Andra Pradesh Medical PG Preparation – ADHD vs. Autism

Autism & ADHD – Tips for APPGMET 2015, DNB and AIPGMEE

Andhra Pradesh medical PG exam 2015 is approaching amidst the uncertainties. APPGMET is a single exam for Seemaandhra and Telangana this year. There are plenty of topics that are important for APPGMET. We thought to bring the distinction between ADHD and ASD as a key topic for Andhra Pradesh Medical PG, AIIMS, AIPGMEE, DNB and other medical PG exams this year. It is a neuro-developmental topic from child psychiatry and paediatrics. This is very frequently repeated and often confusing! G2M statistics shows that 60% of candidates get the diagnoses mixed up.

Autism

ADHD

THE TRIAD OF AUTISM (Q1)

  1. Difficulties in social and emotional interaction 
  2. Difficulties in social communication and language 
  3. Difficulties in flexibility of thoughts and imagination

The two conditions – They are very different, but can be confusing when a clinical case scenario is given. Usually asked questions are marked as Q1 Q2 etc. 

Is age given in the question?

Autism or Autism Spectrum Disorder (ASD) is evident by 12-18 months (can be before the age of 3). ADHD is usually a child of 5-7 years age and below 12 (symptoms should be present before the age of 12, according to the new DSM 5) (Q6)

What about this scenario?

A 4-year-old boy, started at school recently. His teacher says that he does not concentrate and he does not like being in groups. He struggles to make friends. 

Here the child has social communication issues and anxiety in a social setting (groups). He is not making friends because of his lack of social skills. Here the concentration problem is because of his anxiety or lack of interest in the surroundings. This is a classic case of Autism. There will be delayed language development history in most cases. (Q7)

Two more points on ASD

** Presence of stereotypic, restrictive, and repetitive patterns of behavior, interests, and activities is a sign of Autism. (Q9)

** Child ignores friends and likes to play on his own is a sign of Autism (Q10)

** Poor interpretation of verbal and non-verbal social cues is a sign of Autism (Q11)

Obviously the above signs should be accompanied by the other symptoms and signs to qualify the diagnosis. The usual psychometric tests used for Autism are called ADOS, DISCO and 3Di. (Q12)

 THE TRIAD OF ADHD (Q2)

  1. Hyperactivity
  2. Impulsivity
  3. Attention Deficit 

What about this scenario?

A 8-year-old child is fidgety and restless. He does not listen in the lessons and has poor peer relationships. 

Here being fidgety and restless is hyperactivity. Not listening to teachers is inattention. Poor friendships and relationships in this scenario is not from a social-communication problem. It is from a difficulty in listening to others and understanding others. This is an ADHD scenario. (Q3)

3 types of ADHD

Inattentive Type (more attention symptoms). This is common in girls. (Q4)

Hyperactive Type (more hyperactivity symptoms). This is common in boys. (Q5)

Combined Type

What about this scenario?

A 10-year-old boy is seen by a paediatrician following an accident whilst crossing the road. He does things without thinking and regrets later. His academic record is poor and teachers report him as restless and with poor concentration. He does not have friends. 

In this scenario, the child is impulsive. He crosses the road without thinking of consequences. He acts before he thinks – this is impulsivity. He has inattention and hyperactivity. He does not have friends because of his impulsivity and inattention. This is a case of ADHD. (Q8)

I rate this topic as high-yielding. I have given 12 Questions here. They were repeated in many forms over a 100 times all over India. It is important to read the question carefully because concentration problem and social skills problem can be present in both!! More questions are available on G2M and platinum pack is the best to learn topic-wise. Psychiatry, skin, anaesthesia and radiology are high-yielding small subjects for medical PG. Never ignore these subjects!

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