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ADHD and Autism PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "ADHD and autism".
This medical PowerPoint presentation talks about ADHD (Attention Deficit Hyperactivity Disorder) and Autism Spectrum Disorder (ASD), two separate neurological conditions.
ADHD (Attention Deficit Hyperactivity Disorder) and Autism Spectrum Disorder (ASD) are two separate neurological conditions, but they can sometimes co-occur or share similar symptoms, which can make them difficult to differentiate.
ADHD is a disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that interferes with daily functioning. In contrast, ASD is a neurodevelopmental disorder characterized by difficulties with social communication and interaction, as well as restricted and repetitive patterns of behavior, interests, or activities.

Tags : ADHD, Attention Deficit Hyperactivity Disorder, Autism Spectrum Disorder, ASD, neurological conditions, neurodevelopmental disorder, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 2208 | Downloads : 11

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Slide 1-

ELFT Training Packagesfor Primary Care ADHD and autism Responsible Clinician for contact: Frank Röhricht Associate Medical Director
Slide 2-

Inattention Hyperactivity Impulsivity What is ADHD?
Slide 3-

Symptom groups
Slide 4-

Also…… Present for >6/12 Present from before age of 6-7 years Pervasive across settings Causing significant impairment Not better explained by alternative diagnosis
Slide 5-

Developmental impact of ADHD Pre-school Adolescent Adult School-age College-age Behavioural disturbance Behavioural disturbance Academic problems Difficulty with social interactions Self-esteem issues Academic problems Difficulty with social interactions Self-esteem issues Legal issues, smoking and injury Academic failure Occupational difficulties Self-esteem issues Substance abuse Injury/accidents Occupational failure Self-esteem issues Relationship problems Injury/accidents Substance abuse
Slide 6-

Just a childhood disorder? Inattention persists in 50-60% If 5-10% in children, then 3-6% in adults Impact in adults Socioeconomic Academic, employment, relationships, driving Psychological Low self-esteem, unhappiness, ‘ups and downs’, stress Comorbidities MSc in Family Medicine Programme
Slide 7-

Diagnostic criteria (DSM-IV-TR) Inattention symptoms Hyperactivity/impulsivity symptoms Before 7y/o Impairment in at least two settings (study, work, relationships, family/friends etc.) Can’t be better explained by another disorder Consider amending the criteria for adults Reduce severity/number of required symptoms Increase variety of symptoms, less hyperactivity, more inattention MSc in Family Medicine Programme
Slide 8-

Diagnostic Criteria Hyperkinetic Disorder ICD-10 Inattention and hyperactivity/impulsivity 6/12 + < 6 years Symptoms present in > 1 setting Significant impairment Absence of other disorder 1.5% prevalence ADHD DSM-IV Inattention and/or hyperactivity/impulsivity 6/12 + < 7 years Some impairment in > 1 setting Significant impairment Not better explained by another disorder 5% prevalence
Slide 9-

Diagnosis NICE Sept 2008 Should only be made by a specialist psychiatrist, paediatrician or other healthcare professional with expertise in ADHD Full clinical and psychosocial assessment Full developmental and psychiatric history Observer reports and MSE Assessment of needs, comorbidity, psychosocial circumstances, physical health Assessment of parents’ mental health
Slide 10-

ADHD Assessment - Newham CFCS family interview child interview physical examination psychometric assessment school liaison +/- classroom observation parent and teacher rating scales feedback to parent and child
Slide 11-

Family interview History of presenting complaint Information about school performance Assess for alternate or co-morbid disorders Obstetric history Developmental history Family history and functioning Past Medical / Psychiatric history Observations within the session
Slide 12-

2. Child interview functioning within the family, school and peer group general evaluation of psychopathology child’s attitude to and coping with their difficulties social skills deficits ability to concentrate and persist evidence of language disorder Internalising symptoms
Slide 13-

3. Physical examination Assessment of underlying medical problems contributing to presentation Assessment for potential contraindications to pharmacological intervention Baseline measurements of height, weight and blood pressure may be conveniently completed at this time The child should be accompanied by their parent or carer for such examination
Slide 14-

4. Psychometric assessment no psychological test which decisively characterises ADHD basic assessment of the child’s cognitive functioning more formal psychometric testing (eg WISC) if cognitive delay suspected
Slide 15-

