ADHD & AUTISM

DR. S. NAMBI
MD, DPM. PROFESSOR & HEAD, DEPT. OF PSYCHIATRY, CHRI

ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD) 
ADHD ± The most common neurobehavioral disorder of childhood. Most prevalent chronic health conditions affecting school aged children. Characterized by combination of over-activity, poorly modulated behavior with marked inattention and lack of persistent task involvement. Seen in 4-5% of children in general population. Boys are 2-3 times more affected than girls. Manifest before the age of seven.

CHARACTERISTICS OF ADHD
‡ ADHD is a complex condition, one child with ADHD may have different symptoms from another child with ADHD. ‡ ADHD is a medical condition characterized by a persistent pattern of: I. Inattention. II. Hyperactivity, III. Impulsivity.

III. Predominantly Inattentive Type. II. Combined Type .SUBTYPES OF ADHD I. Predominantly Hyperactivity/Impulsive Type.

consisting of day dreaming. hyperactivity and impulsiveness are sometimes present. Predominantly Inattentive ADHD: ‡ Main problem is inattention. . but to a lesser degree.THREE SUBTYPES OF ADHD 1. children here are more passive.

‡ Inattention may be present.2. Although. . this sometimes is not as obvious. Predominantly Hyperactivity/Impulsive ADHD: ‡ Hyperactivity and Impulsive behaviors are present.

3. Combined ADHD: ‡ All three ADHD behaviors. inattention and impulsivity are present in fairly equal measures. hyperactivity. .

. 2.HYPERKINETIC BEHAVIOR As children they: 1. Are restless and cannot sit still. Cannot concentrate on any given task (leading to scholastic difficulties) 4. Impulsive 7. Fiddle with everything around. 5. 6. Show temper tantrums. 3. Show episodes of rage or crying. Emotionally excitable.

POOR ATTENTION SPAN 1. These patients may have many other associated symptoms like: ‡ impulsivity. . ‡ emotional liability. These children do not concentrate on any task and leave most tasks unfinished. 2. ‡ poor scholastic progress and ‡ antisocial behavior.

VI. II. Soft neurological signs are common. The disorder is more common in orphanages where proper raring atmosphere is not available. Majority of these patients do show developmental delays. III. VII. V. . Genetic factors seem to play some part. IV. The condition improves with maturation. Others believe that the disorder occurs due to maturational lag of the central nervous system.ETIOLOGY OF ADHD I. Psychosocial factors may play some part.

Causing significant disturbance. academic or occupational functioning. Onset not later than seven years of age.CLINICAL FEATURES OF ADHD I. Inattention. Impulsivity IV. V. Hyperactivity III. . distress. school. and other settings also. VI. Pervasiveness ± the problems should be present at home. or impairment in social. II.

. Hyperactive symptoms improve with age. Mental Retardation Epilepsy OUTCOME: 1. 16 to 80% of children tend to suffer till their adolescents. but inattention symptoms tend to persist. 2.COMORBIDITIES Oppositional defiant disorders Conduct disorders.

MANAGEMENT OF ADHD 1. Drug Therapy 2. Psychosocial Therapy .

Methylphenidate in doses of 0. 5. 4. Dextroamphetamine is given in a dose of 5-10 mg/day.DRUGS USED IN THE TREATMENT OF ADHD ‡ CNS STIMULANTS: 1. .25-1 mg/kg/day is effective. 3. Dextroamphetamine and Methylphenidate are the drug of choice. These drugs reduce hyperactivity and improve attention span. 2. They are to be given in the morning and at noon because nightime dose may produce sleep difficulty.

DRUGS USED IN THE TREATMENT OF ADHD ‡ NON-STIMULANT: Atomoxetine (1-1.4 mg/kg qd) ‡ ANTIDEPRESSANTS. like imipramine in the dosage from 50-150 mg/day have been used in India .

