1. EDUCATIONAL BACKGROUND
LATEST POSITION
• MD– Universitas Indonesia (2008)
• Pediatrician - Universitas Indonesia (2015)
• Pediatric Neurologist - Universitas Indonesia (2021)
• Staff Divisi Pediatrik RSUD Koja
dr. Ivan Riyanto Widjaja, Sp.A(K)
Koja General Hospital – Jakarta
Columbia Asia Pulomas
3. • Lack of response to
name, Lack of sharing
interest, Lack of pointing
• Lack of response when
talk to, Very active
Early warning
signs
• M-CHAT = 7 (moderate
risk)
• ACRS = 21 (Suggestive
ADHD)
Screening • ASD (?)
• ADHD(?)
Diagnosis
Typical 36 Months
• Shows affection for friends without prompting
• Carries on a conversation using two to three sentences
• Copies adults and friends
• Plays make-believe with dolls, animals, and people
Parents complaints
4. Language Development
Milestone Mean age Red flag
Cooing 2-3 months 6 months
Babbling 6-8 months 10 months
Meaningful non-verbal 9-10 months 12 months
Pointing 10-11 months 12 months
2-words sentences 18-22 months 24 months
3-words sentences 24-30 months 36 months
5.
6. Hyperactive vs Active
Hyperactivity and Impulsivity (DSM-5)
• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is
expected.
• Often runs about or climbs in situations where it is not
appropriate (adolescents or adults may be limited to feeling
restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been
completed.
• Often has trouble waiting their turn.
• Often interrupts or intrudes on others (e.g., butts into
conversations or games)
• Symptoms of hyperactivity-impulsivity
have been present for at least 6
months to an extent that is disruptive
and inappropriate for the person’s
developmental level
• Several symptoms are present in two
or more settings
• There is clear evidence that the
symptoms interfere with, or reduce the
quality of, social, school, or work
functioning.
9. Autism Spectrum Disorder (ASD)
Persistent deficits in
social communication
and social interaction
across multiple contexts
Restricted, repetitive
patterns of behavior,
interests, or activities
ASD
American Psychiatric Association. Diagnostic and statistical manual of mental disorders : dsm-5.
[Internet]. Edisi ke-5th. Airlington: American Psychiatric Publishing; 2013.
11. Attention-deficit Hyperactivity Disorder (ADHD)
Inattention
• Fails to give close attention to details
• Difficulty sustaining attention
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to
finish schoolwork
• Difficulty organizing tasks and activities
• Avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort
• Often loses things necessary for tasks or activities
• Easily distracted by extraneous stimuli
• Forgetful in daily activities
Hyperactivity and
impulsivity
• Fidgets
• Leaves seat in situations when remaining seated is
expected
• Runs about or climbs in situations where it is
inappropriate
• Unable to play or engage in leisure activities quietly
• “On the go”
• Talks excessively
• Blurts out an answer before a question has been
completed
• Difficulty waiting his or her turn
• Interrupts or intrudes on others
American Psychiatric Association. Diagnostic and statistical manual of mental disorders : dsm-5.
[Internet]. Edisi ke-5th. Airlington: American Psychiatric Publishing; 2013.
12. ADHD (AAP)
• Insufficient evidence to recommend diagnosis or treatment for
children younger than 4 years
• Diagnosis – DSM-5
• Treatment
• Preschool (4-6 yr) - Parent training in behavior à Medication
• Elementary (6-12 yr) – Medication and parent training or classroom behavior
therapy
• Adolescent (12-18 tr) - Medication
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of
attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144:3–5.
13. ASD and ADHD
ASD ADHD
ASD
(DSM IV)
ASD with
ADHD as
Comorbid
(DSM-5)
More resistant to
Stimulant
American Psychiatric Association. Diagnostic and statistical manual of mental disorders : dsm-5.
[Internet]. Edisi ke-5th. Airlington: American Psychiatric Publishing; 2013.
Leitner Y. The co-occurrence of autism and attention deficit hyperactivity disorder in children
what do we know? Front Hum Neurosci. 2014;8:1–8.
14. ASD and ADHD
ASD
• Social
Communication
and Interaction
• Repetitive
Behavior
ADHD
• Inattention
• Hyperactivity
• Impulsivity
• Social
difficulties
• Attention
Problem
• Emotion
regulation
problem
Leitner Y. The co-occurrence of autism and attention deficit hyperactivity
disorder in children what do we know? Front Hum Neurosci. 2014;8:1–8.
15. ASD vs ADHD (differences)
“Hyperactive”
Impulsive
Restricted
interest
16. ASD
• Social interaction and
communication deficit
• Repetitive behavior
• Stereotypic hyperactivity
• Diagnosed mostly at 2-3 years
old (starting at 18 mo)
ADHD
• Social communication deficit is
not the hallmark
• Purposeful hyperactivity
• Excessive talking
• Not enough evidence to be
diagnosed < 4 years old
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment
of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144:3–5.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders : dsm-5. [Internet]. Edisi ke-5th. Airlington:
American Psychiatric Publishing; 2013.
17. Summary
• ASD an ADHD share some phenotypic similarities but have distinct
diagnostic criteria
• Children 2-3 years old with language delay consider ASD above ADHD
• Interpret screening result wisely
• Management depending on diagnosis
