Autism Spectrum Disorder

Table of Contents

AUTISM

Autism, also known as autistic spectrum disorder, is a childhood psychiatric disorder characterized by communication impairment, social interaction impairment, and restricted and repetitive activities.

Causes of Autism

IDIOPATHIC The exact cause of autism is still unknown,

But it is believed to result from a combination of genetic and environmental factors.

Genetic Factors: Genetic factors are believed to play a significant role in autism. Numerous studies have shown that there is a higher risk of developing autism if a family member has the condition. Certain genes have been identified as potential contributors to the development of autism, although no single gene has been identified as the sole cause. It is likely that multiple genes, in combination with other factors, contribute to the development of ASD.
Neurotransmitter Imbalances: Imbalances in neurotransmitters, the chemical messengers in the brain, have been implicated in autism. Specifically, abnormalities in the levels or functioning of neurotransmitters such as serotonin, dopamine, and gamma-aminobutyric acid (GABA) have been observed in individuals with ASD. These imbalances may affect brain development and the regulation of mood, behavior, and social interactions.
Brain Development and Connectivity: Research has shown that individuals with autism may have atypical brain development and connectivity. Studies using various neuroimaging techniques have revealed differences in brain structure, function, and connectivity in individuals with ASD. These differences may affect the development and organization of neural networks involved in social interaction, communication, and sensory processing.
Environmental Factors: While genetic factors play a significant role, environmental factors may also contribute to the development of autism. Prenatal and early-life exposures, such as maternal infections during pregnancy, exposure to certain chemicals or medications, complications during birth, and prenatal factors like advanced parental age, have been studied as potential environmental contributors to ASD. However, the specific environmental factors and their interactions with genetic factors are still being explored.
Immune System Dysfunction and Inflammation: Some research suggests that immune system dysfunction and chronic inflammation may be involved in the pathophysiology of autism. Abnormal immune responses, including alterations in cytokine levels and the presence of certain autoantibodies, have been observed in individuals with ASD. It is hypothesized that immune dysregulation and inflammation may affect brain development and contribute to the behavioral and cognitive symptoms of autism.

Classifications of Autism

According to Severity

Based on the degree of severity and level of support ASD are classified into 3 types.

Severity level		Social communication	Restricted, repetitive behaviors
Level 3	Requiring very substantial support	Severe deficits in verbal and non-verbal communication skills Severe impairment in functioning Very limited initiation of social interactions Minimal response to social overtures from others	Inflexibility of behavior Extreme difficulty in coping with change Repeated behavior markedly interferes with functioning in all spheres Great distress/difficulty changing focus or action
Level 2	Requiring substantial support	Marked deficits in verbal and non-verbal communication skills Marked impairment in functioning Limited initiation of social interactions	Difficulty in coping with change Distress/difficulty changing focus or action Repetitive behaviors occur frequently
Level 1	Requiring support	Without support, deficits in verbal and non-verbal communication skills Atypical and unusual social responses	Interference with functioning in one or more context Problems of organization and planning hamper independence

According to Diagnostic Criteria

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Autistic Disorder (Classic Autism): Autistic disorder, also known as classic autism, is the most severe and well-known type of autism. Individuals with this type of autism typically exhibit significant social, communication, and behavioral challenges. They may have delayed language development, difficulty with social interactions, repetitive behaviors, and a limited range of interests.
Asperger’s Syndrome: Asperger’s syndrome is considered a milder form of autism. Individuals with Asperger’s syndrome generally have average or above-average intelligence but struggle with social interactions and nonverbal communication. They may have intense interests in specific subjects and may exhibit repetitive behaviors or routines.
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS): PDD-NOS is a classification used when an individual displays some, but not all, of the characteristics associated with autism. People with PDD-NOS may have difficulties with social communication, interaction, and behavior, but the symptoms may not fully meet the criteria for autistic disorder or Asperger’s syndrome.
Childhood Disintegrative Disorder (CDD): Childhood disintegrative disorder is a rare condition in which children develop typically for a period of time but then experience a significant loss of previously acquired skills. These skills may include language, social abilities, and motor functions. CDD usually occurs between the ages of 2 and 4, and the cause is not well understood.
Rett Syndrome: Rett syndrome is a genetic disorder that primarily affects females. It is characterized by normal development in early childhood, followed by a regression in skills and the emergence of specific symptoms such as loss of purposeful hand skills, repetitive hand movements, and difficulties with language and social interactions.

