easily distracted Is forgetful  dsm-v At least six hyperactivity/impulsivity symptoms Fidgets with hands/feet or squirms in seat. Has difficulty remaining still Runs/climbs excessively in childhood Acts as if driven by a motor Has difficulty engaging in activities Talks excessively Blurts out answers before questions have been completed Has difficulty waiting or taking turns Interrupts or intrudes upon others  Differential Diagnosis Oppositional Defiant disorder Mood Disorders and Conduct Disorder Substance Use Disorder Childhood Anxiety Disorders  Treatment Multimodal treatment plan; Medications are the most effective treatment for decreasing core symptoms, but should be used in conjunction with educational and behavioral interventions.  pharmacological tx 60 mg total daily dose! First line treatment; Stimulants #1 Methylphenidate #2 Dextroamphetamine Second line; Alpha 2 agonists (Clonidine) can be used instead or as adjunctive therapy to stimulants. May be used in children who respond poorly to other medications, experience side effects, or have coexisting conditions such as tics.  pharmacological tx Goodman & Gilman 14th edition Treatment may start with a dose of 5 mg in the morning and at lunch. Catecholamines may be Adverse Effects involved in the control of The dose is increased insomnia, anorexia and attention at the level of gradually over a period of weight loss, which may be cerebral cortex. weeks depending on the associated with response. suppression of growth in Methylphenidate is children. effective in children with Due to its short duration ADHD and is the most action, most children require common intervention. two or three doses each day.  Referencias Goodman & Gilman Pharmacology 14th Edition Current Diagnosis & Treatment, Psychiatry 3rd Edition Essentials of psychiatry in primary care: Behavioral health in the medical care You can access to all these books through Access Medicine.  Definition Autism spectrum disorder is a neurodevelopmental disorder in which patients suffer from pervasive difficulties with social communication and have repetitive, restricted interests and behaviors. The neurodevelopmental disorders are a group of conditions with onset in the developmental period. The disorders typically manifest early in development, often before the child enters school, and are characterized by developmental deficits or differences in brain processes that produce impairments of personal, social, academic, or occupational functioning. Diagnostic Criteria  Diagnostic Features The essential features of autism spectrum disorder are persistent impairment in reciprocal social communication and social interaction (Criterion A), and restricted, repetitive patterns of behavior, interests, or activities (Criterion B). These symptoms are present from early childhood and limit or impair everyday functioning (Criteria C and D) Many individuals have language deficits, ranging from complete lack of speech through language delays, poor comprehension of speech, echoed speech, or stilted and overly literal language. In older children and adults without intellectual impairments or language delays, deficits in social-emotional reciprocity may be most apparent in difficulties processing and responding to complex social cues.  There may be absent, reduced, or atypical social interest, manifested by rejection of others, passivity, or inappropriate approaches that seem aggressive or disruptive. These difficulties are particularly evident in young children, in whom there is often a lack of shared social play and imagination (e.g., age-appropriate flexible pretend play) and, later, insistence on playing by very fixed rules. There may be an apparent preference for solitary activities or for interacting with much younger or older people. Frequently, there is a desire to establish friendships without a complete or realistic idea of what friendship entails. Stereotyped or repetitive behaviors include simple motor stereotypies (e.g., hand flapping, finger flicking), repetitive use of objects (e.g., spinning coins, lining up toys), and repetitive speech (e.g., echolalia, the delayed or immediate parroting of heard words; use of “you” when referring to self; stereotyped use of words, phrases, or prosodic patterns).  Development and Course The age and pattern of onset also should be noted for autism spectrum disorder Symptoms are typically recognized during the second year of life (age 12–24 months) but may be seen earlier than 12 months if developmental delays are severe, or noted later than 24 months if symptoms are more subtle. First symptoms of autism spectrum disorder frequently involve delayed language development, often accompanied by lack of social interest or unusual social interactions (e.g., pulling individuals by the hand without any attempt to look at them), odd play patterns (e.g., carrying toys around but never playing with them), and unusual communication patterns (e.g., knowing the alphabet but not responding to own name)  The best established prognostic factors for individual outcome within autism spectrum disorder are presence or absence of associated intellectual developmental disorder and language impairment (e.g., functional language by age 5 years is a good prognostic sign) and additional mental health problems. Individuals with Epilepsy, as a autism comorbid spectrum diagnosis, is disorder are at associated with greater risk for greater suicide death intellectual compared with disability and those without lower verbal autism ability. spectrum disorder.  Differential Diagnosis Attention-deficit/hyperactivity disorder. Although potentially difficult to discriminate ADHD from autism spectrum disorder, the developmental course and absence of restricted, repetitive behaviors and unusual interests in ADHD help in differentiating the two conditions. A concurrent diagnosis of ADHD should be considered when attentional difficulties or hyperactivity exceeds that typically seen in individuals of comparable mental age, and ADHD is one of the most common comorbidities in autism spectrum disorder. Psychiatric comorbidities also co-occur in autism spectrum disorder. About 70% of individuals with autism spectrum disorder may have one comorbid mental disorder, and 40% may have two or more comorbid mental disorders. Anxiety disorders, depression, and ADHD are particularly common. Avoidant/restrictive food intake disorder is a fairly frequent presenting feature of autism spectrum disorder.