Quick Answer
Autism and ADHD are compulsory child-psychiatry topics for NEET PG — DSM-5 criteria, first-line medications and Indian screening infrastructure recur every year. Lock these:
- DSM-5 collapsed autism subtypes — Asperger and PDD-NOS are gone; one umbrella diagnosis ASD.
- ASD core criteria — social communication deficits (A) plus restricted repetitive behaviours (B); early onset (C); impairment (D); not better explained by ID (E).
- No medication treats core autism — ABA and early intensive behavioural intervention are first-line.
- Risperidone and aripiprazole are FDA-approved for irritability and aggression in ASD.
- Vaccines DO NOT cause autism — Wakefield fraud retracted.
- ADHD DSM-5 — six symptoms of inattention and/or hyperactivity-impulsivity in two or more settings, present before age 12.
- Three ADHD subtypes — predominantly inattentive, hyperactive-impulsive, combined.
- Stimulants first-line — methylphenidate or amphetamines; 70 percent response.
- Atomoxetine — SNRI, non-stimulant alternative; useful with tics, substance use, or poor stimulant tolerance.
- India — Rashtriya Bal Swasthya Karyakram (RBSK) screens for the 4 Ds; INCLEN diagnostic tools validated locally.
Autism spectrum disorder and ADHD are compulsory child-psychiatry topics for NEET PG — DSM-5 criteria, first-line medications, evidence-based behavioural interventions and Indian public-health infrastructure recur every year. This deep dive covers both conditions, comorbidities and India-specific screening and access issues.
Autism spectrum disorder (ASD)
DSM-5 diagnostic criteria
- A — Persistent deficits in social communication and social interaction across multiple contexts.
- Deficits in social-emotional reciprocity (reduced sharing of interests, emotions, affect).
- Deficits in nonverbal communicative behaviours (eye contact, gestures, facial expression).
- Deficits in developing, maintaining and understanding relationships.
- B — Restricted, repetitive patterns of behaviour, interests or activities (at least two of):
- Stereotyped or repetitive motor movements, use of objects or speech (echolalia).
- Insistence on sameness, inflexible adherence to routines or rituals.
- Highly restricted, fixated interests that are abnormal in intensity or focus.
- Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
- C — Symptoms must be present in the early developmental period.
- D — Symptoms cause clinically significant impairment.
- E — Not better explained by intellectual disability or global developmental delay.
Severity levels 1 (requiring support), 2 (requiring substantial support), 3 (requiring very substantial support) are graded separately for social and restricted-repetitive domains.
DSM-5 abolished the DSM-IV subtypes — autistic disorder, Asperger disorder, childhood disintegrative disorder and PDD-NOS all now fall under ASD.
Epidemiology and etiology
- Prevalence about 1 in 36 (2023 US CDC); Indian community studies report about 1 in 100 or lower, largely reflecting under-diagnosis.
- Male-to-female ratio about 4:1, though girls are under-diagnosed.
- Strong genetic contribution — heritability estimates around 80 percent.
- Syndromic causes — Rett (MECP2), fragile X (FMR1), tuberous sclerosis (TSC1/TSC2), Angelman, Prader-Willi.
- Non-syndromic candidate genes — neurexin, neuroligin, SHANK3, CHD8, and hundreds of others contribute small individual effects.
- Environmental risk factors — advanced parental age, prematurity, low birth weight, in utero valproate exposure.
- Vaccines do not cause autism — the 1998 Wakefield paper was fraudulent, retracted, and refuted by multiple large studies.
Comorbidities
- Intellectual disability (about 30 percent).
- Epilepsy (about 20 to 30 percent, bimodal peaks in early childhood and adolescence).
- ADHD (co-occurs in 30 to 50 percent).
- Anxiety and depression.
- Sleep disorders.
- Gastrointestinal problems.
- Feeding disorders and ARFID.
Screening and diagnosis
- M-CHAT-R/F — Modified Checklist for Autism in Toddlers, revised with follow-up; administered at 16 to 30 months as a general screener.
- ADOS-2 — Autism Diagnostic Observation Schedule; gold-standard clinician-administered observation.
- ADI-R — Autism Diagnostic Interview, revised; caregiver interview.
- INDT-ASD — INCLEN Diagnostic Tool for ASD, validated for Indian populations.
- Comprehensive developmental, language, cognitive and medical evaluation.
Treatment
- Early intensive behavioural intervention (EIBI) and applied behaviour analysis (ABA) — strongest evidence when started before age 3, 20 to 40 hours per week.
