This document summarizes a talk on whether ADHD and ASD are two manifestations of the same underlying disorder or distinct disorders. The talk discusses evidence from clinical observations, genetics, cognitive measures, and brain imaging. Clinically, there is significant overlap between ADHD and ASD symptoms. Genetically, twin and family studies show shared genetic influences between the disorders. Polygenic risk scores predict traits related to both ADHD and ASD. Copy number variants have also been linked to both disorders. Cognitive profiles show heterogeneity but some common deficits. Overall, the evidence suggests ADHD and ASD have both shared and distinct features, possibly representing different points on a neurodevelopmental continuum.
Presentatie autisme escap 2015m4 madrid how_malleable_is_autism_escap_postUtrecht
This document discusses research on early intervention for autism spectrum disorder (ASD). It finds that high-intensity, comprehensive early intervention models can significantly improve outcomes for young children with ASD. Interventions like the Early Start Denver Model (ESDM) have been shown to substantially increase IQ scores, language abilities, and adaptive behaviors in children with ASD. Lower intensity parent-implemented interventions have also demonstrated effectiveness but produce more modest gains and have less long-term data available. The document emphasizes the need to identify children with ASD as early as possible, provide accurate early diagnoses, and ensure access to evidence-based early intervention services.
Common mental illnesses often emerge between 10 and 30 years of age. Endophenotypes are likely formed by the first two decades of life, while activation processes may occur proximal to illness emergence. Depressive symptoms vary in severity and presentation depending on age and sample characteristics. Biomarkers like cognitive tests and gene-environment interactions can help identify individuals at risk of developing depression.
KEYNOTE presentation (June 2015), ESCAP Expert Paper (July 2015), TV interview and abstract by professor Beate Herpertz-Dahlmann (Aachen University) on new developments in the diagnostics and treatment of adolescent eating disorders
Utrecht/Kenniscongres2016/14.2./ S. Mous/Hersenpathologie en autisme spectrum...Utrecht
The document summarizes research on autism spectrum disorder (ASD) in individuals with tuberous sclerosis complex (TSC). It finds that ASD is common in TSC, with a prevalence of around 40-50%. It also finds that having more cortical tubers, as seen on MRI scans, is related to more severe ASD. However, cognitive functioning also plays an important explanatory role. While ASD remains significant even for those with higher IQ, it is important to provide regular psychiatric/behavioral follow-up and management for ASD adapted to developmental level in individuals with TSC.
KEYNOTE presentation by professor Celso Arango (Hospital General Universitario Gregorio Marañón. IiSGM, Universidad Complutense, CIBERSAM. Madrid, Spain) on developmental trajectories in early-onset psychoses, held at the ESCAP 2015 Congress in Madrid, Monday June 22nd 2015
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
Amanda Gulsrud, PhD: Current Research on ASD in Adulthood: The Evidence and t...Semel Admin
The document summarizes current research on autism spectrum disorder (ASD) in adulthood. It finds that while autism symptoms and behavior problems tend to decrease with age on average, adaptive functioning may decline in midlife. Most young adults with ASD are unemployed after high school, which is a critical transition point. Longitudinal studies also show influences of socioeconomic factors, with those from lower-income families showing less improvement. More research is still needed into interventions for adults with ASD, especially regarding employment. Existing programs have had some success incorporating behavioral techniques and social skills training.
Mirella Dapretto, PhD: Sensory Over-Responsivity in ASD: Insights from Neuroi...Semel Admin
1) The document discusses sensory over-responsivity (SOR) in autism spectrum disorder (ASD) and insights from neuroimaging research.
2) A study found that youth with ASD displayed greater brain activation than typically developing youth in primary sensory areas, amygdala, hippocampus, and orbitofrontal cortex in response to sensory stimuli.
3) Activation in these areas correlated with parental ratings of SOR severity, suggesting neural hyper-responsivity in ASD youth is related to behavioral symptoms of SOR.
Presentatie autisme escap 2015m4 madrid how_malleable_is_autism_escap_postUtrecht
This document discusses research on early intervention for autism spectrum disorder (ASD). It finds that high-intensity, comprehensive early intervention models can significantly improve outcomes for young children with ASD. Interventions like the Early Start Denver Model (ESDM) have been shown to substantially increase IQ scores, language abilities, and adaptive behaviors in children with ASD. Lower intensity parent-implemented interventions have also demonstrated effectiveness but produce more modest gains and have less long-term data available. The document emphasizes the need to identify children with ASD as early as possible, provide accurate early diagnoses, and ensure access to evidence-based early intervention services.
Common mental illnesses often emerge between 10 and 30 years of age. Endophenotypes are likely formed by the first two decades of life, while activation processes may occur proximal to illness emergence. Depressive symptoms vary in severity and presentation depending on age and sample characteristics. Biomarkers like cognitive tests and gene-environment interactions can help identify individuals at risk of developing depression.
KEYNOTE presentation (June 2015), ESCAP Expert Paper (July 2015), TV interview and abstract by professor Beate Herpertz-Dahlmann (Aachen University) on new developments in the diagnostics and treatment of adolescent eating disorders
Utrecht/Kenniscongres2016/14.2./ S. Mous/Hersenpathologie en autisme spectrum...Utrecht
The document summarizes research on autism spectrum disorder (ASD) in individuals with tuberous sclerosis complex (TSC). It finds that ASD is common in TSC, with a prevalence of around 40-50%. It also finds that having more cortical tubers, as seen on MRI scans, is related to more severe ASD. However, cognitive functioning also plays an important explanatory role. While ASD remains significant even for those with higher IQ, it is important to provide regular psychiatric/behavioral follow-up and management for ASD adapted to developmental level in individuals with TSC.
KEYNOTE presentation by professor Celso Arango (Hospital General Universitario Gregorio Marañón. IiSGM, Universidad Complutense, CIBERSAM. Madrid, Spain) on developmental trajectories in early-onset psychoses, held at the ESCAP 2015 Congress in Madrid, Monday June 22nd 2015
This document summarizes Peter Fonagy's presentation on psychotherapy for emerging borderline personality disorder. It discusses what is known about treating BPD in adolescence, including evidence for DBT, MBT, ERT, HYPE, and pharmacotherapy. It also summarizes results from RCTs comparing MBT to treatment as usual, finding that MBT was more effective in reducing self-harm, depression, BPD traits, and improving mentalization and attachment. The document considers whether BPD can be validly diagnosed in adolescence and reviews prevalence studies showing similar rates to adults.
Amanda Gulsrud, PhD: Current Research on ASD in Adulthood: The Evidence and t...Semel Admin
The document summarizes current research on autism spectrum disorder (ASD) in adulthood. It finds that while autism symptoms and behavior problems tend to decrease with age on average, adaptive functioning may decline in midlife. Most young adults with ASD are unemployed after high school, which is a critical transition point. Longitudinal studies also show influences of socioeconomic factors, with those from lower-income families showing less improvement. More research is still needed into interventions for adults with ASD, especially regarding employment. Existing programs have had some success incorporating behavioral techniques and social skills training.
