13.8 Autism Spectrum Disorder (ASD)

Question 1

Autism Spectrum Disorder

Answer 1

• Complex neurodevelopmental disorders of brain function

Includes
- Autism
- Asperger’s (AS)
- Developmental disorder

Behavior Domains Affected
- Difficulty with social communication and social interaction
- Unusually restricted, repetitive behavior in interests/activities

Question 2

Cause of Autism

Answer 2

• Unknown
• Genetic
• Immune system and environmental factors
• NOT CAUSED BY MMR VACCINE

Question 3

Clinical Manifestations of Autism

Answer 3

• Apparent by age 3
• Hallmark is failure of social interactions and communication development

S/S
- Children show less interest in social activities
- Abnormal eye contact
- Decrease response to their name
- Decreased use of imitation
- Verbal/Motor delays

• Repetitive behaviors (machine like movements) that are obsessive like head banging, flapping arms and hands, spinning in circles.
• Abnormalities in sensory stimuli (extreme reaction to touch, loud noises, smells, etc)
• Emotionally labile
• Moderate to severe cognitive impairment
• They may excel in a particular area but have severe deficits in other areas.
• ABSENCE OR DELAY IN SPEECH IS OFTEN THE 1ST SYMPTOM (NO BABBLING BY 12 MONTHS OLD, SINGLE WORD BY 16 MONTHS, 2 WORD PHRASES BY 24 MONTHS)
• REGRESSION IS A RED FLAG, CHILDREN DEVELOP NORMALLY THEN REGRESS SUDDENLY ESPECIALLY WITH EXPRESSIVE LANGUAGE

Question 4

Other Bodily Symptoms

Answer 4

• GI (constipation)
• Pica
• Alternative diets and supplements may be needed to provide good nutrition
• Seizures
• Delayed development of hand dominance
• Persistent primitive reflexes
• Head and brain enlargement
• Sleep disturbances

Question 5

Diagnosis ASD

Answer 5

• Qualitative social interaction impairment and communication
• Presence of repetitive behaviors
• Developmental delays within first few years of life
• SCREENING FOR AUTISM IS DONE AT 2 Y/O CALLED AGES AND STAGES QUESTIONNAIRE (can you child to A,B,C,D)
• Early intervention is incredibly important for ASD proper growth and development and figuring out the child’s norm.

Question 6

Nursing Considerations ASD

Answer 6

• Each child is unique
• NO CURE but there is therapy
• Best treatment is highly structured routines and intensive behavior modification programs. THEY THRIVE OFF ROUTINE DO NOT DO WELL WITH CHANGE

When patient is hospitalized
- Mimic child’s routine, likes/dislikes
- Special toys that are important to the child (keep safety in mind because of cognitive impairment in terms of toys)
- Orient these children and avoid overstimulation
- Sensitive to touch or loud noises so ask the parent how you can approach their child without startling them.
- SHORT, DIRECT SENTENCES

Question 7

Nurse Survival During Hospitalization

Answer 7

• Find out what works with parents
• Calm, firm, respectful approach
• Modeling of acceptable behavior
• Get child’s attention before speaking
• Set clear limits and be consistent
• Reward them
• Safe environment
• Emotional Support (alleviate feelings of guilt, shame or stress on caregivers. Watchout for caregiver role strain. Identify support systems such as social work.)