5a. School - liaison Talk to class teacher or SENCO Information re core ADHD symptoms Other symptoms Peer and adult relationships Learning Statement / Level of extra help provided Teacher’s opinion of problem behaviour
Slide 16-

5b. School - observation Observation of 2 different types of activity e.g. structured work and playtime. Symptoms of overactivity and inattention Attention-seeking behaviour Peer relationships Baseline activity level of whole class Actions of teaching staff to help contain behaviour Is this a typical day for this child?
Slide 17-

6. Rating scales Parent Strengths & Difficulties Questionnaire (SDQ) Conners Parent Rating Scale (Short or Long) Self SDQ Conners-Wells’ Self-Report Scale (Short or Long) Teacher SDQ Conners Teacher Rating Scale (Short or Long) Children’s Global Assessment Scale (CGAS)
Slide 18-

7. Feedback to parent and child diagnoses & management plan agreed follow-up arrangements made referral on to specialist services if needed letter or report sent to GP and parent +/- child brief summary sent to the school
Slide 19-

Adult ADHD – future dx changes Changes in DSM – V Increasing the required age of onset for symptoms to age 12 or earlier (previously age 7 or earlier) Inclusion of additional examples of how symptoms typically look in older adolescents and adults Elimination of required “impairment” “There is clear evidence that the symptoms interfere with, or reduce, the quality of social, academic, or occupational functioning.”
Slide 20-

Differential Dx ‘Cornerstones’ of diagnosis Detailed clinical interview (+coping strategies) Symptom rating scales Collateral information – need evidence of developmental symptoms Assess comorbidities Diagnostic dilemma for symptoms first noticed in adulthood Is it due to another disorder that overlaps (comorbidity) OR is it ADHD undiagnosed in childhood?
Slide 21-

Initial Presentation ‘I did an online form’ ‘my kid has it’ ‘I use drugs’ ‘I have feel unfulfilled for years’ ‘I get into trouble’ ‘I never get things right’ MSc in Family Medicine Programme
Slide 22-

What Doctors worry about It’s just a popular fad It’s a ‘choice’, not a illness Stimulants are just used to improve studying Stimulants are addictive Stimulants are not licensed Stimulant market value Monitoring is complicated Treatment is expensive MSc in Family Medicine Programme
Slide 23-

Evolution of ADHD symptoms with age(adapted from Stahl’s Essential Psychopharmacology, 2013)
Slide 24-

Advice after Diagnosis NICE Sept 2008 Self-instruction manuals for parents and other materials based on behavioural techniques Stress value of balanced diet and regular exercise Dietary change generally not recommended Dietary fatty acids not recommended
Slide 25-

Pre-school children NICE Sept 2008 Drug treatment not recommended Parent-training / education programme If effective, monitor for recurrence of symptoms If ineffective, consider referral to tertiary service
Slide 26-

School-age, mod ADHD, mod impairmentNICE Sept 2008 Drug treatment not indicated as first-line treatment Parent-training / education programme +/- group treatment (CBT/social skills training for child Consider individual psychological interventions for older adolescents If effective, review for comorbid problems If ineffective, consider drug treatment
Slide 27-

School-age, severe ADHD, severe impairmentNICE Sept 2008 Offer drug treatment as first-line treatment Parent-training / education programme
Slide 28-

Stimulants Methylphenidate Sustained release Concerta XL (70/30) Medikinet XL (50/50) Equasym XL (50/50) Immediate release Ritalin Methylphanidate HCL
Slide 29-

Choice of Drug Treatment NICE Sept 2008 Methylphenidate, atomoxetine and dexamfetamine Consider: Comorbidities (eg tics, epilepsy) Different adverse effects Potential problems with compliance Potential for drug diversion and misuse Family / child preference Cost
Slide 30-

Behavioural & Psychological interventions Parent-training / education programmes 1st line for < 6yrs or not severe ADHD associated with lower levels of medication useful in the treatment of comorbid disorders particularly oppositional or conduct disorders group or individual based Group CBT and social skills training Social skills with peers Problem solving Self-control Listening skills Dealing with expressing feelings
Slide 31-

Treatment – Newham CFCS Psychoeducation Pharmacotherapy - 1st line - 2nd line - practicalities - others medications Psychosocial interventions Treatment Algorithms
Slide 32-