Mirella Dapretto, PhD: Sensory Over-Responsivity in ASD: Insights from Neuroi...Semel Admin
1) The document discusses sensory over-responsivity (SOR) in autism spectrum disorder (ASD) and insights from neuroimaging research.
2) A study found that youth with ASD displayed greater brain activation than typically developing youth in primary sensory areas, amygdala, hippocampus, and orbitofrontal cortex in response to sensory stimuli.
3) Activation in these areas correlated with parental ratings of SOR severity, suggesting neural hyper-responsivity in ASD youth is related to behavioral symptoms of SOR.
Dan Geschwind, MD, PhD: Advances in Genetics 2016Semel Admin
Advances in genetics have identified hundreds of genes associated with autism spectrum disorder (ASD) risk. Knowing the genetic causes has implications for treatment, recurrence risk, and prevention. While ASD has extreme genetic heterogeneity, studies in animal models, human cells, and post-mortem tissue aim to identify convergent biological pathways and circuits impacted across various genetic mutations. This research seeks to develop targeted therapies for ASD and demonstrates the potential of precision medicine approaches for neurodevelopmental disorders.
Diagnosis and Management of ADHD The Adult PatientMahendra Perera
This document discusses the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in adult patients. It begins with an overview of the historical and epidemiological features of ADHD, noting that the prevalence in adults is estimated to be 3-6% and 5-10% in children. It then covers the diagnosis of ADHD based on classification systems like the DSM and ICD, describing the presentation of symptoms in adults. The document discusses common co-occurring conditions like substance use disorders and bipolar disorder. It provides guidance on the management of adult ADHD through a multimodal approach including medication, psychology, lifestyle changes, and family support.
Zoned, Stoned And Blown - by Louis B. Cady, M.D. and Lisa Seif, LCSW, CADAC02...Louis Cady, MD
This presentation reviews the diagnosis, treatment, and sobriety maintenance of dual diagnosis disorders ( psychiatric disorders coupled with chemical dependency and/or alcoholism), using a synthetic blend of two talented clinicians' experiences, humor, and review of precision diagnosis, treatment formulations, and interventions.
This document discusses the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adults, focusing on clinical aspects of medication management. It describes how stimulant medications like methylphenidate and amphetamines are the best documented and most effective treatment for ADHD symptoms. Behavioral therapies can also be effective, either alone or in combination with medication. The optimal treatment is medication management combined with behavioral therapy.
Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for YouVisualBee.com
This document discusses a presentation about implementing the recommendations from two AAP clinical reports on autism spectrum disorders. The objectives are to describe the recommendations in the reports, utilize the AAP autism screening algorithm in practice, and identify strategies for implementing tools from the AAP Autism Toolkit. The toolkit contains resources like screening tools, management checklists, fact sheets, and referral forms to help primary care physicians screen for and manage autism in their practice. Screening conforms to Bright Futures guidelines and can be considered a quality improvement effort.
Mike Stawski: Who are These People? A Profile of Patients and their Families ...Beitissie1
The document summarizes key findings from a study conducted by the Outpatient Unit for Neurodevelopmental Psychiatry (OUDP) at Schneider Children's Medical Center in Israel. The study aimed to profile patients and examine treatment effectiveness. It found that most patients had behavioral problems, physical disabilities, and prior psychotropic medication. Treatment at OUDP involved less antipsychotics, more non-medical interventions, and led to improvements in irritability. The study also found correlations between patients' adaptive skills, behavioral problems, and parental mental health.
This document is an abstract for an expert roundtable supplement on best practices in diagnosing and treating adult ADHD. It discusses key points about the epidemiology of adult ADHD, including that approximately 4% of US adults have ADHD. It also notes that adults with ADHD experience significant impairments in executive functioning and adaptive functioning. Further, most adults with ADHD have at least one comorbid psychiatric disorder, making diagnosis and treatment more complex. The roundtable aims to review epidemiology data on adult ADHD, discuss common impairments, and consider differential diagnoses and common comorbidities.
This document describes the methodology of the Transitions Study, which aims to test a clinical staging model of mental illness progression in young people. The study involves a longitudinal cohort of 802 young people aged 12-25 who are receiving care at youth mental health services in Australia. Annual follow-up assessments will track participants over time to investigate psychological, social, and genetic markers that may define clinical stage or predict transition to more severe stages of mental disorders. The results could improve understanding of mental illness development and identify targets for preventing progression.
This case series discusses the management of psychiatric comorbidities in autism spectrum disorders. It describes three case studies of patients with ASD who were treated for symptoms of hyperactivity, behavioral issues, depression, and rigidity. Treatments included medications like risperidone, fluoxetine, lamotrigine, and sertraline, as well as CBT. Most patients experienced improvements in their comorbid symptoms and some also experienced gains in core autism symptoms from these interventions. The document advocates for treatments shown to help shared symptoms between ASD and other disorders.
ADHD is becoming much prevalent in childhood and adolescent , comorbidities like learning disability, anxiety, depression, autism spectrum disorder and tourette syndrome . Regarding the treatment we have to put in mind the comorbid disorder . Amphetamine Methylphenidate, Atomoxetine and behavioral treatment are considered of value in treating ADHD and comorbidities , ,
Evidence-based counseling therapies for attention-deficit/hyperactivity disor...Jeffrey Ahonen
This presentation addresses psychotherapuetic treatment of attention-deficit/hyperactivity disorder in adults. A brief overview is presented of the current conceptualization of this disorder in the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A brief discussion is set forth regarding mental health counseling therapies that have demonstrated effectiveness in helping adults to cope and improve social and occupational functionality.
This presentation might be useful as an introduction to psychotherapeutic treatment of ADHD in adults, particularly within an undergraduate or lower-level graduate course in psychology or mental health counseling.
iCAAD London 2019 - Dr Alberto Pertusa - Addiction treatment: What new medica...iCAADEvents
In this presentation, Consultant Psychiatrist and international addictions specialist, Dr McPhillips, will provide an overview of emerging medical treatments for addiction and Dr Pertusa will discuss ADHD & addiction.
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This document provides an overview of a course on depressive disorders in children and adolescents. The four sessions will cover epidemiology and clinical presentation, evaluation and diagnosis, pharmacotherapy and medical treatments, and non-pharmacologic treatments. Key points include variations in depressive symptoms by developmental stage, diagnostic criteria for major depressive disorder, importance of differential diagnosis and high rates of comorbidity. Rating scales are commonly used but have limitations. Factors like family history, medical conditions, and environment contribute to risk.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
- Dr. Stephen Grcevich presented on the treatment of pediatric bipolar disorder at Children's Hospital Medical Center of Akron on June 30, 2016.
- He reviewed key literature on effective pharmacotherapy for pediatric bipolar disorder, including FDA-approved medications like risperidone, aripiprazole, and quetiapine. Data from the TEAM study showed risperidone was more effective than lithium or divalproex for initial treatment of childhood mania.
