🔑 Key Learning

  • Autism often presents between ages 2–4 with delayed speech, poor social interaction, and repetitive, ritualistic behaviours.
    • NICE recommends AQ-10 screening tool. 
  • ADHD involves persistent inattention, hyperactivity, and impulsivity across multiple settings.
  • Methylphenidate is 1st line pharmacological therapy in ADHD for school-age children.

🧩 Autism Spectrum Disorders

👀 Clinical Features

  • More common in boys
  • Typically presents around 2–4 years
  • Triad of impairments:
    • Impaired social interaction (e.g. avoids eye contact, plays alone)
    • Speech and language delay (e.g. literal interpretation)
    • Repetitive behaviours and strong preference for routines

🧪 Assessment

  • NICE recommends the AQ-10 screening tool
  • 10 questions, completed in under 10 minutes
  • A score of 6 or more suggests possible autism → refer for full assessment

💊 Management

  • Applied Behavioural Analysis (ABA)
    • Improves language, social skills, and reduces repetitive behaviours

👧 Rett Syndrome

🧬 Pathophysiology

  • Rare X-linked genetic disorder due to MECP2 mutation
  • Occurs almost exclusively in girls

👀 Clinical Features

  • Normal development until ~6 months
  • Then stagnation and regression:
    • Regression/loss of motor and language milestones
    • Repetitive hand movements (e.g. wringing, tapping)
    • Hypotonia, feeding difficulties
    • Features of autism and severe learning disability

⚡ ADHD (Attention Deficit Hyperactivity Disorder)

🩺 Diagnostic Criteria

  • Symptoms must:
    • Be present before age 7
    • Persist for >6 months
    • Impair function in ≥2 settings (e.g. home and school)

👀 Clinical Features

  • Inattention: distracted, poor organisation, forgetful
  • Hyperactivity: fidgeting, excessive running/climbing
  • Impulsivity: interrupts others, blurts out answers

💊 Management

Age 2–5 (Pre-school)

  • 1st line: ADHD-focused parent training programmes
  • Medication is not usually recommended

Age ≥6 (School-age children)

  • Group-based education/support for parents
  • Individual parent training if needed
  • If significant impairment despite environmental support:
    • 1st line: methylphenidate
  • CBT if symptoms persist despite medication

Adults with ADHD

  • 1st line: methylphenidate or lisdexamfetamine
  • Offer CBT or other psychological interventions alongside medication if ongoing symptoms

📝 Exam Clues & Clinchers

  • Child with no eye contact, speech delay, repetitive play → suspect autism, use AQ-10
  • 6-year-old disrupts class, fidgets, poor concentration → ADHD likely → methylphenidate if impairment is significant
  • Regression after normal early development, stereotyped hand movements in a girl → consider Rett syndrome