Psychoeducation information to child, parents and teachers symptoms of the condition, aetiology, treatment options, management advice, medication effects and side-effects, expected course and prognostic features information leaflets or booklets on ADHD and co-morbid diagnoses specific teaching and management recommendations Parent Support Group
Slide 33-

Stimulants-2 Amphetamines Sustained Release – Elvanse (newly licensed) - Adderall (USA) Immediate Release Dexamphetamine Modafinil - histamine agonist??
Slide 34-

Pharmacotherapy – 1st line immediate-release methylphenidate Equasym® Ritalin® modified-release methylphenidate Concerta XL® Equasym XL® Medikinet XL®
Slide 35-

Pharmacotherapy – 2nd & 3rd line Atomoxetine (Strattera®) Dexamfetamine sulphate Immediate-release (Dexedrine®) Dexamfetamine dimesylate Prodrug (Elvanse®)
Slide 36-

1. Physical screen Assessment of history of exercise syncope, undue SOB and other CVS symptoms Family history of heart disease or sudden death in young person Height & weight Pulse & blood pressure & heart sounds If there are concerns regarding the child’s physical state, consider ECG or referral to GP or paediatrician for further assessment Risk assessment for substance misuse and drug diversion All examination results should be recorded in the medical notes
Slide 37-

2a. Initiation of treatment Methylphenidate-IR Dose titration over 4-6 wks - lowest effective dose / maximum therapeutic effect / minimum adverse effects response to MPH variable and cannot be predicted on a dose/body weight basis Commenced at a low level (0.2 mg/kg/dose) and be increased until either a good result is achieved, or adverse effects appear, or a ceiling of 0.7 mg/kg/dose t.d.s.
Slide 38-

2b. Initiation of treatment Methylphenidate-IR For most children, the starting dose of MPH will be 5 mgs b.d or t.d.s. Children with comorbid developmental disorders may require even lower starting doses Within 2 weeks of commencing treatment or adjusting dose, contact with parent to enquire about effect and side effects of treatment at home and at school The total dose of MPH should not normally exceed 60 mgs daily, (may go up to max of 90 mgs MPH-IR daily if poor response)
Slide 39-

2c. Initiation of treatment Methylphenidate-MR Concerta XL®, Equasym XL®, Medikinet XL® may also be used from the start of therapy - avoids stigma at school, improved compliance, but less dose flexibility Starting dose of 18 mg/day (Concerta XL®) or 10 mg/day (Equasym XL®, Medikinet XL®) If treatment commenced with MPH-IR, once a stable dose is achieved, treatment may switch to MPH-MR
Slide 40-

3a. Ongoing Monitoring Effects and side-effects of medication should be monitored at each appointment Feedback should be obtained from both parents and teachers Abbreviated Conner’s Rating Scales and Strengths & Difficulties Questionnaires Height & weight should be monitored at month 3 and 6, then every 6 months and recorded on a centile chart Pulse & blood pressure should be monitored every 3 months and recorded on centile chart Blood testing & ECG only if clinically indicated Annual review to assess ongoing need for meds Consider comorbidities and treat where appropriate
Slide 41-

3b. Monitoring - Side Effects Headache / stomach ache / nausea Appetite suppression Increased emotionality Tachycardia & Hypertension Delayed sleep onset Tics Psychosis Suicidal thoughts / Self-harm and liver damage (Atomoxetine) Drug misuse and diversion
Slide 42-

5. Termination of treatment In the UK it is common to tail off medication as the young person completes their schooling. Should be gradual to avoid rebound effects In some cases, patients may require continuing medication into adulthood Transition policy with adult services
Slide 43-

Psychosocial Interventions Brief parent-training / education ADHD Parenting Group Community Parent Support Group EP advice to schools Systemic therapy Other CAMHS therapeutic interventions
Slide 44-

Non-stimulantsBenefit is not as pronounced and takes longer to manifest; No addiction/diversion riskRole in specific comorbidities Atomoxetine (NRI - only Rx licensed in adult ADHD) Reboxetine (NRI) Bupropion (NDRI) Duloxetine (SNRI) Venlafaxine (SNRI) Nortriptiline (TCA)
Slide 45-

Monitoring and follow up BP Pulse Weight Initial ECG Monitor for anxiety, elated mood, psychosis Need to avoid caffeine CBT
Slide 46-