- Naturalistic developmental behavioural interventions (NDBI) — Early Start Denver Model, JASPER, PRT.
- Speech and language therapy.
- Occupational therapy for sensory processing and adaptive skills.
- Educational support — Individualised Education Plan (IEP); Persons with Disabilities Act protections in India.
- Parent training — Hanen More Than Words, PACT.
- Medications for co-occurring symptoms only — SSRIs for anxiety, stimulants for co-occurring ADHD, risperidone or aripiprazole (both FDA-approved) for severe irritability and aggression, melatonin for insomnia.
- No medication treats core autism.
Attention deficit hyperactivity disorder (ADHD)
DSM-5 diagnostic criteria
- A persistent pattern of inattention and/or hyperactivity-impulsivity interfering with functioning or development.
- Six or more symptoms of inattention (five for age 17 and over) or six or more of hyperactivity-impulsivity (five for age 17 and over), persisting for at least 6 months.
- Present in two or more settings.
- Onset of several symptoms before age 12.
- Not better explained by another mental disorder.
Symptom groups
- Inattention (9 symptoms) — careless mistakes, difficulty sustaining attention, not listening, failing to finish tasks, difficulty organising, avoiding tasks needing mental effort, losing things, easily distracted, forgetful.
- Hyperactivity-impulsivity (9 symptoms) — fidgeting, leaving seat, running or climbing inappropriately, unable to play quietly, on the go, talking excessively, blurting out answers, difficulty waiting turn, interrupting.
Subtypes
- Predominantly inattentive.
- Predominantly hyperactive-impulsive.
- Combined.
Epidemiology
- Prevalence about 7 to 9 percent in children, 4 percent in adults.
- Male-to-female ratio about 2 to 3:1; girls under-diagnosed, often present with inattentive subtype.
- Genetic contribution — heritability around 74 percent.
- Environmental risks — prematurity, low birth weight, prenatal alcohol and tobacco exposure, lead.
Comorbidities
- Learning disabilities.
- Oppositional defiant disorder and conduct disorder.
- Anxiety and depression.
- Tic disorders.
- Substance use disorders in adolescence and adulthood.
- ASD (bidirectional overlap).
Assessment
- DSM-5 criteria.
- Rating scales — Vanderbilt (paediatric care), Conners (comprehensive), SNAP-IV (research), completed by parents and teachers.
- Comprehensive medical and developmental evaluation to exclude alternatives (sleep disorder, thyroid dysfunction, hearing/vision, epilepsy, absence seizures).
- Baseline BP, pulse, growth chart, cardiac history and family history of sudden cardiac death.
Treatment
- Stimulants first-line — methylphenidate (Ritalin, Concerta) or amphetamines (Adderall, Vyvanse). Response about 70 percent; two-thirds of non-responders to one class respond to the other. Large effect size.
- Monitor — appetite, weight, height (growth suppression, drug holidays), BP and pulse, sleep, tics, mood.
- Non-stimulants — atomoxetine (SNRI, useful with substance-use or tic comorbidity), guanfacine and clonidine (alpha-2 agonists, helpful with tics, sleep and oppositional symptoms).
- Behavioural therapy and parent training programmes (Triple P, PCIT-derived).
- Classroom accommodations — preferential seating, extra time, movement breaks, IEP or 504 plan.
- Combined stimulant + behavioural — MTA study showed superior long-term outcomes.
Adult ADHD
- Often under-diagnosed; presents with organisational difficulty, procrastination, emotional dysregulation, occupational and relationship problems.
- Diagnostic principles the same; adult rating scales (ASRS).
- Treatment principles the same; stimulants remain first-line.
- Substance-use risk and diversion require careful prescribing.
India-specific context
- Rights of Persons with Disabilities Act 2016 recognises both ASD and ADHD as disabilities entitled to educational accommodation, benefits and disability certificates.
- Rashtriya Bal Swasthya Karyakram (RBSK) — nationwide screening for the 4 Ds (defects, deficiencies, diseases, developmental delays) from birth to 18 years, delivered through mobile health teams visiting anganwadis and schools; positive screens referred to District Early Intervention Centres (DEICs).
- INCLEN Diagnostic Tool for ASD (INDT-ASD) — validated Indian tool.
- Methylphenidate access — regulated under the Narcotic Drugs and Psychotropic Substances Act; available at tertiary paediatric neurology and psychiatry centres; atomoxetine and alpha-2 agonists more widely available.
