Curriculum Vitae

• Nama : Dr. Purboyo Solek, SpA(K)

• Institusi : FK UNPAD, Bandung
• Pendidikan
• S1 : FK UNPAD, lulus 1985
• Sp1 : Ilmu Kesehatan Anak, FK UNPAD, 1997
• Sp2 : Neurologi Anak, FK UI, 2002
• Jabatan : Staf Neurologi FK UNPAD
• Organisasi :
- IDAI
- Direktur Medis Child Development and Autism
Center Indigrow Bandung
- Konsultan Asosiasi Disleksia Indonesia
 Dr. Purboyo Solek, SpA(K)

Faculty of Medicine
Universitas Padjajaran, Bandung
Education
• Medical doctor : Faculty of Medicine, Universitas
Padjajaran, 1985
• Pediatrician : Department of Paediatric,
Faculty of Medicine, Universitas Padjajaran,
1997
• Consultant : Paediatric Neurology,
Faculty of Medicine, Universitas Indonesia,
2002
Position
Lecturer of neurology departement in Faculty of
Medicine, Universitas Padjajaran, Bandung
Organization
- Indonesian Pediatric Society
Autism and Attention Deficit
Hyperactivity Disorder
(ADHD):
How to differentiate?

Purboyo Solek
Neurology Division
Department of Pediatric/ Medicine Faculty
Padjadjaran University/Hasan Sadikin General Hospital Bandung
 Controversial issue….
DSM 4 DSM 5

• Pervasive Autism spectrum

Developmental Disorder disorder (ASD)
(PDD)

ASD = ADHD
• ASD # ADHD
 FLASH BACK..
Autism and Other Pervasive
Developmental Disorder (PDD)

DSM 4;Volkmar and Rutter, 1994

Kaufmann W, 2013
PERVASIVE DEVELOPMENTAL DISORDERS

Autistic
PDD-NOS disorder

Asperger Rett
Syndrome
Syndrome

Childhood
Disintegrative
Disorder
 SCIENTIFIC FACTS...

• Prevalence 1: 10.000 ; now 1: 150

• Male : female = 4 : 1

• Approximately 75-85% autism child showed IQ level that

is far below average (intellectual disability)
 DEVELOPMENTAL AREA THAT
IMPAIRED
Social Language/com
Behaviour
Interaction munication

Cognitive Locomotor Emotion

Sensory profile
 Autism Type Based on social interaction skill
(Wing & Gold, 1996,2016)

ACTIVE BUT
ALOOF PASIVE
ODD
• Very minimal • Able to • Unable to
eye contact interact interact due
• Unable to shortly to
initiate or • Unable to ‘hyperactivity’
maintain sustain behaviour
interaction interaction while doing
some odd
behaviour
Stiff
 Autism Type Based on Cognitive Level

LOW • Severe Intellectual Disability

FUNCTIONING • Severe complexity of symptoms

MIDDLE • Moderate Intellectual Disability

FUNCTIONING • Moderate complexity of symptoms

• Mild intellectual disability or Borderline

HIGH • Very few has normal IQ
FUNCTIONING • Minimal complexity of symptoms
 ‘ESTIMATING’ COGNITIVE LEVEL

COMPLEXITY OF
SYMPTOMS

If the symptoms showed

The more complex of
not too complex, cognitive
symptoms showed, the
level might be slightly
lower cognitive level (low
below normal (high
functioning)
functioning)
 KEY WORDS

• Pervasive disorders in terms of social interaction,

communication, language, cognitive, locomotor, sensorik
and emotion
• IQ level far below average
• Inadequate eye contact
• Genetic role
• Treatment of Choice : BEHAVIOUR THERAPY
 MANAGEMENT

Occupational
Therapy
Speech
Therapy

Sensory
Integration
Therapy

Behaviour Therapy &

Pharmacotherapy
 LONG-TERM OUTCOME

Methode
Cognitive Family
Age of
Level suport
treatment
Attention Deficit Hyperactivity Disorder

Hyperactivity
and Onset < 12 years
inattention
old
Impulsivity

Social function
Min 6 months All setting
impairment

Normal IQ level

DSM 5
A NEW UNDERSTANDING
OF ADHD IN CHILDREN
AN ADULTS

Brown TE, 2013

 ADH
D
BEHAVIOUR
DISORDER

DEVELOPMENTAL DISORDER OF THE

COGNITIVE MANAGEMENT SYSTEM OF THE
BRAIN  EXECUTIVE FUNCTION
Brown TE, 2013
 EXECUTIVE FUNCTIONS IMPAIRED
IN ADHD
EXECUTIVE FUNCTIONS
( WORK TOGETHER IN VARIOUS
COMBINATIONS)