Adult ADHD Just a childhood disorder? Inattention persists in 50-60% If 5-10% in children, then 3-6% in adults Impact in adults Socioeconomic Academic, employment, relationships, driving Psychological Low self-esteem, unhappiness, ‘ups and downs’, stress Comorbidities in up to ¾ adults
Slide 47-

Adult ADHD Diagnostic criteria (DSM-IV-TR) Inattention symptoms Hyperactivity/impulsivity symptoms Before 7y/o Impairment in at least two settings (study, work, relationships, family/friends etc.) Can’t be better explained by another disorder Consider amending the criteria for adults Reduce severity/number of required symptoms Increase variety of symptoms
Slide 48-

Adult ADHD Changes in DSM – V Increasing the required age of onset for symptoms to age 12 or earlier (previously age 7 or earlier) Inclusion of additional examples of how symptoms typically look in older adolescents and adults Elimination of required “impairment” “There is clear evidence that the symptoms interfere with, or reduce, the quality of social, academic, or occupational functioning.”
Slide 49-

Evolution of ADHD symptoms with age(adapted from Stahl’s Essential Psychopharmacology, 2013)
Slide 50-

Adult ADHD ‘Cornerstones’ of diagnosis Detailed clinical interview (+coping strategies) Symptom rating scales Collateral information Assess comorbidities Diagnostic dilemma for symptoms first noticed in adulthood Is it due to another disorder that overlaps (comorbidity) OR is it ADHD undiagnosed in childhood?
Slide 51-

Initial presentation ‘I did an online form’ ‘my kid has it’ ‘I use drugs’ ‘I have feel unfulfilled for years’ ‘I get into trouble’ ‘I never get things right’ ‘I was OK at school but felt an outcast’
Slide 52-

What doctors worry about It’s just a popular fad It’s a ‘choice’, not a illness Stimulants are just used to improve studying Stimulants are addictive Stimulants are not licensed Stimulant diversion Monitoring is complicated Treatment is expensive It’s all a conspiracy by ‘big pharma’
Slide 53-

‘Unpacking’ the syndrome and its biological corelates Individual symptom domains corelate with cortico-striato-thalano-cortical ‘loops’ involving different parts of the PFC Sustained attention – Dorsolateral prefrontal cortex Selective attention – Anterior cingulate cortex Hyperactivity – Prefrontal motor cortex Impulsivity – Orbitofrontal cortex Comorbid conditions have similar corelates in nearby prefrontal/limbic CSTC loops
Slide 54-

It’s a ‘tuning’ problem It’s about efficient information processing...or not as the case may be! Dopamine – regulates ‘noise’ strength Noradrenaline – regulates ‘signal’ strength Too little or too much of either creates a ‘tuning’ problem (inverted bell curve model)
Slide 55-

How best to ‘tune’
Slide 56-

StimulantsLicensed in children but unlicensed for adults Prescribed in adults under specialist supervision/adviceControlled drug prescribing – hassle!! Methylphenidate Sustained release Concerta XL (70/30) Medikinet XL (50/50) Equasym XL (50/50) Immediate release Ritalin Methylphanidate HCL Amphetamines Sustained release Elvanse (newly licensed) Adderall (USA) Immediate release Dexamfetamine Modafinil - Histamine agonist??
Slide 57-

Non-stimulantsBenefit is not as pronounced and takes longer to manifestNo addiction/diversion riskRole in specific comorbidities Rx with NRI function Atomoxetine (NRI - only Rx licensed in adult ADHD) Reboxetine (NRI) Bupropion (NDRI) Duloxetine (SNRI) Venlafaxine (SNRI) Nortriptiline (TCA) a2A adrenergic agonists Clonidine (a2A, a2B, a2C, imidazoline) Guanfacine (a2A)
Slide 58-

What to treat first ?- comorbidities Substance misuse Bipolar disorder Anxiety disorder ADHD Depression Nicotine dependence
Slide 59-

Introduction What are the Autism Spectrum Disorders? What are the diagnostic criteria? What are the eligibility requirements for Special Education in Minnesota?
Slide 60-

Autism Spectrum Disorders (Also known as pervasive developmental disorders) Pervasive Developmental Disorder Not Otherwise Specified (or atypical autism) Rett Syndrome Childhood Disintegrative Disorder Asperger Syndrome Autism
Slide 61-