- ABA-trained therapists remain scarce and concentrated in metros; parent-mediated interventions increasingly promoted as scalable.
- Stigma — hyperactivity and social difficulty often framed as parenting failures or moral problems; awareness campaigns and school-based mental health programmes are expanding.
- Insurance coverage — Mental Healthcare Act 2017 mandates parity; IRDAI directives require inclusion of mental illness, but coverage for behavioural therapy remains uneven.
- Tertiary centres — NIMHANS Bengaluru, AIIMS Delhi, PGI Chandigarh, CMC Vellore lead child and adolescent psychiatry; voluntary organisations (Action for Autism, Autism Society of India, ADHD India) play major advocacy roles.
NEET PG MCQ traps
- ASD prevalence — about 1 in 36 (2023 US CDC).
- DSM-5 collapsed autism subtypes — Asperger and PDD-NOS abolished.
- Male-to-female ratio ASD — about 4:1.
- Fragile X — most common inherited genetic cause of ID and a common syndromic cause of ASD.
- Vaccines do NOT cause autism — Wakefield fraud retracted.
- First-line ASD treatment — early intensive behavioural intervention / ABA.
- Risperidone and aripiprazole — FDA-approved for ASD-related irritability.
- No medication treats core autism.
- M-CHAT-R/F — universal ASD screener at 16 to 30 months.
- INCLEN INDT-ASD — Indian-validated diagnostic tool.
- ADHD prevalence — 7 to 9 percent children, 4 percent adults.
- DSM-5 ADHD — symptoms before age 12; two or more settings.
- Three ADHD subtypes — inattentive, hyperactive-impulsive, combined.
- Stimulants first-line — methylphenidate and amphetamines.
- Atomoxetine — SNRI, non-stimulant; useful in comorbid tics or substance use.
- Guanfacine and clonidine — alpha-2 agonists; helpful with sleep and tics.
- MTA study — combined medication plus behavioural best long-term outcome.
- Growth suppression and appetite loss monitored on stimulants.
- Rashtriya Bal Swasthya Karyakram (RBSK) — India's 4 Ds screening.
- Rights of Persons with Disabilities Act 2016 — recognises ASD and ADHD as disabilities.
Frequently asked questions
What are the DSM-5 criteria for autism spectrum disorder and how does it differ from DSM-IV?
DSM-5 defines autism spectrum disorder (ASD) as (A) persistent deficits in social communication and interaction across multiple contexts, exemplified by deficits in social-emotional reciprocity, deficits in nonverbal communicative behaviour, and deficits in developing and maintaining relationships; (B) restricted, repetitive patterns of behaviour, interests or activities exemplified by stereotyped or repetitive motor movements or speech, insistence on sameness, highly restricted and fixated interests, and hyper- or hypo-reactivity to sensory input; (C) symptoms present in the early developmental period; (D) symptoms cause clinically significant impairment; and (E) symptoms are not better explained by intellectual disability. Severity is graded 1 (requiring support), 2 (requiring substantial support) and 3 (requiring very substantial support) separately for the social and restricted-repetitive domains. DSM-5 abolished the DSM-IV subtypes autistic disorder, Asperger disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD-NOS), collapsing them into the single umbrella diagnosis autism spectrum disorder. Male-to-female ratio is about 4:1, though girls are increasingly recognised to be under-diagnosed.
What is the evidence-based treatment for autism spectrum disorder and which medications are useful?
There is no medication that treats the core symptoms of autism (social communication deficits, restricted and repetitive behaviours). The mainstay of treatment is early intensive behavioural intervention (EIBI) and applied behaviour analysis (ABA), which has the strongest evidence for improving adaptive functioning, language and IQ when started before age 3 and delivered at 20 to 40 hours per week. Speech and language therapy, occupational therapy for sensory processing, and educational support with an individualised education plan (IEP) are essential adjuncts. Naturalistic developmental behavioural interventions (NDBI, including Early Start Denver Model) are increasingly favoured. Medications are used only for co-occurring symptoms — SSRIs for anxiety, stimulants or non-stimulants for co-occurring ADHD, risperidone or aripiprazole (both FDA-approved) for severe irritability, self-injury and aggression in ASD, melatonin for insomnia. Screen and manage co-occurring epilepsy, sleep disorders, gastrointestinal problems, feeding disorders and intellectual disability. Vaccines do not cause autism — the 1998 Wakefield paper linking MMR to autism was fraudulent and retracted, and multiple large studies have subsequently confirmed no causal link.