Signs and Symptoms

Social interaction impairment:

Failure to respond to the name
Preference for playing in isolation
Reduced interest in other people
Lack of eye contact
Physically aggressive behavior
Self-injurious behaviors due to frustration (e.g., biting oneself)

Communication impairment:

Poor language development
Lack of communication gestures
Mute
Issues with combining words in speech
Failure to respond to their name

Repetitive and restricted behaviors:

Preoccupation with certain objects and mannerisms
Resistance to change
Overreaction or underreaction to one or more senses

Management of Autism

Aims of management

Promoting Communication and Social Interaction
Reducing Challenging Behaviors
Supporting Cognitive and Behavioral Development

Early Intervention: Early identification and intervention are important in optimizing outcomes for individuals with autism. Nurses and medical team do evaluations, and initiate appropriate interventions as early as possible.
Behavioral Therapies: Behavioral therapies, such as Applied Behavior Analysis (ABA), are often utilized in the management of autism. These therapies focus on modifying behaviors, teaching new skills, and promoting positive interactions. Nurses may collaborate with behavior analysts and therapists to implement and monitor these interventions.
Speech and Language Therapy: Communication difficulties are common in individuals with autism. Speech and language therapy can help improve language development, communication skills, and social interaction. Nurses may provide support and resources to families to ensure consistent follow-up and participation in therapy sessions.
Medications: In some cases, medications may be prescribed to manage specific symptoms associated with autism, such as hyperactivity, anxiety, or aggression. Nurses play a role in monitoring medication effectiveness, side effects, and educating families about proper administration.
Family Support and Education: Providing support and education to families is crucial in the management of autism. Nurses can offer guidance on coping strategies, community resources, and access to support groups. They can also provide families with accurate and up-to-date information about autism and advocate for their needs within healthcare and educational settings.
Individualized Care Plans: Individualized care plans are essential in managing autism. Nurses collaborate with families, educators, and therapists to develop personalized plans that address the unique strengths and challenges of each individual. These plans may include specific goals, strategies, and accommodations to optimize the individual’s functioning and well-being.
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Use simple and short sentences during conversations when interviewing the patient and the parents.
Develop a trusting relationship with the child and convey acceptance of the child separate from the unacceptable behavior.
Develop a symptom management plan for the child, including obtaining developmental milestones, improving communication skills, promoting good social interaction skills, enhancing the child’s interests, and reducing repetitive behaviors.
Create tasks with a high chance of success, such as guided play and introducing stimulative activities with rewards.
Train social skills and reward positive behaviors like good eye contact, smiling, and helping others.
Introduce one activity at a time and be specific while teaching skills.
Ensure the child’s attention by calling their name and establishing eye contact before giving instructions.
Repeat instructions, provide explanations and clarifications, and avoid assuming understanding.
Simplify activities and teaching techniques when necessary.
Provide assistance during task performance.
Be patient and tolerant.
Gradually decrease assistance and the number of assistants, while assuring the patient that assistance is still available when necessary.
Coordinate overall treatment plans with schools, collateral personnel, the child, and the family.
Assess parenting skill levels, considering intellectual, emotional, physical strengths, and limitations.
Be sensitive to parents’ needs as they often experience exhaustion of parental resources due to prolonged coping with the child.
Provide information and materials related to the child’s disorder and effective parenting techniques to the parents or guardians, using written or verbal step-by-step explanations.
Educate the child and family on the use of psycho stimulants and practice strategies for dealing with the child’s behaviors.

Nursing Interventions when caring for a child with Autism.

