Autism spectrum disorder(ASD) Comorbidities

Autism spectrum disorder(ASD) Comorbidities

Attention Deficit Hyperactivity Disorder (ADHD)

            This is a common childhood mental disorder characterized by poor attention levels and hyperactivity-impulsivity. It’s known to jeopardize normal brain functioning and delay developmental milestones. Research has indicated that about 50%-70% of individuals with autism spectrum disorder (ASD) present with ADHD disorder. This condition is prevalent but not limited to children, it can also occur in adulthood (National Institute of Mental Health, 2023). The symptoms undergo a specific pattern: inattention, where a person is involuntarily unable to concentrate. For example, the individual can’t maintain focus and stay organized. Secondly, the individual may unnecessarily move about, fidget, and talk aimlessly. This cluster of symptoms is known as hyperactivity and may be interpreted as restlessness. Lastly is impulsivity, where the patient lacks control over their actions. They may be termed as actions without thinking and may consequently compromise their decision-making in various settings (National Institute of Mental Health, 2023).

            To be diagnosed with this condition, a person has to present with at least six symptoms of ADHD for six months that are inconsistent with developmental level and compromise academic, occupational, and social activities. There are three known types of ADHD. First, predominantly inattentive presentation characterized by only symptoms of inattentiveness for six months. Second, predominantly Hyperactive-Impulsive Presentation characterized by only hyperactivity-impulsivity for the past six months. Third, a combined presentation characterized by all symptoms of inattentiveness and hyperactivity-impulsivity for six months.

Causes of ADHD are associated with brain structure and function differences, environmental factors, and premature death. However, genetics is believed to play a significant role in the etiology of ADHD.

Psychopharmacology

The pharmacological management of ASD comorbidities is aimed at reducing anxiety and depression, reducing attention-deficit/hyperactivity symptoms, managing irritability and aggression, treating repetitive behaviors, and reducing epileptic symptoms. To begin with, the management of depression and anxiety, selective serotonin reuptake inhibitors (SSRIs) and Serotonin-Norepinephrine reuptake inhibitors are used—SSRIs such as fluoxetine, sertraline, and citalopram, which reduce anxiety and depression symptoms in individuals. Common side effects include sleep disturbances, increased agitation, and gastrointestinal issues.

The management of ADHD may be done using stimulants and non-stimulants. The stimulants include methylphenidate (Ritalin, Concerta) and amphetamines (Adderall) are commonly prescribed. They are associated with side effects such as reduced appetite, sleep disturbances, and increased anxiety. The stimulants act by increasing the level of dopamine and norepinephrine in the brain, the neurotransmitters involved in attention, focus, and impulse control. The rationale is to reduce disruptive behaviors and enhance the ability to focus on a task.  Non-stimulants include atomoxetine (Strattera), Guanfacine (intuniv) and clonidine (kava) commonly prescribed to those who do not respond to stimulants. Side effects may include gastrointestinal symptoms, fatigue, and mood swings. The non-stimulants increase the norepinephrine levels while alpha-2 adrenergic agonists like guanfacine modulate neurotransmitter activity to improve attention and reduce hyperactivity (Magnus et al., 2023).

Specific Drug

Methylphenidate (Ritalin) is prescribed to start at 5mg twice daily and increase by 5-10 mg weekly until a maximum dose of 60mg. Taken orally 30-45 minutes before meals. Produced in three forms: oral tablets, extended-release tablets, and oral solutions.

Patient Teachings

The patient should not crush or chew the extended-release tablets, should adhere to the prescription, and timing, and not skip a dose. Further, due to abuse and dependence, the patient should keep it out of reach to others. The patient should also be taught the importance of follow-up to monitor any changes, and the importance of a balanced diet lifestyle change, and exercise.

Rationale

Acts on the central nervous system to increase dopamine and norepinephrine hence increasing the level of attention, impulse control, and focus. It is also a first-line drug and has a rapid onset.

Side Effects

Common side effects include dizziness, nausea, irritability, increased blood pressure, and mood swings. However, if any of the following are observed, immediate medical attention is required: chest pain, shortness of breath, hallucinations, uncontrolled movements, and severe anxiety and agitation. (Magnus et al., 2023).

Non-Pharmacological Management

Pharmacological management may be combined with other treatment approaches for a better prognosis. Other approaches may include medication plus behavioral treatment, which involves a three-year follow-up. This approach improves social skills, whereas medications alone cannot. The behavioral therapy mostly focuses on behavioral intervention and cognitive therapy. Mostly, the behavioral interventions focus on the reward systems to encourage desired behaviors and use non-punitive discipline methods to manage undesirable behaviors. Cognitive behavior therapy helps individuals to manage symptoms to enhance organizational skills, time management, and problem-solving.

The other treatment approach is psychological treatment,t which involves parental and family training and is also done to the individual. For instance, the families and parents are educated about ADHD, its symptoms, and its impact. Strategies to support the child, such as creating a structured environment and using consistent routines, are taught. To the individuals suffering from the disorder, they are taught how their condition affects their life (Shrestha et al., 2020). This provides them with skills to manage themselves such as mindfulness and self-monitoring skills. Other non-pharmacological approaches involve school-based interventions, monitoring and follow-up, and lifestyle modifications.

Family Teaching

Family members are also part of the key stakeholders in the management of this condition and should therefore be taught about the following. Firstly, ADHD is a condition that affects their patient’s behavior and learning. They should ensure the patient takes the medication consistently as prescribed. Further, they should observe and report any adverse side effects experienced by the patient, and communicate about their patient’s condition to the school to foster collaboration in strategies for learning and behavior therapy. Lastly, the family should be educated on emergencies and serious side effects.

References

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2023, August 8). Attention Deficit Hyperactivity Disorder (ADHD). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

National Institute of Mental Health. (2023). Attention-Deficit/Hyperactivity Disorder. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic Management of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Review. Translational Pediatrics, 9(S1), S114–S124. https://doi.org/10.21037/tp.2019.10.01

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ASD Comorbidities

Autism spectrum disorder (ASD) often coexists with many other behavioral health conditions.
1. Identify one potential comorbid diagnosis often associated with ASD.
2. Develop a treatment plan for a patient with ASD and your chosen comorbidity.
3. Include any medications with all prescribing information, teaching, side effects, and rationale.                                                              4. Also include any nonpharmacological treatment options with rational
5. Describe the teaching you would provide to the patient and family.
6. This will be turned in as a Word document in APA format.