Скачать презентацию Autism and ADHD Dr Neil Jackson Consultant Community Скачать презентацию Autism and ADHD Dr Neil Jackson Consultant Community

ad0c1a347893a633a74a29f202e0fd56.ppt

  • Количество слайдов: 26

Autism and ADHD Dr Neil Jackson Consultant Community Paediatrician 24 June 2015 A service Autism and ADHD Dr Neil Jackson Consultant Community Paediatrician 24 June 2015 A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Topics • Typical presentations • Aetiology & pathophysiology • Parent support & resources • Topics • Typical presentations • Aetiology & pathophysiology • Parent support & resources • The role of the school A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC. • • • When to refer Who to refer to Medication Sleep Transitions

Typical presentations • ADHD – core symptoms of inattention, hyperactivity and impulsivity. – inattention: Typical presentations • ADHD – core symptoms of inattention, hyperactivity and impulsivity. – inattention: difficulty keeping on task, most often noticed by schools (TV and computer games don’t count) – hyperactivity: “constantly on the go”, little need for sleep, fidget. – impulsivity: poor danger awareness, internal “this is daft” message arrives too late. A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Typical presentations • ADHD – can present as inattentive subtype, i. e. ADD. • Typical presentations • ADHD – can present as inattentive subtype, i. e. ADD. • Age-related: – preschool: injuries, challenging behaviour – school: poor performance, disorganised, oppositional – adolescent: poor performance, smoking, alcohol, anti-social behaviour A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Typical presentations • Autism – ‘triad of impairment’ of communication difficulties, social interaction difficulties Typical presentations • Autism – ‘triad of impairment’ of communication difficulties, social interaction difficulties and stereotyped/repetitive behaviours – many presentations, dependent on age, verbal ability, IQ, parent and school support A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Typical presentations • Autism – preschool: language delay, language regression, echolalia, reduced eye contact, Typical presentations • Autism – preschool: language delay, language regression, echolalia, reduced eye contact, little pretend play, poor name response, not pointing, stereotyped movements or behaviours, unaware of others (socially) A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Typical presentations • Autism – school age: elective mute, unusual prosody or vocab, pronoun Typical presentations • Autism – school age: elective mute, unusual prosody or vocab, pronoun confusion, social impairment (classroom policemen, chasing games only, poor initiation etc), struggling with change to routine, lack of flexibility, sensory difficulties and many more… A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Just naughty? • Pointers away from this – pervasive across all settings – demonstrable Just naughty? • Pointers away from this – pervasive across all settings – demonstrable parental engagement – first line strategies ineffective A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Aetiology/Pathophysiology • ADHD – highly heritable (~80%) – environmental: smoking, alcohol or drug use Aetiology/Pathophysiology • ADHD – highly heritable (~80%) – environmental: smoking, alcohol or drug use in pregnancy, prematurity, LBW/IUGR – prevalence ~1 -2% (M: F 3: 1) – poor frontal lobe/executive functioning (i. e. toddler level impulse, attention and motor control), and reduced catecholamine levels in these areas A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Aetiology/Pathophysiology • Autism – heritable (recurrence risk ~15%) – Fragile X, TS – sporadic Aetiology/Pathophysiology • Autism – heritable (recurrence risk ~15%) – Fragile X, TS – sporadic vs syndromic – no clear environmental triggers – prevalence ~1% (M: F 5: 1) – mirror neurones, neuronal migration/pruning, altered neuroconnectivity A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Parent support • ADHD – www. addiss. co. uk – charity supporting and informing Parent support • ADHD – www. addiss. co. uk – charity supporting and informing parents – behaviour management courses: Triple P, Webster Stratton etc (via school nurses) – CAF/TAC – SENDIASS A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Parent support • Autism – www. nas. org. uk – National Autistic Society – Parent support • Autism – www. nas. org. uk – National Autistic Society – Autism Suffolk (diagnosis dependent) – CAF/TAC – SENDIASS A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

School’s role • ADHD/Autism – independent informant – structure/boundaries re: pervasiveness (may require BSS) School’s role • ADHD/Autism – independent informant – structure/boundaries re: pervasiveness (may require BSS) – assessment of intellect and useful strategies (via SENCo & EP) – social skills support A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Schools • Autism – specific service in place to support staff and child – Schools • Autism – specific service in place to support staff and child – County Inclusive Resource (CIR) – this is diagnosis dependent A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

When to refer • Significant impairment of function A service delivered on behalf of When to refer • Significant impairment of function A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Who to refer to? • ADHD – CAMHS/IDTs via Access and Assessment Team (Mariner Who to refer to? • ADHD – CAMHS/IDTs via Access and Assessment Team (Mariner House, Handford Road) • Autism – <11 yrs – Community Paediatrics via St Helen’s House or Bury CDC – >11 yr – CAMHS ASD team via AAT (as above) A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Referrals • Detail is key – evidence of development, school function, family history, behavioural Referrals • Detail is key – evidence of development, school function, family history, behavioural patterns etc • Supporting letters from schools are invaluable • We will ‘internally’ bounce referrals between community paediatrics & CAMHS where feasible A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Medications • ADHD – stimulants: methylphenidate dexamphetamine many preparations, short and long acting, SE Medications • ADHD – stimulants: methylphenidate dexamphetamine many preparations, short and long acting, SE include appetite suppression, weight loss, headaches and mood disturbance/lability A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Medications • ADHD – NARIs: atomoxetine – adrenergic agonist: clonidine A service delivered on Medications • ADHD – NARIs: atomoxetine – adrenergic agonist: clonidine A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Medications • Autism – no treatment for core symptoms – anxiety: – aggression/lability: – Medications • Autism – no treatment for core symptoms – anxiety: – aggression/lability: – sleep: A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC. SSRIs Risperidone Melatonin

Sleep • First line: Health visitors and school nurses for behavioural input • Medication: Sleep • First line: Health visitors and school nurses for behavioural input • Medication: Melatonin most useful medication, but only works reliably where there are neurodevelopmental difficulties i. e. autism Sedating antihistamines: tolerance can occur, watch for paradoxical agitation. A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Transition to adult services • ADHD – theoretically, to adult mental health services • Transition to adult services • ADHD – theoretically, to adult mental health services • Autism – social services where independence is in question – adult mental health services if anxiety or aggression predominate A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Summary • ADHD – toddler level impulsivity, inattention and hyperactivity in older children; poor Summary • ADHD – toddler level impulsivity, inattention and hyperactivity in older children; poor frontal lobe function • Autism - triad – communication and social impairments, along with stereotypy & rigidity A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Glossary • • ADD – attention deficit only TS – tuberous sclerosis BSS – Glossary • • ADD – attention deficit only TS – tuberous sclerosis BSS – behaviour support service (schools) SENDIASS – special educational needs and disability information, advice and support service CAF – common assessment framework TAC – team around the child SENCo – special educational needs co-ordinator EP – Educational Psychologists A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

Useful links • Childhood attention deficit hyperactivity disorder – http: //www. bmj. com/content/350/bmj. h Useful links • Childhood attention deficit hyperactivity disorder – http: //www. bmj. com/content/350/bmj. h 2168 – www. addiss. co. uk • Autism spectrum disorder: diagnosis and management – http: //ep. bmj. com/content/94/6/161. abstract – www. nas. org. uk A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.

 • Questions? • neil. jackson@suffolkch. nhs. uk A service delivered on behalf of • Questions? • neil. [email protected] nhs. uk A service delivered on behalf of the NHS by Serco, South Essex Partnership University NHS Foundation Trust and Community Dental Services CIC.