Autism Spectrum Disorder

Question 1

Pathophysiology of Autism Spectrum Disorder

Answer 1

> The exact cause of autism continues to be unknown, but is mainly considered to be a genetic disorder, though there may also be issues with brain connectivity

> Defects in the central nervous system may arise from prenatal complications or a combination of genetics, heredity, and medical problems

Question 2

Signs/Symptoms of Autism Spectrum Disorder

Answer 2

1. Developmental delays between 12 and 36 months when the child regresses or loses previously acquired skill
2. Failure to point at objects and gaze at an object jointly with another by 18 months
3. Failure to orient to one’s name, regard people directly, use gestures, and to develop speech
4. Child may be mute, utter only sounds (not words), or repeat words or phrases over and over
5. Infant or toddler spends hours in repetitive activity and demonstrates bizarre motor and stereotypic behavior
6. Infants resist cuddling, lack eye contact, be indifferent to touch or affection and have change in facial expression
7. Toddlers may display hyperactivity, aggression, temper tantrums, or self-injury behaviors (head banging, or hand biting)

Question 3

Risk Factors for Autism Spectrum Disorder

Answer 3

1. Advance maternal age or paternal age
2. Developmental disability
3. Sibling with autism
4. Fragile X syndrome
5. Tuberous sclerosis
6. Birth at less than 26 weeks’ gestation
7. Identical twin
8. Maternal prenatal use of acetaminophen or acetaminophen-containing products

Question 4

Challenges and Complications for a Child with Autism

Answer 4

1. Epileptic seizures
2. Nutritional deficiencies
3. Weight Problems
4. Increased risk of being abused

Question 5

Goal of Therapeutic Management for a child with Autism

Answer 5

Goal: Child to reach optimal functioning within the limitations of the disorder

Question 6

Nursing Assessment: Health Assessment of Autism

Answer 6

1. Note delay or regression in developmental skills, particularly speech and language abilities
2. Parental concerns about the child’s lack of development and communication skill
3. Family History of Autism
4. Resistance to cuddling
5. Lack of eye contact
6. Insomnia

Question 7

Nursing Assessment: Physical Findings for a child with Autism

Answer 7

1. Observe for:
   > A lack of eye contact
   > Failure to look at objects pointed to by the examiner
   > Failure to point to him/herself
   > Failure to let needs be known
   > Perseverative Activities
   > Unusual behavior such as hand flapping or spinning
2. Measure growth parameters (head circumference; macrocephaly or microcephaly)
3. Note presence of large, prominent or posteriorly rotated ears
4. Examine skin for hypo or hyperpigmented lesions
5. Note asymmetry of nerve function or palsy, hypertonia, hypotonia, alteration in deep tendon reflexes, toe walking, loose gait or poor coordination
6. Obtain hearing screening
7. Decreased infant play behavior
8. Delayed smiling response
9. Impaired socialization skill
10. Language impairment
11. Lack of imaginative play
12. Failure to be comforted by caregivers
13. Upset with interruption in routine
14. Cognitive delay
15. Possible, excelled performance in specific areas such as art, music, math, memory, and puzzle building

Question 8

Interventions for a child with Autism

Answer 8

1. Provide parents with an extensive amount of emotional support, professional guidance, and education about the disorder
2. Help parents overcome barriers to obtain appropriate education, developmental and behavioral treatment programs
3. Ensure that a child younger than 36 months of age receives services via local early intervention programs
4. Ensure that a child 3 years or older have an IEP in place if enrolled in the public school system
5. Stress the importance of rigid, unchanging routines
6. Assess the parent’s need for respite care and make referrals
7. Provide positive feedback

Question 9

Patient and Family Teachings for a Child with Autism

Answer 9

1. Include family or caregiver in teaching when appropriate, providing information according to their individual communication and learning needs
2. Be sure to cover:
   > disease, diagnosis, treatment and prognosis
   > prescribed medications
   > importance of consulting with the child’s primary practitioner before giving the child a CBD product
   > physical care of the child to meet needs
   > importance of identifying coping skills and signs of excessive stress
   > need for ongoing evaluation and monitoring by family, school, and practitioners
   > importance of following vaccine schedule
   > strategies to implement behavioral techniques