PS10.1 | Childhood Neurodevelopmental Psychiatry — Summary & Reflection

KEY TAKEAWAYS

ADHD and Autism Spectrum Disorder are the most prevalent neurodevelopmental disorders of childhood, both classified under the ICD-11 neurodevelopmental disorders grouping. ADHD is characterised by developmentally inappropriate inattention and/or hyperactivity-impulsivity, present in two or more settings, with several symptoms onset before age 12 (DSM-5). ASD is characterised by persistent deficits in social communication and social interaction, combined with restricted/repetitive behaviours, present from the early developmental period. The conditions are neurobiologically distinct — ADHD involves dysregulation of prefrontal dopaminergic/noradrenergic networks; ASD involves altered connectivity in the social brain network. Both have strong genetic bases. Management of ADHD is multimodal: psychoeducation, behaviour therapy, and stimulant pharmacotherapy (methylphenidate is first-line). Management of ASD centres on early intensive behavioural intervention, speech therapy, and OT — there is no curative drug for core ASD features. DSM-5 permits dual diagnosis of ADHD and ASD. Differential diagnosis from Intellectual Disability Disorder requires evaluation of global intellectual and adaptive functioning.

REFLECT

Consider a scenario in which a 10-year-old girl in your outpatient clinic has spent years being told she is 'shy' and 'dreamy'. Her parents now report she has no friends, talks about a single topic (historical dates) for hours, and finds changes in timetable extremely distressing. Reflect on: (1) What features in this history suggest ASD rather than ADHD? (2) How would your clinical assessment differ if the child also has a very high IQ on testing? (3) What are the ethical obligations regarding how and when you communicate a psychiatric diagnosis to a child and her family in the Indian healthcare context? Write a brief reflective note on what you would do differently in practice based on what you have learned today.