What is Autism? Four ways to “define” autism DSM-IV Parents with a child with autism Individuals with autism What we know (i.e. stereotypes of autism) Let’s take a look at each one to get a more comprehensive idea of this disorder
Slide 62-

DSM-IV criteria First, important to note that autism is a spectrum disorder characterized by: Impairments in social interaction Impairments in communication Presence of restricted, repetitive behaviors (RRBs) Spectrum = variability within and across these areas 1 in 150 children diagnosed with autism includes the entire spectrum
Slide 63-

DSM-IV criteria (continued) Umbrella term is really Pervasive Developmental Disorders (PDD) 5 different subtypes of PDD Autistic Disorder Asperger’s Disorder PDD-NOS Rhett’s Disorder Childhood Disintegrative Disorder Autism Spectrum Disorders
Slide 64-

Story from a Teenager with ASD “The characteristics of people with Asperger's are the perfect ones to make obtaining friends difficult. Asperger's Syndrome is part of a spectrum of autistic disorders, all linked by a level of non-communication. At the lowest level, we have cases like my brother Eric, a person trapped in a void where communication is only at the most rudimentary level, about the level of a non-expressive two or three year old. Then among several forms at the highest level, we have Asperger's syndrome. Those with Asperger's often suffer from a plethora of symptoms. The most prominent ones are difficulty with reading people's body language, a singular interest in a subject or several subjects (from my own life, I have one major interest in rock music, compulsively looking for new reviews and obsessing over the best quality of sound to listen to them), a slight monotone voice, struggling with proper body distance, and a tendency to use a vocabulary that is of a slightly higher sophistication than most people would use such as when I employ words like vitriolic, inundate, smorgasbord, plethora, paraphernalia, and others of that variety. While obviously every person with the syndrome may not experience each and every single trait, I have experienced all of these symptoms to some degree. Couple that with a fairly shy personality, a shyness that may or may not have anything to do with Asperger's Syndrome, and I am often left feeling like everyone sees me as being quiet and not worth talking to.” (Autismspeaks.org)
Slide 65-

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Slide 66-

Definition Autism Spectrum Disorders: Disorders are characterized by varying degrees of impairment in: (1) Communication skills (2) Social interactions (3) Repetitive and stereotyped patterns of behavior.
Slide 67-

Pervasive Developmental Disorder Not Otherwise Specified (or atypical autism) Persons who display behaviors typical of autism but to a lesser degree and/or with an onset later than three years of age
Slide 68-

Aspergers Similar to mild autism but without significant impairments in cognition and language.
Slide 69-

Autism Definition from IDEA: A developmental disability affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that affects a child’s performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the childe has serious emotional disturbance.
Slide 70-

Autism Characteristics Impaired social interaction Picked up/cuddled Smile/laugh Objects vs. people Impaired communication 50% thought to be mute Robotic, parroting or reverse pronouns Repetitive and stereotyped patterns of behavior Twirling, flapping of hands, rocking Restricted range of interest
Slide 71-

Causes Neurological No single, known cause Genetic Problems Depending on the gene, a child may be more susceptible to the disorder Can affect the way brain cells communicate Can affect the severity of the symptoms Environmental Problems Causes many other health problems Exploring whether or not trigger autism ie. air pollutants and viral infections
Slide 72-

Vaccines and Autism No reliable study has shown a link between the MMR vaccine and autism Avoiding vaccines can place your child at risk for catching serious diseases
Slide 73-

Facts Approximately 1 in 110 children are diagnosed with autism. Over the last 30 to 40 years there has been great increase in the number of diagnosed cases. Autism is the fastest-growing serious developmental disability in the U.S. Sometimes students can be identified as LD or DCD when if fact they have autism.
Slide 74-

More Facts Autism is more prevalent in boys than girls Approximately 3:1 or 4:1 Autism is more prevalent in siblings of those with ASD Autism is more prevalent in those with other developmental disorders such as Fragile X syndrome, Developmental Cognitive Delayed, or Tuberculosis.
Slide 75-

Early Signs of Autism 6 months No big smiles or warm, joyful expressions 9 months No back and forth sharing of sounds, smiles, etc 12 months No consistent response to his/her name No babbling No back and forth gestures, such as pointing showing, reaching, waving, or three-pronged gaze 16 months No words 24 months No two-word meaningful phrases (without imitation or repeating)