- Non-pharmacological treatments like multifamily educational groups, family focused therapy, and DBT can also help reduce mood symptoms and improve functioning for youth with bipolar disorder when used alongside medication.
Adjustment disorder is an abnormal reaction to an identifiable stressor that results in emotional or behavioral symptoms and impairment. It is commonly seen in children who experience depressed mood, irritability, impaired concentration and sleep issues after stressful events. Treatment involves psychotherapy and sometimes medication to alleviate symptoms. Prevention focuses on building coping skills, conflict resolution training and supportive relationships.
Why do neurodevelopmental disorders co-occur?Dorothy Bishop
Neurodevelopmental disorders like autism, dyslexia, and language impairment often co-occur. This document discusses several possible explanations for why this is the case, including shared genetic risk factors, correlated environmental risks, and gene-gene interactions. It also notes evidence that for some children, their language problems may be a "phenomimic" of autism rather than sharing the same root cause. The document advocates classifying children based on their profile of difficulties rather than diagnostic labels, to best address their needs.
Genetics of attention deficit hyperactivity disorder (adhd)Joy Maria Mitchell
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder. ADHD is the commonly studied and
diagnosed as psychiatric disorder. Here we shall see the relation between extraversion and ADHD, neuroticism,
biological relation, Environmental factors and with diagnosis of ADHD. It is known that Genetics is one of the factors
that may contribute to, or exacerbate ADHD. Recent research probing towards the environmental and Genetic factors
causing ADHD differences is the main source for investigation
This document summarizes a study that characterized 61 children with Down syndrome (DS) and autism-spectrum disorder (ASD) using the Aberrant Behavior Checklist (ABC). The study aimed to 1) describe the cognitive and behavioral attributes of children with DS and ASD, 2) distinguish those with DS and ASD from children with typical DS or DS with stereotypy movement disorder using the ABC and DSM-IV criteria, and 3) determine the utility of the ABC for characterizing this group for future research. The study found significant differences in cognitive function between the three groups (DS+ASD, DS+stereotypy, typical DS). Scores on the Lethargy and Stereotypy
Autism Spectrum Disorder A case study of Mikey.pdfKathryn Patel
This case study describes an 8-year-old boy, Mikey, who was diagnosed with Autism Spectrum Disorder at age 4. Mikey is having behavioral issues during his morning routine that disrupt his entire day. An occupational therapy evaluation found that Mikey has sensory processing difficulties, engages in repetitive behaviors, and plays at the social developmental level of a 12-month old. The evaluation suggests occupational therapy to address Mikey's sensory needs and develop his social skills morning routine.
Dan Geschwind, MD, PhD: Advances in Genetics 2016Semel Admin
Advances in genetics have identified hundreds of genes associated with autism spectrum disorder (ASD) risk. Knowing the genetic causes has implications for treatment, recurrence risk, and prevention. While ASD has extreme genetic heterogeneity, studies in animal models, human cells, and post-mortem tissue aim to identify convergent biological pathways and circuits impacted across various genetic mutations. This research seeks to develop targeted therapies for ASD and demonstrates the potential of precision medicine approaches for neurodevelopmental disorders.
Diagnosis and Management of ADHD The Adult PatientMahendra Perera
This document discusses the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in adult patients. It begins with an overview of the historical and epidemiological features of ADHD, noting that the prevalence in adults is estimated to be 3-6% and 5-10% in children. It then covers the diagnosis of ADHD based on classification systems like the DSM and ICD, describing the presentation of symptoms in adults. The document discusses common co-occurring conditions like substance use disorders and bipolar disorder. It provides guidance on the management of adult ADHD through a multimodal approach including medication, psychology, lifestyle changes, and family support.
Zoned, Stoned And Blown - by Louis B. Cady, M.D. and Lisa Seif, LCSW, CADAC02...Louis Cady, MD
This presentation reviews the diagnosis, treatment, and sobriety maintenance of dual diagnosis disorders ( psychiatric disorders coupled with chemical dependency and/or alcoholism), using a synthetic blend of two talented clinicians' experiences, humor, and review of precision diagnosis, treatment formulations, and interventions.
This document discusses the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adults, focusing on clinical aspects of medication management. It describes how stimulant medications like methylphenidate and amphetamines are the best documented and most effective treatment for ADHD symptoms. Behavioral therapies can also be effective, either alone or in combination with medication. The optimal treatment is medication management combined with behavioral therapy.
Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for YouVisualBee.com
This document discusses a presentation about implementing the recommendations from two AAP clinical reports on autism spectrum disorders. The objectives are to describe the recommendations in the reports, utilize the AAP autism screening algorithm in practice, and identify strategies for implementing tools from the AAP Autism Toolkit. The toolkit contains resources like screening tools, management checklists, fact sheets, and referral forms to help primary care physicians screen for and manage autism in their practice. Screening conforms to Bright Futures guidelines and can be considered a quality improvement effort.
Mike Stawski: Who are These People? A Profile of Patients and their Families ...Beitissie1
The document summarizes key findings from a study conducted by the Outpatient Unit for Neurodevelopmental Psychiatry (OUDP) at Schneider Children's Medical Center in Israel. The study aimed to profile patients and examine treatment effectiveness. It found that most patients had behavioral problems, physical disabilities, and prior psychotropic medication. Treatment at OUDP involved less antipsychotics, more non-medical interventions, and led to improvements in irritability. The study also found correlations between patients' adaptive skills, behavioral problems, and parental mental health.
This document is an abstract for an expert roundtable supplement on best practices in diagnosing and treating adult ADHD. It discusses key points about the epidemiology of adult ADHD, including that approximately 4% of US adults have ADHD. It also notes that adults with ADHD experience significant impairments in executive functioning and adaptive functioning. Further, most adults with ADHD have at least one comorbid psychiatric disorder, making diagnosis and treatment more complex. The roundtable aims to review epidemiology data on adult ADHD, discuss common impairments, and consider differential diagnoses and common comorbidities.
This document describes the methodology of the Transitions Study, which aims to test a clinical staging model of mental illness progression in young people. The study involves a longitudinal cohort of 802 young people aged 12-25 who are receiving care at youth mental health services in Australia. Annual follow-up assessments will track participants over time to investigate psychological, social, and genetic markers that may define clinical stage or predict transition to more severe stages of mental disorders. The results could improve understanding of mental illness development and identify targets for preventing progression.
This case series discusses the management of psychiatric comorbidities in autism spectrum disorders. It describes three case studies of patients with ASD who were treated for symptoms of hyperactivity, behavioral issues, depression, and rigidity. Treatments included medications like risperidone, fluoxetine, lamotrigine, and sertraline, as well as CBT. Most patients experienced improvements in their comorbid symptoms and some also experienced gains in core autism symptoms from these interventions. The document advocates for treatments shown to help shared symptoms between ASD and other disorders.
