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Presentation
on Attention Deficit Hyperactivity Disorder for Trinity College Dublin
by Professor Michael Fitzgerald |
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 (Please select
picture to view presentation) |
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Summary
of Available Assessment Instruments for Pervasive Developmental
Disorders |
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Scale
(see legend)
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Uses
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Age
Range
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Method
of Administration
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Population
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ABC
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Screening
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Children
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Completed
by primary carers
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AD
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CARS
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Screening
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Children
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Clinical
rated
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AD
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CHAT
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Screening
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Toddlers
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Parent
+ Clinician
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AD
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ASQ
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Screening
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Child
/ Adult
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Completed
by primary carers
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AD
/ AspD
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ASAS
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Screening
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Children
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Completed
by primary carers
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AspD
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AQ
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Screening
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Adults
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Self
completed
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AspD
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CAST
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Screening
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4
– 11 years
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Completed
by primary carers
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AspD
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ADI
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Screening
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Child
/ Adult
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Interview
+ clinician rated
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AD
/ AspD
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DISCO
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Screening
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Child
/ Adult
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Interview
+ clinician rated
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AD
/ AspD
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ADOS
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Screening
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Child
/ Adult
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Semi-structured
interactive session
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AD
/ AspD
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ASDS
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Screening
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5
– 18 years
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Completed
by primary carers
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AspD
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GADS
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Screening
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3
– 22 years
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Parent
+ clinician
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AspD
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ASDI
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Screening
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Child
/ Adult
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Interview
+ clinician rated
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AspD
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AD
= Autism Disorder; AspD = Asperger’s syndrome; ABC = Autism Behaviour
Checklist; CARS = Childhood Autism Rating Scale;
CHAT = Checklist for Autism in Toddlers; ASQ = Autism Screening
Questionnaire; ASAS = Australian Scale for Asperger’s syndrome;
AQ = Autism Quotient; CAST = Childhood Autism Screening Test; ADI =
Autism Diagnostic Interview.
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Other Medication Used in Children with ASDs |
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Drug
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Class
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Uses
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Adverse Effects
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Haloperidol
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Conventional
antipsychotic
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Modest benefit in
reducing stereotypy and withdrawal
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EPSE, sedation,
irritability, tardive dyskinesias (30%)
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Risperidone
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Atypical
antipsychotic
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Agitation,
aggression, temper control, stereotypy, hyperactivity
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Sleep changes,
sedation, fatigue, lethargy, weight gain
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Valproate
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Anticonvulsant /
mood stabiliser
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75% showed
improvement in emotional lability; no differences observed
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Not reported; skin
rash and increased appetite
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Buspirone
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Anxiolytic
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Reduction of
anxiety in 50%
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Not reported
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Methylphenidate
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Stimulant
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Good to excellent
reduction in hyperactivity and inattention in 50%
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20% unable to
tolerate with more common side effects including agitation, stereotypes
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Guanfacine
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Alpha-2 receptor
agonist
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Increased
attention and improved sleep (25% of cases)
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Minimal
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Lithium
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Mood stabiliser
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Limited
therapeutic benefit; May be useful if bipolar or strong family history
of Bipolar Disorder
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Not reported
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Lamotrigine
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Anticonvulsant
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No evidence of
clinical benefit
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Serious skin rash
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Clonidine
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Alpha-2 receptor
agonist
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Limited benefit in
treating hyperactivity
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Not reported
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Naltrexone
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Inconsistent
effects on self-injury / overactivity
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Increased
frequency of stereotypes
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The
Use of Antidepressants in Children with ASDs
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Drug
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Class
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Uses
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Adverse Effects
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Fluoxetine
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SSRI
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Modest
benefit on repetitive behaviours and improving mood
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Insomnia,
hyperactivity, restlessness, agitation, reduced appetite, risk of
behaviour deterioration
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Fluvoxamine
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SSRI
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Adults:
half showing ‘positive’ response; children: side effects limited use
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Agitation
and behavioural deterioration in children
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Citalopram
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SSRI
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Moderate
improvement in anxiety and mood
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Behavioural
deterioration
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Sertraline
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SSRI
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Reduction
in repetitive behaviour and improvement in mood
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Limited
information available
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Clomipramine
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TCA
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Effective
for OCD symptoms and overactivity in older children; limited evidence
for efficacy in younger children
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EKG
changes and seizures
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Imipramine
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TCA
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Variable
clinical response to depression; reduction in affective blunting
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Negative
symptoms; Disorganisation of speech
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Developmental
Level
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Method
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Notes
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Infant/Pre-school
(play based)
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Guided
Participation
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Coaching
by adults and mediation by trained peers.
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Do-Watch-Listen-Say
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Focussing
on careful selection of play materials to foster participation, and
organisation of the environment to facilitate participation and
cooperation.
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Play
Organizers
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Normotypical
peers taught to encourage sharing, helping and praising to facilitate
play. Some evidence of generalization and maintenance.
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Buddy
Skills
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Teaches
normotypical peers to stay with, play with and talk to their
‘buddies’. Some evidence of improvement in the frequency of
social communication that was generalized to other interactions.
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School-aged
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Social
Stores
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State
a problem and give the child an acceptable response to it.
Usually focuses on maladaptive behaviours. Little evidence of
generalization and maintenance.
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Social
skills groups
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(see
text)
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Peer
Network / Circle of Friends
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Typical peers
taught to initiate and model appropriate social interactions.
Results have shown improvement in interaction and generalization to new
settings
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Adolescence
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Peer
Network / Circle of Friends
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(see
above)
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Visual
schedule / verbal rehearsal
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Using
written and pictorial representations of expected activities and
behaviour.
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Social
skills group
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(see
text)
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Training
scripts
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Scripts
are provided that give the opportunity to ask questions in response to
others’ initiation of conversation
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