Regulating Utilizing
Organizing Focusing Managing Monitoring
alertness. working
prioritizing sustaining frustation and self-
Sustaining memory
and and shifting and regulating
effort and and
activating to attention to modulating action
processing accessing
work tasks emotion
speed recal
1 2 3 4 5 6
Activation Focus Effort emotion Memory Action

PRE FRONTAL CORTEX Brown TE, 2013

SCIENTIFIC FACTS…

• Genetical based Neurodevelopmental disorder

• Gen Transporter Dopamin and Gen Reseptor Dopamin D4
• Dysfunction of pre frontal and dysfunction of fronto
striatal circuit
• Impairment of dopaminergic and noradrenergic system
SCIENTIFIC FACTS...

• Prevalence : 3 – 5% school-aged children

• Cognitive level : > Normal or average
• Unintervened cases  50% will remain ‘troublesome’ in
adulthood

• More than 30% ADHD has more than 1 co-morbid

THREE CHARACTERISTICS OF
ADHD
INATENTION

HYPERACTIVE

IMPULSIVE
 TYPE OF ADHD

HYPERACTIVE-
INATENTION
IMPULSIVE
• Day dreaming • Restless

• Slow motion • Hyperactive

• Disorganized
• Learning difficulty
• Clumsy
• Depression
• ‘trouble maker’
• Anxiety
• Dominantly in Male
• Male : Female = 1:1
 CLINICAL SYMPTOMS

• Pay no attention to assignment

• Poor compliance to assignment
• Does not comply to school’s rules and procedures
• Impolite
• Annoying other students
• Poor academical achievement
• Frequently suspended but always rebel
 MANAGEMENT

• Multimodal Treatment Study of Children

With Attention Hyperactivity Disorder (MTA
study)
• Methyl phenidate + Behaviour Therapy 
MUCH BETTER, comparing to Behaviour
Therapy only
LONG-TERM OUTCOME
UNINTERVENED ADHD

10-20% HIGH 30%

CRIMINALITY “NORMAL”
LEVEL INDIVIDU

50-60%
‘TROUBLESOME’
ADULT
 KEY WORDS

• Three characteristics occur in all setting

• Normal or above average cognitive level
• VERY GOOD SOCIAL INTERACTION
• Genetic
• Mostly with Co-morbid
• Management : Pharmacology AND Behaviour Therapy
 DIFFERENTIATE ADHD ~ AUTIS

AUTISM, ‘Active but Odd’

ADHD
type
• VERY GOOD CONTACT • VERY POOR CONTACT
• Good communication skill • Pervasive impairment in
within context communication
• Able to initiate and • Unable to initiate a social
maintain a social interaction
interaction • Improper playing
• Good interactive play • Maladaptive behaviour,
• No maladaptive behaviour rigid, stereotypic
• Normal or above average • Far below average IQ Level
cognitive level
 SUMMARY
• ADHD & AUTISM are both neurodevelopmental disorders

• AUTISM is one of Pervasive Developmental Disorder, ADHD IS

NOT (DSM 4)

• Both diagnosis of ADHD and AUTISM could NOT be applied to one

person due to different basic characteristic (Cognitive level, social
interaction and communication skill ) (DSM 4)

• Active but Odd type of AUTISM could show mimic symptoms of

‘hyperactivity’, but it is NOT ADHD

• AUTISM and ADHD show VERY DIFFERENT long-term outcomes

 EXECUTIVE FUNCTIONS IMPAIRED IN
ADHD & AUTISM
EXECUTIVE FUNCTIONS
( WORK TOGETHER IN VARIOUS
COMBINATIONS)

Regulating Utilizing
Organizing Focusing Managing Monitoring
alertness. working
prioritizing sustaining frustation and self-
Sustaining memory
and and shifting and regulating
effort and and
activating to attention to modulating action
processing accessing
work tasks emotion
speed recal
1 2 3 4 5 6
Activation Focus Effort emotion Memory Action

DIFFERENT SEVERITY Brown TE, 2013

THANK YOU

purboyosolek@yahoo.com