ADHD is becoming much prevalent in childhood and adolescent , comorbidities like learning disability, anxiety, depression, autism spectrum disorder and tourette syndrome . Regarding the treatment we have to put in mind the comorbid disorder . Amphetamine Methylphenidate, Atomoxetine and behavioral treatment are considered of value in treating ADHD and comorbidities , ,
Evidence-based counseling therapies for attention-deficit/hyperactivity disor...Jeffrey Ahonen
This presentation addresses psychotherapuetic treatment of attention-deficit/hyperactivity disorder in adults. A brief overview is presented of the current conceptualization of this disorder in the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A brief discussion is set forth regarding mental health counseling therapies that have demonstrated effectiveness in helping adults to cope and improve social and occupational functionality.
This presentation might be useful as an introduction to psychotherapeutic treatment of ADHD in adults, particularly within an undergraduate or lower-level graduate course in psychology or mental health counseling.
iCAAD London 2019 - Dr Alberto Pertusa - Addiction treatment: What new medica...iCAADEvents
In this presentation, Consultant Psychiatrist and international addictions specialist, Dr McPhillips, will provide an overview of emerging medical treatments for addiction and Dr Pertusa will discuss ADHD & addiction.
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This document provides an overview of a course on depressive disorders in children and adolescents. The four sessions will cover epidemiology and clinical presentation, evaluation and diagnosis, pharmacotherapy and medical treatments, and non-pharmacologic treatments. Key points include variations in depressive symptoms by developmental stage, diagnostic criteria for major depressive disorder, importance of differential diagnosis and high rates of comorbidity. Rating scales are commonly used but have limitations. Factors like family history, medical conditions, and environment contribute to risk.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
- Dr. Stephen Grcevich presented on the treatment of pediatric bipolar disorder at Children's Hospital Medical Center of Akron on June 30, 2016.
- He reviewed key literature on effective pharmacotherapy for pediatric bipolar disorder, including FDA-approved medications like risperidone, aripiprazole, and quetiapine. Data from the TEAM study showed risperidone was more effective than lithium or divalproex for initial treatment of childhood mania.
- Non-pharmacological treatments like multifamily educational groups, family focused therapy, and DBT can also help reduce mood symptoms and improve functioning for youth with bipolar disorder when used alongside medication.
Adjustment disorder is an abnormal reaction to an identifiable stressor that results in emotional or behavioral symptoms and impairment. It is commonly seen in children who experience depressed mood, irritability, impaired concentration and sleep issues after stressful events. Treatment involves psychotherapy and sometimes medication to alleviate symptoms. Prevention focuses on building coping skills, conflict resolution training and supportive relationships.
Why do neurodevelopmental disorders co-occur?Dorothy Bishop
Neurodevelopmental disorders like autism, dyslexia, and language impairment often co-occur. This document discusses several possible explanations for why this is the case, including shared genetic risk factors, correlated environmental risks, and gene-gene interactions. It also notes evidence that for some children, their language problems may be a "phenomimic" of autism rather than sharing the same root cause. The document advocates classifying children based on their profile of difficulties rather than diagnostic labels, to best address their needs.
Genetics of attention deficit hyperactivity disorder (adhd)Joy Maria Mitchell
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder. ADHD is the commonly studied and
diagnosed as psychiatric disorder. Here we shall see the relation between extraversion and ADHD, neuroticism,
biological relation, Environmental factors and with diagnosis of ADHD. It is known that Genetics is one of the factors
that may contribute to, or exacerbate ADHD. Recent research probing towards the environmental and Genetic factors
causing ADHD differences is the main source for investigation
This document summarizes a study that characterized 61 children with Down syndrome (DS) and autism-spectrum disorder (ASD) using the Aberrant Behavior Checklist (ABC). The study aimed to 1) describe the cognitive and behavioral attributes of children with DS and ASD, 2) distinguish those with DS and ASD from children with typical DS or DS with stereotypy movement disorder using the ABC and DSM-IV criteria, and 3) determine the utility of the ABC for characterizing this group for future research. The study found significant differences in cognitive function between the three groups (DS+ASD, DS+stereotypy, typical DS). Scores on the Lethargy and Stereotypy
Autism Spectrum Disorder A case study of Mikey.pdfKathryn Patel
This case study describes an 8-year-old boy, Mikey, who was diagnosed with Autism Spectrum Disorder at age 4. Mikey is having behavioral issues during his morning routine that disrupt his entire day. An occupational therapy evaluation found that Mikey has sensory processing difficulties, engages in repetitive behaviors, and plays at the social developmental level of a 12-month old. The evaluation suggests occupational therapy to address Mikey's sensory needs and develop his social skills morning routine.
April 2nd is observed as World Autism Awareness Day to raise awareness for autism spectrum disorder (ASD) and the rights of those living with autism. ASD is a neurodevelopmental disorder characterized by difficulties with social interaction and communication. Symptoms typically appear during early childhood and can include issues with social skills, communication, repetitive behaviors, and sensory processing. While the causes are unknown, genetics and environmental factors are thought to play a role. Treatment focuses on therapies to improve social and communication skills.
Autism Spectrum Disorders: Making AAP Policy and the Toolkit Work for YouVisualBee.com
This document discusses an upcoming presentation on implementing the recommendations from two AAP clinical reports on autism spectrum disorders. The objectives of the presentation are to describe the recommendations in the reports, utilize the AAP autism screening algorithm in practice, and identify strategies for implementing tools from the AAP Autism Toolkit. The speakers will discuss epidemiology of ASDs, diagnostic criteria, roles of primary care physicians, identification and evaluation of children with ASDs, and management of children with ASDs. They will highlight key points from the clinical reports and discuss the content and goals of the AAP Autism Toolkit.
This document discusses autism spectrum disorder (ASD), including:
- ASD is a neurodevelopmental disorder characterized by difficulties with social interaction and communication, as well as restrictive and repetitive behaviors.
- Screening and assessments are important for identifying ASD using tools like the M-CHAT-R and ADOS.
- Treatment involves behavioral, educational, and medical approaches like medications targeting specific symptoms.
This study aimed to identify phenotypic predictors of quality of life (QOL) in youth with fragile X syndrome (FXS) by analyzing data from 27 individuals with FXS. The study found that social and school QOL were areas of reduced QOL compared to physical and emotional domains. High levels of irritability negatively correlated with family QOL. Significant social impairment also negatively correlated with individual QOL. Scores on measures of behaviors and abilities may help identify targets for clinical treatment to improve QOL. Larger and longitudinal studies are needed to generalize findings and track developmental trajectories of QOL over time.
Behavioral disorders screening and prediction1Sonu Kumar
Behavioral disorders are common in children and adults and can negatively impact one's life if left untreated. Some common behavioral disorders include anxiety disorders, disruptive behavioral disorders, and ADHD. Emotional symptoms of behavioral disorders may include anger, blaming others, and difficulty handling frustration. Physical symptoms are generally absent aside from potential issues from substance abuse. Autism is a type of behavioral disorder characterized by challenges with social skills and communication. Artificial intelligence can help predict autism and other behavioral disorders through analysis of behavioral screening data to enable early diagnosis and improved outcomes.