What are the three DSM-5 subtypes of ADHD and how is it diagnosed?
DSM-5 defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Six or more symptoms of inattention (for children under 17; five or more from age 17) or six or more symptoms of hyperactivity-impulsivity must be present, in two or more settings (home, school, work), for at least six months, and must have been present before age 12. The three subtypes are — predominantly inattentive presentation (six or more inattentive but fewer than six hyperactive-impulsive), predominantly hyperactive-impulsive presentation (six or more hyperactive-impulsive but fewer than six inattentive), and combined presentation (six or more of each). Inattentive symptoms include careless mistakes, difficulty sustaining attention, not listening, failing to finish tasks, difficulty organising, avoiding tasks needing mental effort, losing things, easily distracted and forgetful. Hyperactive-impulsive symptoms include fidgeting, leaving seat, running or climbing inappropriately, unable to play quietly, on the go, talking excessively, blurting out answers, difficulty waiting turn and interrupting. Prevalence is about 7 to 9 percent in children and 4 percent in adults; male-to-female ratio is 2 to 3:1. Assessment uses DSM-5 criteria supplemented by Vanderbilt, Conners, or SNAP-IV rating scales completed by parents and teachers, plus a comprehensive medical and developmental evaluation to exclude alternative explanations.
What is the first-line pharmacological treatment for ADHD and what side effects should be monitored?
First-line pharmacological treatment for ADHD is a stimulant — methylphenidate (short-acting, extended release Concerta, Ritalin LA) or an amphetamine (mixed amphetamine salts, lisdexamfetamine, dextroamphetamine). Both classes have large effect sizes with a response rate around 70 percent, and roughly two-thirds of patients who fail one class respond to the other. Stimulants require careful monitoring — appetite suppression and weight loss, growth suppression (plot height and weight at each visit; consider drug holidays), insomnia (dose earlier in the day, avoid late doses), increased blood pressure and heart rate (baseline and follow-up BP and pulse; caution or avoid in structural heart disease), tics (may emerge or worsen, though evidence for causation is limited), rebound irritability, and abuse and diversion potential (Schedule II controlled substances). Non-stimulant alternatives include atomoxetine (a selective noradrenaline reuptake inhibitor; useful when stimulants are ineffective, poorly tolerated, or where substance-use or tic comorbidity limits stimulant use; slower onset, requires 4 to 6 weeks for full effect; hepatotoxicity and suicidal ideation are labelled risks) and alpha-2 agonists guanfacine and clonidine (particularly helpful for co-existing tics, anxiety or insomnia and for oppositional symptoms). Behavioural interventions, parent training and classroom accommodations are essential adjuncts; the MTA study showed that combined medication plus behavioural treatment produced the best long-term outcomes.
How are ADHD and autism managed in India given controlled-substance regulations and screening infrastructure?
India recognises both ADHD and autism spectrum disorder as disabilities under the Rights of Persons with Disabilities Act 2016, which mandates screening, early intervention and inclusive education. The Rashtriya Bal Swasthya Karyakram (RBSK) is a nationwide programme that screens children from birth to 18 for the 4 Ds — defects, deficiencies, diseases and developmental delays including ASD and ADHD — through mobile health teams visiting anganwadis and schools; positive screens are referred to district early intervention centres. The Indian AAP has published paediatric practice guidelines for ADHD assessment and management, and the INCLEN diagnostic tool for autism (INDT-ASD) has been validated in Indian populations. Access to methylphenidate is regulated under the Narcotic Drugs and Psychotropic Substances Act and is available at tertiary paediatric neurology and psychiatry centres; atomoxetine and alpha-2 agonists are more widely available. ABA-trained therapists remain scarce and concentrated in metros, with parent-mediated interventions increasingly promoted as scalable alternatives. Stigma, cultural framing of hyperactivity and social difficulty as parenting problems, and lack of insurance coverage for behavioural therapy are significant barriers. Tertiary centres — NIMHANS Bengaluru, AIIMS Delhi, PGI Chandigarh, CMC Vellore — lead child and adolescent mental health services, and voluntary organisations (Action for Autism, Autism Society of India) play a major role in advocacy and family support.
This content is for educational purposes for NEET PG exam preparation. It is not a substitute for professional medical advice, diagnosis, or treatment. Clinical information has been reviewed by qualified medical professionals.
Written by: NEETPGAI Editorial Team
Reviewed by: Pending SME Review
Last reviewed: September 2026
