Autism
and Attention Deficit Hyperactivity Disorder
by Dr Avril Brereton
Autism
and Attention Deficit Hyperactivity Disorder (ADHD)
are the two main classes of neurodevelopmental
disorders which begin in early childhood. Symptoms
of attention deficit and hyperactivity are a common
problem in children with autism. The problem of
excessive hyperactive, inattentive and impulsive
behaviour in children is not new and has been
described in medical literature from the 19th
century.
What causes ADHD?
Current
theories include an interaction of:
-
genetic
predisposition
-
central nervous system dysfunction resulting from
pre and early postnatal traumatic or toxic events
and environmental and social influences
How is ADHD diagnosed?
The
diagnosis is based on a clinical judgement that
there are sufficient symptoms of inattention and
hyperactivity/impulsivity together with the decision
that these symptoms cause significant impairment in
daily functioning in at least 2 settings and are not
consistent with the developmental level of the
child. The diagnosis requires a careful and
comprehensive history of the child’s development and
behaviour from the parents and other informants such
as the teacher, together with observation of the
child in both structured and unstructured activity.
A structured cognitive assessment, apart from
providing information on specific learning
difficulties and related problems such as deficits
in short term auditory memory, will also reveal
problems with concentration and distractibility.
What are the symptoms?
-
Apart
from high levels of distractibility and inattention,
children with ADHD:
-
are
disorganised and are usually unable to follow
routine and complete tasks
-
have
difficulty monitoring their behaviour and therefore
often interrupt others
-
have
difficulty following rules
- have
inappropriate and impulsive behaviour
Those who also suffer
from hyperactivity:
These
behaviours are influenced by the environment and the
degree of external stimulation and sensory
complexity. Therefore, observers may report
differences in behaviour depending upon the
context. For example a teacher in a busy noisy
classroom setting is more likely to observe
inattention than a teacher’s aide who has the child
for individual teaching in a quiet library
environment. However, the symptoms and impairments
are usually observed, at least to some extent, in
all aspects of the child’s daily life.
Associated problems:
-
The
primary symptoms of ADHD in children often lead to
hostile interactions with other children who may
reject them.
-
The
majority of children with ADHD have various learning
difficulties and relatively poor school performance
in relation to their intellectual abilities.
-
Approximately 25% of individuals with ADHD have
intellectual disability including delayed language
development.
-
Children with ADHD have difficulty falling asleep,
wake early and their sleep is often unsettled and
complicated by breathing and snoring difficulties.
How does ADHD affect
children with autism?
At
least 13% of children with autism meet diagnostic
criteria for ADHD. Symptoms of attention deficit and
hyperactivity in children with autism impede and
disrupt their learning, school adjustment and family
life. These symptoms of ADHD are responsive to
educational, behavioural and pharmacological
managements used for children with ADHD, although
not always as successfully.
Management:
A
multimodal approach to management including
medication, special education, behaviour
modification and parent education and skills
training, is likely to lead to the most enhanced
treatment response. Medication is the most
important aspect of treatment, but multimodal
treatments which consider the complex learning,
behavioural and social problems of the child
improves outcome.
An
elimination diet is effective for children where the
specific provocative food such as tartrazine can be
identified, but are of benefit to fewer children
than medication.
Stimulant medications (methylphenidate and
dexamphetamine) are the most frequently used
medications. Trials of the efficacy of stimulant
medication clearly demonstrate immediate improvement
in inattention, impulsivity and hyperactivity and a
reduction in aggression. The longer term effects on
learning and academic achievement are less clear and
there is a lack of good long term evidence of the
effectiveness of stimulant medication.
Useful websites:
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