Cognitive and Socio-Emotional Resilience in Dyslexiafumikohoeft
The document discusses cognitive and socio-emotional resilience in dyslexia. It begins by providing background on the costs of dyslexia and importance of an integrative approach. It then introduces a resilience framework for understanding dyslexia, focusing on both cognitive and socio-emotional resilience factors. Regarding cognitive resilience, it discusses research finding increased activity in the left dorsolateral prefrontal cortex in resilient readers compared to poor readers, suggesting this region may support cognitive flexibility and learning. For socio-emotional resilience, it points to protective internal and external factors like growth mindset, family support, and peer relationships.
This document summarizes current research on autism spectrum disorder (ASD) to help clinicians provide guidance to families. It discusses that ASD is characterized by difficulties with social communication and repetitive behaviors. While ASD is lifelong, outcomes have improved in recent decades due to things like increased community support services. However, most individuals still require lifelong support. The document reviews signs and symptoms of ASD based on diagnostic criteria, issues around screening and diagnosis at different ages, risk factors and causes, available treatments and their effectiveness, transitions individuals face, and recommendations for clinicians in assisting families.
President of MSSA Prof. Dr. Vladimir Trajkovski prsented the his topic: "Association between cerebral palsy and autism spectrum disorders" at 8th interdisciplinary congress: "Cerebral palsy and other movement disorders" on 1-2 of November 2018 in Moscow, Russia.
Summary of activities related to FASD at the Ron Joyce Children's Health Centre, Hamilton, ON, Canada presented at: FASD - Achieving New Heights Together in Burlington, ON, Canada on March 22, 2019.
This document summarizes research on sensory processing characteristics in children with developmental disabilities. It finds some overlap between diagnoses but also distinct patterns. Children with autism showed the most varied sensory profiles, while those with ADHD, Down Syndrome, or Fragile X tended to share common traits within each diagnosis. For ADHD, traits included mild auditory and tactile issues. Those with Down Syndrome often had under-responsiveness and low energy. Children with Fragile X frequently had problems across all sensory domains that were more severe. The review had some limitations but provides initial evidence that sensory subtypes identified in autism may also apply to other developmental disabilities.
This document outlines a proposed research study examining whether dairy products and vitamin B12 are dietary inducers of autism spectrum disorder (ASD). The study would involve dividing 20 ASD participants ages 2-35 into four groups with varying diets and vitamin supplementation. Behaviors would be observed and questionnaires administered over 120 days to analyze the effects of the dietary manipulations. The research aims to test the hypothesis that ASD behaviors are influenced by levels of lactose, B vitamins, and sugar in the diet. Ethical considerations for conducting research with ASD participants are also discussed.
Autism is a lifelong neurodevelopmental disorder defined by difficulties with social interaction and communication, as well as restrictive and repetitive behaviors. The core features of autism must be present for diagnosis and typically appear during the first two years of life. While the specific causes of autism are unknown, there is strong evidence for a genetic basis. Diagnosis involves comprehensive assessment tools, and early diagnosis allows for earlier intervention leading to improved outcomes. Treatment requires a multidisciplinary approach.
Returning genetic research results in neurodevelopmental disorders: report an...KBHN KT
This report originated from discussions at the Annual Brain Development Conference in
late 2013 between researchers in the Neuroethics Core and Autism Spectrum Disorders
Project of NeuroDevNet. Discussants felt that return of research results is a pertinent
issue but that researchers are missing a comprehensive picture of the recommendations,
approaches and empirical data related to the return of research results in genetics studies
in children, in neurodevelopmental disorders, and specifically in autism.
This report provides an overview of recent genetic studies of autism spectrum disorder
(ASD), and reviews the ethical guidance (policies and peer-reviewed literature) and
best practices on the return of individual research results in adult and pediatric genetic
research. We focus on this case because of the wealth of genetic research being
carried out in families and cohorts to explain the etiology of ASD and because there is a
burgeoning literature on parental perspectives on the return of results in this case. The
empirical perspectives are collected and summarized and provide context with regard to
researcher and parent perspectives on the return of genetic results in ASD studies.
We conclude by making recommendations about the return of both incidental and
ASD-related findings and highlight issues that merit further discussion, including the
role of the child or adolescent with developmental disability in decision-making, and
the importance of risk communication. We believe that the report will be of use not only
for those working in the area of ASD but more broadly in the field of pediatric genetic
research and neurodevelopmental disorder research. For example, the publication of new
evidence showing that genetic alterations play an important role in the etiology of cerebral
palsy in some children means that genetic research may becoming increasingly common
in other areas of the study of neurodevelopmental disorders.
Wat als mijn kind een eetstoornis heeft? Folder voor ouders, door ouders - Bu...Utrecht
Een eetstoornis heeft maar weinig met eten te maken. Het is vooral het niet willen voelen van pijnlijke gedachten en gevoelens.
Wij zijn er van overtuigd dat niemand een eetstoornis hoeft te hebben. En dat kinderen die wel een eetstoornis hebben snel de juiste hulp verdienen. De angst van ouders rondom het gewicht van een kind is heel begrijpelijk.
Deze handleiding over omgaan met een kind met een eetstoornis is ontstaan doordat ouders het lef hadden om naar ouderavonden toe te gaan om met ons te spreken over de eetproblemen bij hun kind.
Wij wensen u succes met het toepassen van die tips die u aanspreken. Het is onze wens dat uw kind snel weer gezond en gelukkig is.
De initiatiefnemers:
Bénédicte Conijn
Lily Raymakers
Patricia Bos
Buro PUUR, 2017
Origineel bestand voor downloaden is te vinden op:
https://www.buropuur.nl/images/BPmateriaal/4de_druk_handleiding_ouders_klein.compressed.pdf
Bekijk meer informatie over eetstoornissen / eetproblemen op de website van het Kenniscentrum Kinder- en Jeugdpsychiatrie:
https://www.kenniscentrum-kjp.nl
Utrecht/Kenniscongres2016/ 21/ L. Los en M. Katoen/Middelenmisbruik
S5 jan buitelaar_adhd_asd_overlap
1. ADHD and ASD: two
manifestations of the same
disorder?
Jan Buitelaar
Radboud University Medical Center
Donders Institute for Brain, Cognition and Behavior
Department of Cognitive Neuroscience, and
Karakter Child and Adolescent Psychiatry University Center
Nijmegen, The Netherlands
ESCAP, Madrid, June 20, 2015
2. Conflict of interest
Speaker Advisory Board Research Support Involved in
clinical trials
Lilly X X X X
Janssen Cilag X X X
Medice X
Shire X X X
Pfizer X
Novartis X
Otsuka/BMS X
Servier X
Roche X
Vifar X
Potential Conflict of Interest - Jan Buitelaar
8. ADHD and ASD: two manifestations of the same
disorder?