Promote Communication Skills: Encourage and support the development of communication skills by using visual aids, augmentative and alternative communication (AAC) devices, and social stories. Provide a communication-friendly environment and use simple and concise language to facilitate understanding.
Implement Structure and Routine: Establish consistent routines and visual schedules to provide predictability and reduce anxiety. Help the child understand and follow daily routines through visual cues and verbal prompts.
Manage Sensory Sensitivities: Create a sensory-friendly environment by reducing excessive noise, bright lights, and other sensory triggers. Offer sensory breaks or provide sensory tools like fidget toys or weighted blankets to help the child self-regulate.
Support Social Interaction: Facilitate social interactions by creating opportunities for the child to engage with peers, such as structured play activities or social groups. Teach and reinforce appropriate social skills, such as sharing, taking turns, and making eye contact.
Provide Emotional Support: Recognize and address the emotional needs of the child with ASD. Use calming techniques, such as deep breathing exercises or sensory input, to help manage anxiety or emotional distress.
Collaborate with the Multidisciplinary Team: Work closely with the child’s healthcare team, including therapists, psychologists, and educators, to ensure coordinated and comprehensive care. Share relevant information and collaborate on treatment plans and interventions.
Educate the Family: Provide education and support to the child’s family, including information about ASD, available resources, and strategies for managing challenges at home. Help them access support groups or connect with other families in similar situations.
Assist with Medication Management: If medications are prescribed, educate the family about the purpose, potential side effects, and proper administration of medications. Monitor the child’s response to medication and communicate any concerns to the healthcare provider.
Facilitate Self-Care Skills: Teach and encourage age-appropriate self-care skills, such as grooming, dressing, and feeding. Use visual cues and step-by-step instructions to assist the child in developing independence and promoting self-confidence.
Advocate for the Child: Serve as an advocate for the child with ASD and ensure their needs are met in various settings, such as school, community, and healthcare settings. Communicate with teachers, caregivers, and other professionals to promote understanding and inclusion.

Nursing Diagnosis

You can formulate nursing diagnosis from the following issues.

Impaired Social Interaction: This nursing diagnosis reflects difficulties in initiating or maintaining social interactions, limited eye contact, and challenges in understanding social cues and norms.
Impaired Verbal Communication: Many individuals with autism experience delays or difficulties in speech and language development, which may lead to impaired verbal communication. This diagnosis addresses challenges in expressing needs, understanding and using language, and engaging in effective communication.
Impaired Nonverbal Communication: Individuals with autism may struggle with nonverbal communication skills, such as body language, facial expressions, and gestures. This diagnosis focuses on difficulties in understanding and utilizing nonverbal communication.
Risk for Injury: Individuals with autism may engage in repetitive or self-injurious behaviors, pose safety risks due to sensory-seeking or sensory-avoiding behaviors, or have difficulty recognizing and responding to potential dangers. This diagnosis addresses the increased risk of injury or harm.
Anxiety: Many individuals with autism experience anxiety and heightened levels of stress due to difficulties with communication, social interactions, and sensory sensitivities. This diagnosis focuses on the individual’s feelings of apprehension, restlessness, and increased stress levels.
Impaired Coping: This nursing diagnosis addresses challenges in effectively managing stress, regulating emotions, and adapting to changes or transitions. Individuals with autism may exhibit maladaptive coping mechanisms or have difficulty adjusting to new situations.
Disturbed Sleep Pattern: Sleep disturbances, including difficulties with falling asleep, staying asleep, or having irregular sleep patterns, are common among individuals with autism. This diagnosis relates to disruptions in the normal sleep-wake cycle.
Impaired Self-Care: Some individuals with autism may require assistance with various aspects of self-care, including grooming, dressing, and feeding. This diagnosis addresses difficulties in performing activities of daily living independently.
Parental Role Conflict/Stress: This nursing diagnosis acknowledges the potential challenges and stress experienced by parents or caregivers of individuals with autism. It encompasses the emotional, physical, and psychological impact on parents or caregivers in managing the care of a child with ASD.

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