Define ADHD
Attention deficit hyperactivity disorder (ADHD) = is a neurodevelopment disorder featuring the core features of:
* Difficulty maintaining attention
* Excessive energy
* Activity
* Impulsivity
Which gender is ADHD more common in?
Males
(twice as likely)
What factors are thought to cause ADHD?
- Genetic (there is significant heritability)
- Pregnancy-related factors (e.g., maternal smoking, premature birth and low birth weight)
- Environmental factors
When do ADHD symptoms start and how?
In childhood
= Should be consistent across settings
When a person displays symptoms only at work or school but is calm and focused at home, this is suggestive of an environmental effect rather than an underlying diagnosis.
Features of ADHD
When many of these features are present, and they are adversely affecting the person.
- Short attention span
- Easily distracted
- Quickly moving from one activity to another
- Quickly losing interest in a task
- Inability to persist with and complete tasks
- Constantly moving or fidgeting
- Impulsive behaviour
- Disruptive behaviour
- Difficulty managing time
The Adult ADHD Self-Report Scale (ASRS) can be used as a screening test to support a referral.
Management of ADHD
Conservative management:
* Self-management strategies
* Reasonable adjustments
Medication (when conservative Mx fails): Central nervous system stimulants:
* Methylphenidate
* Dexamfetamine
* Lisdexamfetamine
* Atomoxetine
What monitoring requirements are needed when taking medication (CNS stimulants) for ADHD?
- HR
- BP
- Weight
- Mood changes
What are the 3 areas are impaired in ASD?
- Social interaction
- Communication
- Behaviour
ASD: Name some deficits in social interaction
- Lack of eye contact
- Delay in smiling
- Avoiding physical contact
- Unable to read non-verbal cues
- Difficulty establishing friendships
- Not displaying a desire to share attention (e.g., not playing with others)
ASD: Name some decifits in communication
- Delay, absence or regression in language development
- Lack of appropriate non-verbal communication (e.g., smiling, eye contact, responding to others and sharing interest)
- Difficulty with imaginative or imitative behaviour
- Repetitive use of words or phrases
ASD: Name some decifits in behaviour
- Greater interest in objects, numbers or patterns than people
- Stereotypical repetitive movements (e.g., self-stimulating movements, such as hand-flapping or rocking)
- Intense and deep interests that are persistent and rigid
- Repetitive behaviour and fixed routines
- Anxiety and distress with experiences outside their regular routine
- Extremely restricted food preferences
Name some members of an MDT for ASD management
- Child and adolescent mental health services (CAMHS)
- Psychologists
- Speech and language specialists
- Dieticians
- Paediatricians
- Social workers
- Specially trained educators and special school environments
- Charity organisations (e.g., National Autistic Society)
Define learning disability
Learning disability = a general umbrella term encompassing a range of different conditions - that affect the ability of the child to develop new skills
Define dyslexia
Specific difficulty in reading, writing and spelling.
Define dysgraphia
Specific difficulty in writing.
Define dyspraxia
AKA developmental co-ordination disorder
Specific type of difficulty in physical co-ordination.
It is more common in boys. It presents with delayed gross + fine motor skills and a child that appears clumsy.
Define auditory processing disorder
Specific difficulty in processing auditory information
Define non-verbal learning disorder
Specific difficulty in processing non-verbal information - such as body language + facial expressions
Define profound and multiple learning disability
Severe difficulties across multiple areas - often requiring help with all aspects of daily life
What is the severity of a learning disability bsaed on?
IQ (intelligence quotient):
* 55 – 70: Mild
* 40 – 55: Moderate
* 25 – 40: Severe
* Under 25: Profound
Aetiology of learning disabilities?
No clear cause
Family history = increases the risk
Environmental factors = increase risk:
* Abuse
* Neglect
* Psychological trauma
* Toxins
Name some conditions that have strong associations with learning disability
- Genetic disorders: Downs syndrome
- Antenatal problems: fetal alcohol syndrome and maternal chickenpox
- Problems at birth: prematurity and hypoxic ischaemic encephalopathy
- Problems in early childhood: meningitis
- Autism
- Epilepsy
Management of learning disability
MDT:
* Health visitors
* Social workers
* Schools
* Educational psychologists
* Paediatricians, GPs and nurses
* Occupational therapists
* Speech and language therapists
Is capacity decision-specific?
Yes!
Having a learning disability does not prevent patients from being able to make decisions
They may require more time, effort and decision aids to be able to fulfil the criteria. It may take several attempts on different days or at different times of day to be able to make a decision.