These neurodevelopmental disorders are
thought to result from the disruption of normal
brain development and related neurobiological
mechanisms during the prenatal and early
postnatal period
9. Outline of the talk
Clinical issues
Genetics
Cognitive measures
Brain function and structure
Implications – new concepts
10. ASD and ADHD are developmental disorders
with early onset and strong persistence over time
Autism Spectrum Disorder versus ADHD
ASD
• Onset before age 3
• >90% persistence into
adulthood
ADHD
• Onset before age 12
• About 50% have onset at 2-3 year
• 70% persistence into adolescence
• 30-50% persistence into
adulthood
11. Clinical overlap between ASD and ADHD
ADHD Autism
25-50% of subjects with ASD
have ADHD symptoms that
merit clinical treatment (for
review see Rommelse et al.
Eur Child Adolesc
Psychiatry 2010,19:281-95. )
12. Clinical overlap between ADHD and ASD
ADHD Autism
25-50% of children with ADHD are severe socially disabled and/or have
at least mild ASD symptoms (Green et al., 1996; Luteijn et al., 2000;
Goldstein and Schwebach, 2004; Mulligan et al., 2009; Nijmeijer et al.,
2008; Santosh and Mijovic, 2004). This also applies to population
samples (Reiersen et al., 2007) (for review see Rommelse et al., 2010).
Inattention as
the linking
pin ?
13. Clinical overlap between ADHD and ASD
- population-based sample
ADHD Autism
Reiersen et al., 2007
17. Theoretical models for overlap – co-occurrence
• One overarching disorder
• Common cause – shared risk factors
– Genetic factors
– Environment (e.g. obstetric adversity)
• Common neurobiological substrate
• Disorder A causes disorder B
• Disorder A is risk factor to disorder B
• Overlap in defining symptoms
19. Are ASD and ADHD different manifestations of
one overarching disorder?
Gradient model
20. Different disorders with common causes
Common causes
ADHD ASD+ADHD ASD
Specific causes
ADHD
Specific causes
ASD
21. Different disorders with common neural substrates
Common substrates, e.g.
dysfunction of PFC
ADHD ASD+ADHD ASD
Specific causes
ADHD
Specific causes
ASD
22. Outline of the talk
Clinical issues
Genetics
Cognitive measures
Brain function and structure
Implications – new concepts
23. Clinical observations
Clinicians will rather often observe the following:
• Proband diagnosed with ASD
• Sibling later referred and diagnosed with ADHD
(and ASD broad phenotype)
• Another sibling referred because of ADHD or
dyslexia or social problems
26. Shared genetic influences on ADHD and ASD
symptoms
• TEDS (community sample of 6,771 twins 8 year old)
• Ratings on the Childhood Asperger Syndrome Test
• Ratings on the Conners' DSM-IV subscales.
• ASD and ADHD traits were significantly correlated in
the general population (.54 for parent data, .51 for
teacher data).
• All genetic correlations were >.50
• Higher genetic correlations at more extreme levels
of ADHD and ASD
Ronald et al., 2008, J Child Psychol Psychiatry 49:535-42
27. Shared genetic influences on ADHD and ASD
symptoms
• Adult sample of 674 young Autralian Twins
• Self-report data from 11 SRS items and 12 DSM-IV
ADHD symptoms
• Phenotypic correlation between ASD and ADHD
symptoms was moderate.
• ADHD and ASD traits were both moderately heritable.
• The genetic correlation between SRS and ADHD
was 0.72
Reiersen et al., 2008, Twin Res Hum Genet 11:579-85
28. Shared genetic influences on ADHD and ASD
symptoms
• 9- and 12-year-old Swedish twin pairs born between
1992 and 2000 (N=10,895) Lichtenstein et al., 2010, Am J Psychiatry
31. Causes of genetic disease
(adapted from McCarthy et al., 2008)
Very rare Rare Uncommon Common
High
Intermediate
Modest
Low
Frequency
of genetic
defect
Penetrance
Monogenic
Diseases
Multi-
factorial
Diseases
0.10.010.001
Common disease – common variant model
32. Causes of genetic disease
(adapted from McCarthy et al., 2008)
Very rare Rare Uncommon Common
High
Intermediate
Modest
Low
Allele
frequency
Prenetrance
Monogenic
Diseases
Multi-
factorial
diseases
0.10.010.001
Oligogenic
Diseases
Major Rare Variant
About 10-20% of ASD?
Major Rare Variant
About 5-10% of ADHD?
33. Causes of genetic disease
(adapted from McCarthy et al., 2008)
Very rare Rare Uncommon Common
High
Intermediate
Modest
Low
Allele
frequency
Prenetrance
Monogenic
Diseases
Multi-
factorial
diseases
0.10.010.001
Oligogenic
Diseases
Major Rare Variant
About 5-10% of ADHD?
39. SNPs – Single Nucleotide Polymorphisms
Person 1
Person 2
13.000.000 SNPs in human genome
• used as landmark for chromosomal location
• may change function/regulation of a gene product
40. Genetic Risk for ADHD Contributes to
Neurodevelopmental Traits in the General Population
• Polygenic risk scores were calculated in the ALSPAC population
sample (N = 8229) based on a discovery case-control genome-
wide association study of childhood ADHD.
• Regression analyses were used to assess whether polygenic
scores predicted ADHD traits and ASD-related measures
(pragmatic language abilities and social cognition) in the ALSPAC
sample.
• Polygenic risk for ADHD showed a positive association with ADHD
traits (hyperactive-impulsive, p = .0039; inattentive, p = .037)
• Polygenic risk for ADHD was also negatively associated with
pragmatic language abilities (p = .037) but not with social cognition
(p = .43).
Martin et al. Biol Psychiatry 2014 Feb 25
41. Polygenic score predicting multiple correlated
outcomes
Martin et al. Biol Psychiatry 2014 Feb 25.
Based on ADHD
case-control
contrast
43. Biological overlap of ADHD and ASD: evidence
from copy number variants
Martin et al. J Am Acad Child Adolesc Psychiatry 2014 Jul;53(7):761-70
44. Biological overlap of ADHD and ASD: evidence
from copy number variants
• After correction for multiple testing, genes involved in 3
biological processes (nicotinic acetylcholine receptor
signalling pathway, cell division, and response to
drug) showed significant enrichment for case CNV hits in
the combined ADHD and ASD sample.
• The results of this study indicate the presence of
significant overlap of shared biological processes
disrupted by large rare CNVs in children with these 2
neurodevelopmental conditions.
Martin et al. J Am Acad Child Adolesc Psychiatry 2014 Jul;53(7):761-70
45. Conclusions sofar
• Evidence for genetic overlap
between autism and ADHD
• Multifactorial and oligogenetic forms
• Both disorders of synaptic structure/
efficiency, cell adhesion, neurite
outgrowth, signalling pathways
46. Outline of the talk
Clinical issues
Genetics
Cognitive measures
Brain function and structure
Implications – new concepts
47. Cognitive deficits
• Both ASD as ADHD are
heterogenous at the cognitive level
• Data suggest multiple impairment
models rather than one universal or
primary cognitive deficit
49. Are ASD and ADHD different manifestations of
one overarching disorder?
