ADHD and Autism PDF

Neurodevelopmental Disorders: Attention Deficit/ Hyperactivity Disorder (ADHD) ADHD has two clusters of symptoms: Inattention Hyperactivity/ (particularly problems Impulsivity engaging Type 2 (Behavior Disinhibition) attention to ove...

Neurodevelopmental Disorders: Attention Deficit/ Hyperactivity Disorder (ADHD) ADHD has two clusters of symptoms: Inattention Hyperactivity/ (particularly problems Impulsivity engaging Type 2 (Behavior Disinhibition) attention to override Type 1 attention)  Three subtypes of ADHD Combined presentation Predominantly inattentive presentation Predominantly hyperactive-impulsive presentation  Associated with ADHD Symptoms must be evident in childhood, before age 12 (used to be before age 7) For 50-60%, symptoms continue into adulthood About 7-10% of children Boys more likely than girls: c. 70% are boys Can be irritable and demanding; May be rejected by other children Some problems associated with ADHD Academic achievement – Score 10 pts lower on IQ tests Learning disabilities or communication problems (c. 50% of those w ADHD) Health problems Sleep problems May develop conduct disorder, or abuse substances, or break the law  An alternative look at ADHD: Behavior Disinhibition Disorder (Russell Barkley) Is impulsivity the core, central symptom? Perhaps it is not an input problem, but an output problem, i.e., impulse control issues. The problem is with a particular type of sustained attention: goal-directed persistence. Behavior Disinhibition D/O, cont. Four proposed subtypes: ADD - Inattentive type ADHD - Pure type ADHD - Aggressive type (c. 30% of those with attention deficits) ADHD - Anxious type  Causes of ADHD Genetics (siblings 3-4* more likely to have ADHD) Neurological immaturity/ under-functioning of brain circuit: – Prefrontal cortex (cognition, motivation) – Striatum (working memory, planning) – Cerebellum (motor behaviors) – Faulty interconnectivity Dopamine (& maybe norepinephrine) abnormalities Prenatal and birth complications (low birth weight, prematurity, maternal alcohol use…) Environmental toxins (e.g., lead, air pollution) Stress and disruptions in family Is not caused by food intolerance or diet, but hyperactivity might be exacerbated by it Medication Treatments for ADHD Stimulants: e.g., Ritalin (methylphenidate), Adderall, Dexedrine (70-85% have decreased problematic behavior & increased positive mood, interactions, & goal- directedness) Q: Are these medications over-prescribed? Norepinephrine-related meds: reduce tics, increase cognitive performance Buproprion (Wellbutrin): antidepressant, affects dopamine  ADHD: Q: Are we being intolerant of childhood playfulness? (Panksepp article) What are the brain functions of play? Additional Treatments for ADHD Cog-Behavioral training programs with parents and teachers: change rewards & punishments – Reinforce attention, goal-directedness, & prosocial behavior – Extinguish impulsive/ hyperactive behaviors – Research shows: reduces ADHD symptoms Parent education: – Operant conditioning; perhaps token economy Educational management in the classroom  Autism Spectrum Disorder In DSM-IV, Autism was part of the “Pervasive Developmental Disorders” which included: Autistic Disorder Asperger’s Disorder Rett’s Disorder Childhood Disintegrative Disorder Pervasive Developmental Disorder NOS  Autism Spectrum Disorder -- Impairment in Two Domains: Impairment in social interaction & communication Restricted, repetitive, stereotyped patterns of behavior, interests, and activities.  Associated with Autism Spectrum Disorder Onset of symptoms is in early childhood. Is a chronic, lifelong condition. More boys than girls (about 80% of those diagnosed with autism are boys)  Intellectual Ability & Autism Spectrum Disorder Often (at least 50% of time) it is associated with intellectual disability (in DSM-IV was called “mental retardation”) About 50% never develop useful speech Best predictor of outcome: IQ & amount of language development before age 6 Rarely there are savants  But the Autism Spectrum encompasses a wide range of functioning See Temple Grandin: The world needs all kinds of minds (1st 7 minutes or so) https://www.youtube.com/watch?v=fn_9f5x0 f1Q&t=108s Causes of autism spectrum disorder NOT vaccines: no reputable research supports the vaccine-autism link (story of Dr. Andrew Wakefield…) Cognitive: difficulty integrating info from various senses. Deficits in theory of mind. Lovaas: perceptual deficits so that child can process only one stimulus at a time. Genetics: MZ’s: 60-80%; DZ’s= 10% concordance. Prenatal exposure to infection, chemicals, alcohol, drugs. Neurological issues: there is a high rate of birth complications; various indications of irregular brain functioning.  Treatments of autism Behavioral therapy, particularly Lovaas’s operant conditioning approach; can include parents Lovaas Videotapes: Tape 1, Part 2 at https://www.youtube.com/watch?v=uX1fz5d2wnw Structured educational services Community integration efforts SSRI’s may reduce repetitive behavior & aggression Neuroleptics (i.e., anti-psychotics) may decrease rocking, self-mutilation, other repetitive behaviors Stimulants can improve attention  Asperger’s Disorder – was in DSM-IV, but now is on high- functioning end of the autism spectrum No impairment in communication or intellectual disability. But do have: Impairment in social interaction Restricted, stereotyped patterns of behavior, interests, activities.