ASD
Definition & DDx
Qualitative impairment in social interaction and communication, as well as repetitive
stereotyped behaviour, interests and activities
DDx
- ADHD / Social communication disorder
o Normal language skills and imaginative play; lack of restriction in interests
- Global developmental delay/intellectual disability
- Developmental language disorder
Anatomy & Risks
Impairments and behaviours normally evident before 2-3yo
Strong genetic influences
Symptoms & Complications
Social communication and interaction
- Children play frequently alone and are uninterested in other children
- Fail to regulate social interaction with nonverbal cues
- Fail to form and maintain appropriate relationships
Repetitive behaviours, interests, and activities
- Repetitive motor mannerisms
- Inflexible adherence to non-functional routines/rituals
Investigations
Social communication and behaviours assessed on scale 1-3 for each domain
History taking
- Collateral o Mannerisms
- Social/emotional o Coping with change
o Friends - Language and communication
o Understanding o Pitch, tone and content of
emotions/social cues speech
o Special interests - Behavioural history
- Flexibility of thought o Temper/meltdowns
o Repetitive rather than o Obsessions/fears/phobias
imaginative play - Birth/developmental/family history
Treatment/Management & Side effects
- Early educational and behavioural interventions
- No consistent evidence for medication improving social communication
- SSRIs for reduction of repetitive stereotyped behaviour, OCD, anxiety, and aggression
- Antipsychotics for aggression, self-injury
- Methylphenidate for co-existing ADHD
,ADHD
Definition & DDx
Persistent inattention and/or hyperactivity/impulsivity with an element of developmental
delay
DDx
- Learning disabilities
- Conduct disorder
- ASD
- Mood disorders
Anatomy & Risks
Twice as common as autism - most diagnoses between 3-7
DSM-5 diagnosis
- ≥6 inattention symptoms for - Several symptoms ≤12yo
≥6mths inappropriate for - Symptoms in ≥2 settings
developmental level - Symptoms interfere with
- ≥6 hyperactivity-impulsivity functioning and not better
symptoms for ≥6mths/is disruptive explained by another mental
and inappropriate for disorder
developmental level
Symptoms & Complications
- Inability to o Loses things necessary for
o Follow through instructions tasks
o Play quietly o Doesn’t listen when directly
o Wait their turn spoken to
o Sustain tasks o Interrupts/intrudes on
o Concentrate others
o Sit still when expected o Answers before question is
- Often finished
o Forgetful in daily activities o Inappropriately runs/climbs
Investigations
10-week ‘watch and wait’ period to observe changes in symptoms
ECG baseline, weight and height before starting any medications
Qb Test – combines attention and impulse control measurements with activity recordings
collected by infra-red camera
Treatment/Management & Side effects
Drug therapy last resort for >5s
- Methylphenidate first line
o 6-week trial basis
o Side-effects: abdo pain/nausea/dyspepsia/weight loss
o Monitor weight/height 6mthly
- Switch to lisdex if no response
o Dexamfetamine if lisdex effective but not tolerated
Adults - methylphenidate/lisdexamfetamine can be first line
, Pressure of Speech
Definition & DDx
Relentless flow of speech
- Urgency to communicated with increased volume and decreased response to social
cues
Anatomy & Risks
Commonest causes
- Mania/hypomania - often accompanied by grandiosity, decreased need for sleep,
distractibility
- Schizophrenia – during acute episodes with positive symptoms
- Anxiety disorders – driven by feelings of worry/panic
- ADHD – rapid, interruptive speech patterns
Other causes
- Substance induced – cocaine, amphetamines, high dose caffeine
- FTD – disinhibition
- Hyperthyroidism
- Corticosteroid medication – high dose/prolonged use
- Frontal lobe lesion
Definition & DDx
Qualitative impairment in social interaction and communication, as well as repetitive
stereotyped behaviour, interests and activities
DDx
- ADHD / Social communication disorder
o Normal language skills and imaginative play; lack of restriction in interests
- Global developmental delay/intellectual disability
- Developmental language disorder
Anatomy & Risks
Impairments and behaviours normally evident before 2-3yo
Strong genetic influences
Symptoms & Complications
Social communication and interaction
- Children play frequently alone and are uninterested in other children
- Fail to regulate social interaction with nonverbal cues
- Fail to form and maintain appropriate relationships
Repetitive behaviours, interests, and activities
- Repetitive motor mannerisms
- Inflexible adherence to non-functional routines/rituals
Investigations
Social communication and behaviours assessed on scale 1-3 for each domain
History taking
- Collateral o Mannerisms
- Social/emotional o Coping with change
o Friends - Language and communication
o Understanding o Pitch, tone and content of
emotions/social cues speech
o Special interests - Behavioural history
- Flexibility of thought o Temper/meltdowns
o Repetitive rather than o Obsessions/fears/phobias
imaginative play - Birth/developmental/family history
Treatment/Management & Side effects
- Early educational and behavioural interventions
- No consistent evidence for medication improving social communication
- SSRIs for reduction of repetitive stereotyped behaviour, OCD, anxiety, and aggression
- Antipsychotics for aggression, self-injury
- Methylphenidate for co-existing ADHD
,ADHD
Definition & DDx
Persistent inattention and/or hyperactivity/impulsivity with an element of developmental
delay
DDx
- Learning disabilities
- Conduct disorder
- ASD
- Mood disorders
Anatomy & Risks
Twice as common as autism - most diagnoses between 3-7
DSM-5 diagnosis
- ≥6 inattention symptoms for - Several symptoms ≤12yo
≥6mths inappropriate for - Symptoms in ≥2 settings
developmental level - Symptoms interfere with
- ≥6 hyperactivity-impulsivity functioning and not better
symptoms for ≥6mths/is disruptive explained by another mental
and inappropriate for disorder
developmental level
Symptoms & Complications
- Inability to o Loses things necessary for
o Follow through instructions tasks
o Play quietly o Doesn’t listen when directly
o Wait their turn spoken to
o Sustain tasks o Interrupts/intrudes on
o Concentrate others
o Sit still when expected o Answers before question is
- Often finished
o Forgetful in daily activities o Inappropriately runs/climbs
Investigations
10-week ‘watch and wait’ period to observe changes in symptoms
ECG baseline, weight and height before starting any medications
Qb Test – combines attention and impulse control measurements with activity recordings
collected by infra-red camera
Treatment/Management & Side effects
Drug therapy last resort for >5s
- Methylphenidate first line
o 6-week trial basis
o Side-effects: abdo pain/nausea/dyspepsia/weight loss
o Monitor weight/height 6mthly
- Switch to lisdex if no response
o Dexamfetamine if lisdex effective but not tolerated
Adults - methylphenidate/lisdexamfetamine can be first line
, Pressure of Speech
Definition & DDx
Relentless flow of speech
- Urgency to communicated with increased volume and decreased response to social
cues
Anatomy & Risks
Commonest causes
- Mania/hypomania - often accompanied by grandiosity, decreased need for sleep,
distractibility
- Schizophrenia – during acute episodes with positive symptoms
- Anxiety disorders – driven by feelings of worry/panic
- ADHD – rapid, interruptive speech patterns
Other causes
- Substance induced – cocaine, amphetamines, high dose caffeine
- FTD – disinhibition
- Hyperthyroidism
- Corticosteroid medication – high dose/prolonged use
- Frontal lobe lesion