• Latent class analysis (LCA) was performed
on Social Communication Questionnaire
(SCQ) and Conners’ Parent Rating Scale
(CPRS-R:L) data of 644 children.
• Classes were compared for comorbid
symptoms and their cognitive profiles of
motor speed and variability, executive
functioning, attention, emotion recognition
and central coherence.
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
50. Are ASD and ADHD different manifestations of
one overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
Age
% male
IQ
SCQ
Inatt
Hyp/Imp
51. Hypotheses
H1: overarching disorder hypothesis: If true,
symptomatic expression can be regarded as ‘noise’
and classes will more similar than different in
associated traits
è LC1 = LC2 = LC3 = …
H2: ADHD is a less severe subtype within the ASD
spectrum. LCA will then identify at least one ADHD
class without ASD symptoms, but no ASD class
without ADHD symptoms, and all classes will show
rather similar associated traits
è LC1 (ADHD) < LC2 (ASD) < LC3 (ADHD+ASD).
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
52. Hypotheses
Ho: Alternatively, ASD and ADHD do not constitute
different expressions of one overarching disorder. In
this case, the LCA will identify at least some classes
with pure ADHD or ASD symptoms. Further, the
classes will be more different than similar in terms of
associated traits
è LC1 ≠ LC2 ≠ LC3 …
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
54. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
!
55. Cognitive tests
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
56. Cognitive tests
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
57. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
!
58. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
!
59. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
!
60. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
!
61. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
!
62. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172.
2 classes with high
scores on ASD and
ADHD symptoms,
however with
strongly different
performance on
visuo-spatial skills
ADHD>ASD
N=58
ASD>ADHD
N=59
63. Gradient overarching disorder hypothesis
• In support
– an ADHD class without ASD symptoms
– absence of an ASD class without ADHD symptoms
– cognitive functioning of the simple ADHD-class is less
impaired than that of both comorbid classes.
• In conflict
– severity of ADHD, comorbid oppositional and anxiety
symptoms and cognitive problems were not the
highest in the ASD(+ADHD) class
– some specificity of cognitive deficits across classes.
64. Homogeneous combinations of ASD-ADHD traits
and their cognitive and behavioral correlates in a
population-based sample
• Sofar, approaches to identify more homogeneous subgroups
have studied variability only in the affected population.
• Here we aim to identify subgroups of children with distinct
ASD -ADHD trait profiles in the general population, using
measures sensitive across the ASD and ADHD trait
continua, including the unaffected ends, and show how these
subgroups differ in terms of cognitive functioning.
Van der Meer, Lappenschaar, Hartman, Greven, Buitelaar, Rommelse. J Attention
Disorders 2014
65. Homogeneous combinations of ASD-ADHD traits
and their cognitive and behavioral correlates in a
population-based sample
• We examined continuously distributed ASD and ADHD traits
in relation to other internalizing and externalizing problems
and cognitive functions in 378 children (6-13 years) from a
population sample.
• Latent class analyses (LCA) were conducted on the Autism
Quotient (AQ) and the Strengths and Weaknesses of ADHD
symptoms and Normal behavior (SWAN) rating scale.
Van der Meer, Lappenschaar, Hartman, Greven, Buitelaar, Rommelse. J Attention
Disorders 2014
66. Homogeneous combinations of ASD-ADHD traits
and their cognitive and behavioral correlates in a
population-based sample
• In addition to three concordant classes with low (10.1%),
medium (54.2%) or high (13.2%) scores on both traits, LCA
revealed two discordant classes with more ADHD than
ASD characteristics (ADHD>ASD, 18.3%) and vice versa
(ASD>ADHD, 4.2%).
• Classes were dissociated in visual-spatial functioning,
with ASD>ADHD exhibiting superior, and ADHD>ASD and
the class with high scores on both traits, inferior
performances.
Van der Meer, Lappenschaar, Hartman, Greven, Buitelaar, Rommelse. J Attention
Disorders 2014
67. Are ASD and ADHD different manifestations of one
overarching disorder?
Van der Meer, Oerlemans, van Steijn, Lappenschaar. de Sonneville, Buitelaar, Rommelse J Am Acad
Child Adolesc Psychiatry. 2012 Nov;51(11):1160-1172; Van der Meer, Lappenschaar, Hartman, Greven,
Buitelaar, Rommelse. J Attention Disorders 2014
.
ADHD>ASD
N=58
ASD>ADHD
N=59
ADHD>ASD
N=69
ASD>ADHD
N=16
Replication of two classes
ASD+ADHD with different
visuo-spatial skills
68. Homogeneous combinations of ASD-ADHD traits
and their cognitive and behavioral correlates in a
population-based sample
Conclusions
• A minority of children displays atypical discordant trait profiles
characterized by differential visual-spatial functioning.
• This dissociation was previously also reported in clinical
classes with ASD and ADHD, suggesting that heterogeneity in
ASD and ADHD is rooted in heterogeneity present in the lower
unaffected end of the distribution
Van der Meer, Lappenschaar, Hartman, Greven, Buitelaar, Rommelse. J Attention
Disorders 2014
70. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
71. Using cognitive subtyping to examine the
relationship between ASD and ADHD
• Latent class analyses (LCA) were performed on
motor speed and variability, verbal and visual-spatial
attention, verbal and visual-spatial working memory,
visual pattern recognition and emotion recognition in
360 participants from a population based sample
and 254 participants from a clinic based sample (5
-17 years).
• Classes were compared on several behavioral
symptom scales.
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
72. Using cognitive subtyping to examine the
relationship between ASD and ADHD
• LCAs in the population and clinic samples revealed a
similar four class solution typified by qualitatively
different speed-accuracy trade-offs:
– high accuracy-medium speed (21.9% of the
population sample and 16.5% of the clinic
sample),
– medium accuracy-high speed (24.2% and 24.4%),
– low accuracy-medium speed (35.3% and 39.0%)
and
– low accuracy-low speed (18.6% and 20.0%).
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
73. Using cognitive subtyping to examine the
relationship between ASD and ADHD
• These classes were respectively associated with
lowest en highest levels of ASD and ADHD
symptoms in the clinical sample, with an overall
strong predictive effect.
• Associations with clinical symptoms were much
weaker in the population sample.
• Classes were not characterized by domain specific
cognitive strengths or weaknesses.
