Article - ADHD
ADHD = neurocognitive behavioral developmental disorder, most commonly seen in childhood and
adolescence, which often extends to the adult years
Prevalence: 7-8% of school-age children, 4-5% adults
o Risk factors: male gender, age, chronic health problems, family dysfunction, low SES,
presence of a developmental impairment, urban living
Persistent and maladaptive symptoms of hyperactivity/impulsivity and inattention
o Dopamine
o Prefrontal cortex: connections with striatum, cerebellum, parietal cortex, which may
be smaller or have decreased activation in people with ADHD
Comorbidity:
o Pediatric ADHD with mood, anxiety, and disruptive behavioral disorders
o Adult ADHD: mood, anxiety, and substance use disorders
o Uncomplicated ADHD = ADHD without comorbidities (20-25% of adults with ADHD)
Treatment:
o Pharmacological approaches
Stimulant medications: methylphenidate (OROS lessens ADHD and great
adherence), dexmethylphenidate (earliest onset of efficacy), mixed
amphetamine salts, lisdexamfetamine dimesylate (LDX) (lessens likelihood of
abuse and overdose)
First choice for medication management
More efficacious than non-stimulant medications (also for adults
with ADHD)
Side effects: decreased appetite, trouble with sleep onset, serious
cardiovascular issues, blood pressure, heart rate, exercise
parameters, reduced height and weight
Routine electrocardiography screening before use of stimulant is
mandatory for those with a positive family or personal cardiac
history
Non-stimulant medications: atomoxetine (SNRI) (efficacious, only approved
for adults), clonidine (a-2-adrenergic agonists), guanfacine (a-2-adrenergic
agonists) (effective in short- and long-term)
o Non-pharmacological approaches
Parent and teacher training in effective behavior-management techniques
aimed at reducing problem behaviors associated with ADHD
CBT is skill-based approach for adults with ADHD
o Psychosocial interventions
Training parents in behavioral management
Behavioral parent training (BPT) is effective for children with
disruptive behaviors, irrespective of co-occurring ADHD difficulties
Training parents in operant conditioning techniques
Consultation with teachers/school personnel
Individual work with the child
CBT (usually for adults) (only in combination with medication)
Cognitive activity affects behavior
Cognitive activity can be monitored and modified
Behavioral change can be produced by cognitive change
Challenges of treating ADHD:
o Clinical complexity of the cases (due to comorbid psychiatric disorders)
o Optimal functioning is usually not attained
,o Optimization of the risk benefit ratio requires careful adjustments in doses and
particular distributions of the doses during the day to maximize the effect of
medications
o Non-adherence to treatment is high
, Article – ASD
ASD = neurodevelopmental disorder defined by social communication impairments and restricted,
repetitive behaviors (2.3%)
Prevalence: 2,3%
o More prevalent among men and among special needs kids
o Heritability of 0.81
Genetic variants in 100 genes for significant risk
Affecting gene expression regulation, neurogenesis, chromatin
modification, synaptic function
Maternal factors: gestational hypertension, overweight, preeclampsia, >35
years, higher paternal age, medication use, short and long period between
pregnancies)
Comorbidity: ADHD, intellectual disability, anxiety and depressive disorders, mood disorders
and related behaviors, aggression and self-injury, epilepsy, feeding problems, motor
coordination difficulties, gastrointestinal conditions, sleep difficulties
o Savant skills = special skills that exceed what conventionally seems humanly
possible, most commonly manifest in memory, art, music, mental arithmetic, and
calendar calculation)
Clinical presentation:
o First 2 years of life: poor acquisition of or declines in language skills and
communicative gestures, or failure to learn or adopt skills, diminished
responsiveness in social interactions and presence of repetitive behaviors
o After first 2 years: behavioral or cognitive rigidity, lack of interest in socializing,
restricted interests, lack of imaginative play
Diagnosis of ASD
o Screening
Recommending between 18-24 months of age for ASD is not done anymore
M-CHAT-R total score > 2 is risk for ASD and requires follow-up questions
o Diagnostic assessment
ADI-R = semi-structured interview with the parent(s)
ADOS-2 = semi-structured direct observation of a child's behavior
o Genetic testing (chromosomal microarray, fragile X testing, Rett syndrome MECP2
gene sequencing)
o Physical examinations
Management:
o Goal is to improve function and well-being
o No medications are efficacious
o Pharmacologic interventions (aripiprazole, risperidone) can mitigate behavioral and
emotional dysregulation that co-occurs
Side effects: hyperglycemia, dyslipidemia, weight gain
o Therapeutic interventions (more effective for language than for social
communication):
Behavioral approaches: EIBI, Discrete Trial Training for young children
Developmental approaches: Preschool Autism Communication Trial
TEACCH for everyone
Psychotherapy (CBT) for school-age children and adolescents
GSSIs for adolescents and young adults