. Behavioral Therapy reinforces positive behaviors such as completing homework. household chores.PSYCHOSOCIAL THERAPY Behavioral Therapy: Behavioral Therapy in conjunction with medication provides very good improvement. and discourages negative behaviors.

IV. To punish for the bad behavior. . Consistently encourage and praise the child for her good performance. III. Rewarding the good behavior. Set goals that have a reward such as a prize or privilege. II.Some Tips For Behavioral Therapy I.

This may lead to anxiety. Psychotherapy is of beneficial to these children . self-esteem problems and emotional troubles which in turn aggravate the symptoms. Psychotherapy should also be focused to parents and teachers.PSYCHOTHERAPY Children with ADHD have trouble adjusting with social and academic events. . ODD.

TALK TO YOUR CHILD¶S TEACHERS. WORK TOGETHER TO HELP YOUR CHILD.FIVE STEPS 1. 3. ASK YOUR CHILD¶S DOCTOR FOR HELP. LOOK FOR SIGNS OF ADHD. 2. . 5. 4. LEARN THAT ADHD IS AN ILLNESS THAT CAN BE TREATED.

CHILDHOOD AUTISM .

Deviance in communication.  Characterized by marked and sustained impairment in: 1.  3 to 4 types more common in boys than girls.  Abnormalities in nonverbal communication are present since infancy. .000. Restriction are stereotype patterns of behavior and interest. and 3.Introduction  A condition 1st described by LEO KANNER in 1943. Social interaction. 2.  Prevalence rate 4-5/10.

and gestures to regulate social interaction. or achievements with other people. ‡ Decreased or lack of social reciprocity. interests. ‡ Marked impairment in the use of non-verbal behaviors.CHARACTERISTICS OF AUTISM ‡ Difficulties with social interactions. ‡ Failure to develop peer relationships appropriate to developmental level. . facial expression. body postures. such as eye-to-eye gaze. ‡ A decrease or lack of spontaneous seeking to share enjoyment.

.CHARACTERS OF AUTISM ‡ Impairments in communication. ‡ Lack of varied. ‡ Stereotyped or repetitive use of language or idiosyncratic language. ‡ Delay or total lack of development of spoken language. spontaneous make-believe play or social imitative play appropriate to developmental level.

‡ The child fails to develop normal.AUTISTIC DISORDERS ‡ Usually starts during infancy. ‡ They are referred to as Autistic because they appear to be withdrawn and self observed. verbal and interpersonal communication. . ‡ Usually between 2-3 years of age.

no expression of common interest. ‡ Poor response to other people¶s emotions. ‡ Lack of seeking to share enjoyment or achievements. ‡ Poor relations with the peer.CLINICAL FEATURES Clinical features are described under four heads: 1. . Impairment in reciprocal social interaction: ‡ Poor eye to eye contact. ‡ Poor use of non-verbal expressions like facial expression.

head banging. hand flicking. ‡ Preoccupation with non-functional aspects of objects or toys like smell of toys. 4. Mannerism. 3. . Compulsive non-functional rituals or routine.REPETITIVE BEHAVIOR 2. Restricted repetitive stereotype behavior.

Self-injurious behavior.ASSOCIATED FEATURES ‡ ‡ ‡ ‡ ‡ Erratic sleep patterns PICA. . Poor affect modulation. eating non-edible things. Echopraxia.

‡ The early diagnosis and effective management. . OUTCOME: ‡ Poor outcome. ‡ Condition remains stable for long years.ETIOLOGY AND OUTCOME ‡ Poorly understood ‡ Genetic factors considered to be important. ‡ 10% can achieve some social skills.

TREATMENT ‡ Behavioral. but to help the individual achieve the maximally feasible quality of life. unfortunately. . ‡ The goal of treatment is not merely to lessen symptoms. psychotherapeutic as much as pharmacological approaches can be used to address numerous problems. there is no cure for the core disorder. but.

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