Transcript Nursing Management of Patients with Autism

Kaileigh Sweeney, SN
University of Rhode Island
Mentor: Carolyn Hames
1/110 children in the US are diagnosed with an
Autism Spectrum Disorder (ASD)
 More common than childhood cancer, juvenile
diabetes, and pediatric AIDs combined
 Prevalence increasing 10-17% annually
 More common in boys
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A
general term used to describe a group of
developmental disorders called Pervasive
Developmental Disorders (PDD).
 Wide spectrum of disorders
 Mild to severe impairments
 Low functioning to high functioning
Controversial terminology
Also known as:
Severe end of the spectrum
 Extensive impairments in all areas of
development
 Little or no language
 Little awareness
 “autism symptoms” are visibly apparent
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Mild end of the spectrum
 Intelligence level average or above average
 Impaired social skills
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Desire to communicate
 “don’t know how to go about it”
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Idiopathic:
Multiple theories:
1)
Genetics
2)
Heredity
3)
Inflammation of CNS
4)
Exposure
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Environmental: maternal rubella or cytomegalovirus
Chemical: thalidomide or valproate during pregnancy
NOT CAUSED BY BAD PARENTING!
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Early Diagnoses promote positive outcome
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Symptoms noticed typically when child is 24-48
months
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No medical test
Observed behavior
Educational testing
Psychological testing
Modified Checklist of Autism in Toddlers (MCHAT)
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Other screening tools available for older children
*from birth to 36months every child should be
screened for developmental milestones
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Valid for toddlers 16-30 months
List of questions
Answers determine need for referral to a
developmental specialist
Developmental pediatrician
– Neurologist
– Psychiatrist
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Scoring: child requires follow up if
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Answered “No” to 2 or more critical questions or Answered
“No” to 3 questions
Please fill out the following about how your child usually is. Please try to answer every question. If the behavior
is rare (e.g., you've seen it once or twice), please answer as if the child does not do it. (critical questions in red)
1. Does your child enjoy being swung, bounced on your knee, etc.?
2. Does your child take an interest in other children?
3. Does your child like climbing on things, such as up stairs?
4. Does your child enjoy playing peek-a-boo/hide-and-seek?
5. Does your child ever pretend, for example, to talk on the phone or take
care of a doll or
pretend other things?
6. Does your child ever use his/her index finger to point, to ask for something?
7. Does your child ever use his/her index finger to point, to indicate interest
in something?
8. Can your child play properly with small toys (e.g. cars or blocks) without just
mouthing, fiddling, or dropping them?
9. Does your child ever bring objects over to you (parent) to show you something?
10. Does your child look you in the eye for more than a second or two?
11. Does your child ever seem oversensitive to noise? (e.g., plugging ears)
12. Does your child smile in response to your face or your smile?
13. Does your child imitate you? (e.g., you make a face-will your child imitate it?)
14. Does your child respond to his/her name when you call?
15. If you point at a toy across the room, does your child look at it?
16. Does your child walk?
17. Does your child look at things you are looking at?
18. Does your child make unusual finger movements near his/her face?
19. Does your child try to attract your attention to his/her own activity?
20. Have you ever wondered if your child is deaf?
21. Does your child understand what people say?
22. Does your child sometimes stare at nothing or wander with no purpose?
23. Does your child look at your face to check your reaction when faced with
something unfamiliar?
Yes
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Yes
No
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Yes No
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Yes No
Yes No
Yes No
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Yes No
Also known as:
Autism Spectrum Disorder (ASD)
 Often called “high functioning autism”
 Most diagnoses made between 3-9 years
 Capable of functioning in everyday life
 Individuals Diagnosed have:
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Normal to advanced intelligence level
 Normal to advanced verbalization skills
 Severely Impaired Social Skills
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Scripted, robotic, or repetitive speech
Inappropriate social interactions
Conversations revolving around self
Lack of “common sense”
Problems with reading, math, or writing skills
Obsessions with complex topics
Average to below level non-verbal communicative
skills
Verbal cognitive skills are usually above average
Awkward movements
Odd behaviors/mannerisms
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Requires input from “healthcare team”
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Doctors, teachers, psychologist, therapist, parents
Social skills training
 Alternative therapies
 Medications
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- Antidepressants (social isolation)
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Pervasive Developmental Disorder
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Similar to autism
Affects girls almost exclusively
 Early growth and development
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Followed by slowed growth and
development
Prevalence: 1/10,000 children in the United
States
Severity Ranges from Mild to Severe
 Toe walking
 Lack of eye contact
 Hypotonia (weakened muscle tone)
 Difficulty interacting
with others
 Hand flapping
 Begins with normal
development
 Apraxia (loss of purposeful movements)
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NO CURE
 Physical therapy
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Motor skills
Occupational therapy
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Life skills
Speech therapy
 Splints
 Sensory therapy
 Medical interventions
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Antiepileptic
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Normal development until 3 to 4 years old
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Then children lose
Language skills
 Motor skills
 Social skills
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Delay or lack of spoken language
 Impairment in non-verbal behaviors
 Inability to maintain conversation
 Lack of play
 Loss of motor, social, & communication skills
 Loss of bowel/bladder control
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Medication
 Behavior therapy
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Social skills
 Speech therapy
 Physical therapy
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Obtain history
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Family history
When did symptoms begin?
Motor skills
Language skills
Personality
Behavior
Social skills/interactions
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Decrease stimulation
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Private room
Avoid extraneous auditory and visual distractions
Encourage comforting possessions (toys, blanket, etc)
which may decrease anxiety
Minimize touching child
Minimize eye contact
NO CURE
 Parent education/training
 Specialized educational training
 Language therapy
 Social skills training
 Psychotherapy
 Cognitive/behavioral therapy
 Medications
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Varies from case to case based on severity and
type of autism.
 Some children improve with therapy and
medication management
 Learning about autism helps improve quality of
living for child diagnosed with autism and family
members
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Each child requires individualized assessment &
treatment
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Not all children with ASD are the same
EDUCATION
Teach family members signs and symptoms
 Help parents understand it is NOT a result of “bad
parenting
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Family Support
 Behavioral Modification Programs
 Medications
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Promote positive reinforcement
 Increase social awareness
 Teach verbal communication
skills
 Decrease unacceptable behavior
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*Providing a structured routine for the
child to follow is critical in management of
ASD*
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Treat symptoms
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Hyperactivity
Depression
Anger
Aggression
Self-injurious behavior
Children with autism may not have a typical
response to medication
Monitoring Crucial
 lowest dose possible to be affective
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Stimulants
Ritalin
 Decrease impulses and hyperactivity
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Antidepressants
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Valium, Ativan
SSRIs:
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Zoloft, Prozac, Luvox
Treat anxiety, depression, OCD
Help decrease repetitive behaviors
Improve eye contact
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Antipsychotics:
Haldol, Risperdol, Zyprexa, Geodon
 Treat behavioral problems
 Decrease brains use of Dopamine
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Anticonvulsants:
Tegretol, Lamictal, Topamax
 Monitor drug serum levels
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