Nurse Alert
2. Autistic Disorder
Nursing Diagnoses
• Impaired social interaction related to intrusive behavior
• Noncompliance with expectation of task related to low frustration toler- ance and short attention span
• Risk for injury related to impulsive behavior and the inability to perceive self-harm
Nursing Interventions
• Minimize impulsiveness by scheduling frequent breaks in the activity.
• Break tasks into small steps that the child can complete within their atten- tion span.
• Assist the child in identifying unacceptable and acceptable behaviors.
• Create an environment with minimum distractions.
• Encourage the child to express themself when they become frustrated or hyperactive.
• Monitor the child for fatigue and hunger that can lead to hyperactivity.
• Encourage activities with other children.
NursiNg Alert
Be aware that a diagnosis of a mental disorder can stigmatize the child and the child’s family. Take special care explaining the mental disorder to them and the prognosis for the child.
What Went Wrong?
The cause of autistic disorder is unknown, although researchers have noticed impaired neural development and impaired connections between nerve cells.
Researchers have also noticed abnormal structure and function in the brain.
Researchers believe there is a connection between complications in pregnancy, genetic predisposition, and environmental factors that may influence develop- ment of autistic disorder. Environmental factors include vaccines, exposure to chemicals, and viral infections.
Prognosis
Some researchers have found that 78% of children diagnosed with autistic dis- order have a poor to fair prognosis of overcoming many characteristics of autis- tic disorder. Approximately 60% will be employed, usually in volunteer or part-time work. Many autistic children develop language skills by age 5.
Hallmark signs and symptoms
• Infancy:
• Does not seem to hear
• By 12 months:
• No cooing
• No waving
• No grasping
• No pointing
• By 16 months:
• Unable to say words
• Age 2:
• Rapid regression
• Unable to say phrases
• Loss of social skills
• Loss of language skills
• Age 3 and older:
• Impaired language development
• Inability to communicate effectively
• Repetitive motions and requires sameness
• Poor eye contact
• Fearless and self-injury behaviors
• Unprovoked outbursts
• Inability to make friends
• Inability to be emotional
• Inappropriate make-believe play
• Preoccupied with objects
Common/Interpreting Test results
There is no test that is used to diagnose a child with autistic disorder. The initial physiologic and developmental disorders are ruled out by conducting a:
• Neurologic examination
• Hearing examination
• Vision examination
• Developmental examination
Once physiologic and developmental disorders are ruled out, the child is assessed using the following screening tests:
• Autism Screening Questionnaire: This questionnaire consists of 40 ques- tions and is used to assess the child’s social and communications skills. The child must be at least 4 years old to be assessed using this questionnaire.
• Checklist for Autism in Toddlers: This is a two-part questionnaire, half completed by the child’s parents and the other half by the child’s practi- tioner, and is used to assess the child at age 18 months.
• Childhood Autism Rating Scale: An observer monitors how well the child interacts with people, speaks, listens, and can manage change.
• Screening Test for Autism in 2-Year Olds: An observer monitors a 2-year- old child’s attention and motor and play skills.
The child must demonstrate six characteristics from three of the following categories and at least two from the social interaction category and one from the communication or patterns category.
• Before age 3, delays in
• Imaginative play
• Communication
• Interacting with family
• Impairment in nonverbal behaviors such as expression and postures
• Lack of reciprocal emotions
• Unable to develop friendship with peers
• Communication
• Spontaneous make-believe behavior
• Delay in language development
• Unable to initiate or sustain a conversation
• Patterns
• Unable to deviate from routines
• Repetitive motion
• Preoccupation with objects
Treatment
• No medication is available to treat autistic disorder. Researchers are study- ing the use of medication to control mood swings and outbursts.
• Family counseling: Helps the family cope with the child’s behaviors.
• Residential placement: If the child’s behavior cannot be managed by the family, then the child can be placed in a group home or other facility where trained staff care for the child 24/7.
• Education: Special education programs are available to help the child mod- ify their behavior. A preferred approach is to mainstream the child by plac- ing the child in a regular classroom and providing the child assistance to cope with interacting with the classroom environment. Key to the main- stream approach is the child’s capability to be in a classroom setting.
Nursing Diagnoses
• Impaired social interactions related to inability to develop relationships with peers
• Disturbed through process related to fixation on animated objects
• Impaired communication related to underdeveloped communications skills
Nursing Interventions
• Speak in concrete terms when talking with the child.
• Speak to the child face-to-face.
• Maintain a safe environment.
• Avoid punishing the child since punishment might lead the child to self- injure themself.
• Give rewards for good behavior.
• Recognize behaviors that precede outbursts and intervene immediately.
• Identify situations that triggers outbursts and avoid those situations.
• Maintain a regular schedule using a picture board to show the order of activities.
• Introduce change gradually by modifying the picture board and reviewing the picture board with the child to introduce the child to the change.
• Ask parents to join a parent’s group to help them cope with autistic disorder.