11.06 Autism Spectrum Disorders

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Hey! We are going to learn about Autism Spectrum Disorder in this lesson.

ASD is a complex disorder that affects a person’s ability to interact and communicate socially. As the diagnosis indicates, autism is a spectrum so the degree to which it affects a child’s interactions will vary. Often it will present as restrictive or repetitive behaviours.

The cause is essentially unknown but there has been a lot of research over the last several decades about the different factors that may contribute to its development. One, particularly controversial, study that came out in 1998 that said the MMR vaccine caused autism. This study has been completely discredited and further research has now been done that shows there is the MMR vaccine does not increase the risk for developing Autism. In the outline, I’ve provided a link to a peer reviewed publication of a study conducted from the years of 1999-2013 that will give more detailed information on this if you are interested!

The symptoms associated with ASD are, decreased social interactions, repetitive behaviours, language delays and self-injurious behaviours.

For social interactions the things you want to assess for are, a social smile (which should happen around 6 weeks of age), eye contact, responding to name and variations to what is expected with play. Just as a refresher, we expect kids who are 1-2 years of age to play alongside other kids, which is parallel play. At this age they should also be engaging in symbolic play and imitating the actions they see around them. Around the age of 3, we expect play to continue to be symbolic and imaginative, but they should transition to preferring to play with other kids more than they want to play alone. This is called collaborative play. The absence of this is a primary sign of autism and is often the reason that there is a spike of diagnosis around the age of 3.

Repetitive behaviours can be seen in kids with autism. They may have a fascination with stacking or lining up objects over and over. Routines are also very important. Breaking away from routine can cause a lot of anxiety.

Language delays are common in children with autism. We expect first words by 12-18 months and 2 word phrases by 2, so be on the lookout for delays.

Self-injurious behaviours can occur as well. They may repeatedly pick at their skin, bite themselves or even hit themselves.

Therapeutic management is primarily done through behavioural management. Parents and schools obviously need to be involved. This may include counseling and special education classes at school.

Medications are not helpful for treating autism, but antipsychotics, antidepressants and stimulants may be prescribed to help with other problems the may have.

Medical experiences are often very stressful for kids with autism. This can make providing nursing care a bit challenging. The most important things to keep in mind to help ease the hospital experience of them is to 1) ensure their safety 2) interrupt their routine as little as possible and 3) reduce stimuli. They will need a private room if possible and it’s best to cluster care as much as you can. Always use clear and direct language with the child and allow the parents to help with this as much as possible!

Kids with autism are also likely to have a high pain threshold as well as a difficult time communicating their pain so sure to assess for physiological signs of pain and rely on the parents knowledge of their child.

Your priority nursing concepts for a pediatric patient with autism spectrum disorder are functional ability, cognition and human development.
Let’s go over the key points for this lesson on autism. First, the diagnosis is a spectrum, so the degrees to which it affects social function will vary.

Your assessment of a child with autism should focus on observing social interactions, watching them play, looking for routines and repetitive movements, and assessing for language delays.

Management is through behavioural therapy and requires a multidisciplinary approach.

Nursing care should be adapted to decrease stimuli and avoid disrupting their routine.

Patient safety is extremely important. Remember, verbal delays are common so these patients may have a difficult time communicating their needs, which makes them a vulnerable patient group.

That's it for our lesson on Autism Spectrum Disorder. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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