t46 - neurodevelopmental disorder

ADHD

-affects attention, hyperactivity, and impulse control

-males

-lifelong condition

ADHD patho

-altered dopamine and norepinephrine signaling

ADHD etiology

-unknown

-genetics 74%

-environmental factors

-trauma

-lead exposure

ADHD sx

-difficulty with attention, concentration, short-term memory

-impulsivity, hyperactivity

-not experience under the patients control

-failing to give attention, losing things, not appearing to listen

-fidgeting, excessive talking, difficulty being quite

-at age 9 hyperactivity and impulsivity become less, inattention and cognitive remain

-impaired academic performance

-autoaccidents common, off track calls, forget birthdays

ADHD dx

DSM-5 Criteria

-at least 6 sx from either group

-sx must persist for at least 6 months and negatively impacts directly on social and academics

-sx must be present in at least 2 settings with some sx before age 12

Predominantly inattentive type

-failing to give attention, problem maintaining attention, not appearing to listen, problems organizing, losing things, being distracted, forgetful, failure to do instructions

Predominately hyperactive type

-fidgeting, can't stay seated, excessive talking, driven by motor, blurting out answers, difficulty taking turns, can't stay quite

Labs

-lead testing, TSH, OSA

-teacher input should be gathered for all school age children

Screening

-connor rating scales

-vanderbilt scale

-conners adult ADHD rating scale

ADHD tx

Nonpharm

-psychoeducation, CBT

-high levels of structure

-positive reinforcement

-EEG neurofeedback, omega 3 oils

Pharm

Nonstimulant

-atomoxetine: monitor BP, HR, growth

-guanfacine

-clonidine: BP, HR, growth, appetite

Stimulant

-dextroamphetamine-amphetamine, lisdexamfetamine

-methylphenidate, dexmethylphenidate

amphetamine and methylphenidate

MOA: dopamine and norepinephrine modulation

SE: decreased appetite, insomnia, anxiety, headache, GI upset, dry mouth, tachycardia, increase BP

-CV events, growth suppression, psychosis, seizures, serotonin syndrome

BB: high potential for abuse and dependence

Monitor: regular BP, HR, height, weight

Peds: first line >6 yo

autism spectrum disorder

1. persistent deficits in social communication and social interaction across multiple contexts

2. restricted, repetitive patterns of behavior, interests, or activities

-males

autism spectrum disorder patho

-genetic factors that alter neural connectivity in the brain -> affecting social communications development -> restricted interests and repetitive behaviors

autism spectrum disorder etiology

-family hx

-genetic conditions (fragile X)

-advanced prenatal age

-pregnancy complications

-lack of association with immunization

autism spectrum disorder sx

-persistent deficits in social communication

-restricted, repetitive pattern of behaviors, interests or activities

-plateau or skill loss between ages 12-24 months

-language deficits, absent interest in social interaction

-inappropriate response to social interaction

-getting to close to social partner

-misunderstanding emotional responses

-inability to understand relationships

-stereotypies: hand flapping, rocking, swaying, dipping, tiptoe walking

-only eating certain food, same routine, scripted play

-tactile deafness or resistance to being touched

autism spectrum disorder dx

DSM-5 Criteria

1. persistent deficits in social communication and social interaction across multiple contexts

2. restricted, repetitive patterns of behavior, interests, or activities

-manifestations above

Screening

-9 months: ASQ

-18 months: MCHAT

-24 moths: MCHAT

-30 months ASQ or MCHAT

-all suspected children should have formal audiology evaluation

-chromosome microarray and DNA for fragile X are first tier tests for children with ASD

autism spectrum disorder tx

Nonpharm

-mainstay = OT, speech therapy, applied behavioral analysis

-education, social support

Pharm

-risperidone/aripiprazole -> irritability

-SSRI -> anxiety, repetitive behavior

-stimulants -> attention issues