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
74. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
-‐1,5
-‐1,0
-‐,5
,0
,5
1,0
1,5
mean
sum
score
cogni-ve
domain
Population
Based
Sample
high
accuracy-‐medium
speed(21.9
%)
medium
accuracy-‐high
speed
(24.2
%)
low
accuracy-‐medium
speed
(35.3
%)
low
accuracy-‐low
speed
(18.6
%)
mean
75. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
-‐1,5
-‐1,0
-‐,5
,0
,5
1,0
1,5
mean
sum
score
cogni-ve
domain
Clinic Based Sample
high
accuracy-‐medium
speed
(16.5
%)
medium
accuracy-‐high
speed
(24.4
%)
low
accuracy-‐medium
speed
(39.0
%)
low
accuracy-‐low
speed
(20.1
%)
mean
76. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
-,70
-,50
-,30
-,10
,10
,30
,50
,70
high accuracy medium
speed
medium accuracy high
speed
low accuracy medium
speed
low accuracy low speed
Z-score(effectsizes)
SCQ
AQ
CPRS
Hyperactivity
CPRS Inattention
morebehavioralproblems
Clinic sample
77. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
-,70
-,50
-,30
-,10
,10
,30
,50
,70
high accuracy medium
speed
medium accuracy high
speed
low accuracy medium
speed
low accuracy low speed
Z-score(effectsizes)
SCQ
AQ
CPRS Hyperactivity
CPRS Inattention
SWAN
morebehavioralproblems
Population sample
78. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
-,70
-,50
-,30
-,10
,10
,30
,50
,70
high accuracy medium
speed
medium accuracy high
speed
low accuracy medium
speed
low accuracy low speed
Z-score(effectsizes)
Oppositional
Cognitive problems
Anxiety
Perfectionism
Psychosomatic
Emotional lability
morebehavioralproblems
Clinic sample
79. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
-,70
-,50
-,30
-,10
,10
,30
,50
,70
high accuracy medium
speed
medium accuracy high
speed
low accuracy medium speed low accuracy low speed
Z-score(effectsizes)
Oppositional
Cognitive problems
Anxiety
Perfectionism
Psychosomatic
Emotional lability
morebehavioralproblems
Population sample
80. Using cognitive subtyping to examine the
relationship between ASD and ADHD
Conclusions
• Cognitive subtyping appears a powerful strategy to
uncover the mechanisms underlying ASD and ADHD.
• Do the cross-domain generic cognitive factors have a
specific neural architecture: MRI studies needed.
• The weak associations between cognition and
behavior in the population sample suggest that
cognitive functioning may only predict behavior when
other risk or protective factors are present.
Rommelse, Van der Meer, Hartman, Buitelaar (under review)
81. Conclusions
• There is clinical and genetic overlap
between autism and ADHD
• Behaviour è cognition and comorbidity:
some evidence for autism and ADHD
as part of an overarching disorder
• Cognition è behavior: speed-accurary
trade-off; general principle of neural
architecture
82. Outline of the talk
Clinical issues
Genetics
Cognitive measures
Brain function and structure
Implications – new concepts
83. Whole brain volume in 2-4 year olds (autism vs controls)
Courchesne et al., Neurology, 2001, 57, 245-254
85. Developmental Trajectories of Brain
Volumes
(Castellanos et al., JAMA, 2002)
From: http://www.nimh.nih.gov/events/pradhdmri.cfm
Brain volumes in ADHD
Castellanos et al., 2002
86. Greven et al. JAMA Psychiatry 2015
Total brain volume (= total gray + white matter)
• Main effects of ADHD diagnosis on total brain and
total gray matter volumes
• Total brain 32ml (2.5%), total gray matter 22ml (3%)
smaller in subjects with ADHD
• No diagnosis x age effects
• Unaffected siblings intermediate
89. Distinct and shared intrinsic functional network
centrality in ASD and ADHD
Di Martino et al. Biol Psychiatry 2013
90. Distinct and shared intrinsic functional network
centrality in ASD and ADHD
Di Martino et al. Biol Psychiatry 2013
ADHD: striatum and
pallidum
91. Distinct and shared intrinsic functional network
centrality in ASD and ADHD
Di Martino et al. Biol Psychiatry 2013
ASD: bilateral tempero-
limbic areas
92. Distinct and shared intrinsic functional network
centrality in ASD and ADHD
Di Martino et al. Biol Psychiatry 2013
shared: precuneus
93. Conclusion
• ASD and ADHD are disorders of
brain development and brain
connectivity
• Sofar, stronger evidence for distinct
than for shared neural correlates
• However, studies with small samples
and DSM-based
94. Outline of the talk
Clinical issues
Genetics
Cognitive measures
Brain function and structure
Implications – new concepts
95. Implications
• Integrate / combine research on ASD and ADHD
• Apply theories on ASD to ADHD and vice versa
• Apply research approach used in ASD to ADHD and
vice versa
96. Implications
• Integrate / combine research on ASD and ADHD
• Apply theories on ASD to ADHD and vice versa
• Apply research approach used in ASD to ADHD and vice versa
Theories
1. predictive coding – brain as a prediction machine
2. failure of modularisation
3. connectivity account
4. different factors involved in etiology/genesis versus
remission/recovery
5. symptoms = secundary brain response to primary
synaptic dysfunction
6. secundary brain disease due to primary systemic
disease (inflammation, microbiome, mitochondrial
disease)
7. etiology/onset due to failing / weak EF
97. ADHD and ASD: two manifestations of the same
disorder?
These neurodevelopmental disorders are
thought to result from the disruption of normal
brain development and related neurobiological
mechanisms during the prenatal and early
postnatal period
104. 104
Neurodevelopmental disorder
This is different from a cerebral
lesion in a mature brain
Wide spread ramifications of
neural dysfunction towards a
variety of clinical symptoms
106. 106
Genes Environment
Brain
Clinical symptoms
Abnormal neural
processes
Noisy, less efficient information processing
Noise can be productive: leads to finetuning and optimisation
Too much noise is harmful
What is the problem ?
108. Brain Adaptation and Alternative Developmental
Trajectories
1. Redundancy
2. Reorganization
3. Niche Construction
4. Adjustment of
Developmental rate
Johnson et al. Development and
Psychopathology, 2015
109. Implications – critical need of
• Studies of brain adaptation (genes and
environmental factors)
• New interventions that not necessarily try to
remediate the primary problems
• Studies in high-risk individuals (prior to
developing symptoms, less confounded by later
brain adaptation)
110. Onset versus Persistence vs Remission
Genes, E
GxE
Onset
Remission
Persistence
Genes, E
GxE
Genes, E
GxE
111. Dynamics of Genetic and Environmental Risk Factors
Chang et al. JAMA Psychiatry 2013
112. Onset versus Persistence vs Remission
Genes, E
GxE
Onset
Remission
Persistence
Genes, E
GxE
Genes, E
GxE
Different factors that
influence onset and
that influence
remission
114. The high-risk infant study design
• Participants are younger siblings of children with autism
• 20% of this group will develop autism (cf. 1% of the general
population)
• Data of a European multi-site longitudinal study will be used
• Infants tested at 4, 10, 14, 24, and 36 months of age
• (1) 20% develop ASD
• (2) 80% do not develop ASDHigh-risk
• (3) 99% do not develop ASD
Controls
115. The high-risk infant study design
• Participants are younger siblings of children with autism
• 20% of this group will develop autism (cf. 1% of the general
population)
• Data of a European multi-site longitudinal study will be used
• Infants tested at 4, 10, 14, 24, and 36 months of age
• (1) 20% develop ASD
• (2) 80% do not develop ASDHigh-risk
• (3) 99% do not develop ASD
Controls
Extend to high-risk for ADHD