ADHD = neurocognitive behavioral developmental disorder, most commonly seen in childhood and
adolescence, which often extends to the adult years
Prevalence: 7-8% of school-age children, 4-5% adults
o Risk factors: male gender, age, chronic health problems, family dysfunction, low SES,
presence of a developmental impairment, urban living
Persistent and maladaptive symptoms of hyperactivity/impulsivity and inattention
o Dopamine
o Prefrontal cortex: connections with striatum, cerebellum, parietal cortex, which may
be smaller or have decreased activation in people with ADHD
Comorbidity:
o Pediatric ADHD with mood, anxiety, and disruptive behavioral disorders
o Adult ADHD: mood, anxiety, and substance use disorders
o Uncomplicated ADHD = ADHD without comorbidities (20-25% of adults with ADHD)
Treatment:
o Pharmacological approaches
Stimulant medications: methylphenidate (OROS lessens ADHD and great
adherence), dexmethylphenidate (earliest onset of efficacy), mixed
amphetamine salts, lisdexamfetamine dimesylate (LDX) (lessens likelihood of
abuse and overdose)
First choice for medication management
More efficacious than non-stimulant medications (also for adults
with ADHD)
Side effects: decreased appetite, trouble with sleep onset, serious
cardiovascular issues, blood pressure, heart rate, exercise
parameters, reduced height and weight
Routine electrocardiography screening before use of stimulant is
mandatory for those with a positive family or personal cardiac
history
Non-stimulant medications: atomoxetine (SNRI) (efficacious, only approved
for adults), clonidine (a-2-adrenergic agonists), guanfacine (a-2-adrenergic
agonists) (effective in short- and long-term)
o Non-pharmacological approaches
Parent and teacher training in effective behavior-management techniques
aimed at reducing problem behaviors associated with ADHD
CBT is skill-based approach for adults with ADHD
o Psychosocial interventions
Training parents in behavioral management
Behavioral parent training (BPT) is effective for children with
disruptive behaviors, irrespective of co-occurring ADHD difficulties
Training parents in operant conditioning techniques
Consultation with teachers/school personnel
Individual work with the child
CBT (usually for adults) (only in combination with medication)
Cognitive activity affects behavior
Cognitive activity can be monitored and modified
Behavioral change can be produced by cognitive change
Challenges of treating ADHD:
o Clinical complexity of the cases (due to comorbid psychiatric disorders)
o Optimal functioning is usually not attained
,o Optimization of the risk benefit ratio requires careful adjustments in doses and
particular distributions of the doses during the day to maximize the effect of
medications
o Non-adherence to treatment is high
, Article – ASD
ASD = neurodevelopmental disorder defined by social communication impairments and restricted,
repetitive behaviors (2.3%)
Prevalence: 2,3%
o More prevalent among men and among special needs kids
o Heritability of 0.81
Genetic variants in 100 genes for significant risk
Affecting gene expression regulation, neurogenesis, chromatin
modification, synaptic function
Maternal factors: gestational hypertension, overweight, preeclampsia, >35
years, higher paternal age, medication use, short and long period between
pregnancies)
Comorbidity: ADHD, intellectual disability, anxiety and depressive disorders, mood disorders
and related behaviors, aggression and self-injury, epilepsy, feeding problems, motor
coordination difficulties, gastrointestinal conditions, sleep difficulties
o Savant skills = special skills that exceed what conventionally seems humanly
possible, most commonly manifest in memory, art, music, mental arithmetic, and
calendar calculation)
Clinical presentation:
o First 2 years of life: poor acquisition of or declines in language skills and
communicative gestures, or failure to learn or adopt skills, diminished
responsiveness in social interactions and presence of repetitive behaviors
o After first 2 years: behavioral or cognitive rigidity, lack of interest in socializing,
restricted interests, lack of imaginative play
Diagnosis of ASD
o Screening
Recommending between 18-24 months of age for ASD is not done anymore
M-CHAT-R total score > 2 is risk for ASD and requires follow-up questions
o Diagnostic assessment
ADI-R = semi-structured interview with the parent(s)
ADOS-2 = semi-structured direct observation of a child's behavior
o Genetic testing (chromosomal microarray, fragile X testing, Rett syndrome MECP2
gene sequencing)
o Physical examinations
Management:
o Goal is to improve function and well-being
o No medications are efficacious
o Pharmacologic interventions (aripiprazole, risperidone) can mitigate behavioral and
emotional dysregulation that co-occurs
Side effects: hyperglycemia, dyslipidemia, weight gain
o Therapeutic interventions (more effective for language than for social
communication):
Behavioral approaches: EIBI, Discrete Trial Training for young children
Developmental approaches: Preschool Autism Communication Trial
TEACCH for everyone
Psychotherapy (CBT) for school-age children and adolescents
GSSIs for adolescents and young adults
