Interprofessional Project on

Children with Autism

Spectrum Disorder
Case study analysis

Ericka Armendariz, Diana H. Dang, Crystal Josey, Ashley A. Ninan, Uyen

Tran, & Breana M. Villarreal
Clinical Laboratory Scientists, Occupational Therapy, and Nursing Students
from
UTMB Interprofessional Scholars Program

Case Study
A mom and her 4 year old son came into
the doctors office with complaints of limited
social interaction with peers at school and at
home with siblings, only uses two or three
word sentences, temper tantrums out of
proportion to the situation, and difficulty using
hands for eating, writing and grasping small
objects. She also complained that her son does
not run or enjoy playing on playground. Upon
further questioning, she informed the doctor
that it had recently been brought to her
attention that her house had been painted
with paint containing lead.

Role of the Nurse

The nurse is to be educated about the disease process and know what milestones
are appropriate for certain age ranges.

Understanding normal is essential because it is key to identifying when a

child is not behaving appropriately.

In identifying certain behaviors of the child is what determines the severity of

the illness. (L. King, personal communication, September 10, 2015)

Treatment is based on the severity of the illness

There are two primary nursing roles in the autistic childs everyday life: the general
and school nurse

General Nurse

The general nurse must notice when a child is showing signs of autism. It is the
general nurses job to bring the symptoms to the attention of the healthcare
provider.

In many instances, the nurse acts as the case worker for the child and family.

Providing referrals that are ordered

Facilitates therapies and appointments for the child to make sure

everything is going as planned.

The nurse is also a patients advocate.

Whether that includes questioning a medication order or standing up for the

child or family.

School Nurse

School Nurse Roles

School is a major part of the childs day.

The school nurse administers any prescribed medications.

Also, the school nurse observes the child and is to report any changes in the
childs behavior to his/her parents.

The school nurse is also a caseworker in the school system for the child.

It is the nurses job to inform and educate the teacher of the illness and what
behaviors they may observe from the child.

School nurses also provide hearing/vision screenings early for special needs
children, as well as screening them every year.

Role of Clinical Laboratory

Scientist
Draw blood to:

Monitor response to drug

treatment

Measure thyroid hormone level

(T3 and T4)

TRH stimulation test

Lead and mercury levels

Perform genetic and molecular

tests

Lead Poisoning

Clinical Laboratory Scientists draw blood from the patient into a royal blue top tube and check
for high lead levels

>45 mcg would indicate lead poisoning

It is the CLSs job to monitor the levels of lead and report the results back to the physician

Other supplemental tests:

Zinc protoporphyrin test

Free erythrocyte prophorphyrin assay

To treat the lead exposure chelation therapy would be started

NOTE: While there is no direct relationship between lead poisoning and autism, lead
positioning could exacerbate any preexisting autistic symptoms.

Specimen Process

Blood drawn in a:

Royal blue top tube

Gold top tube (SST: Serum Separator Tube)

Sent to Chemistry & Molecular Lab

Role of Occupational Therapy

Occupational therapy (OT) focuses on performance and participation in basic
and instrumental activities of daily living, play, leisure, social participation,
work, rest and sleep, and education (AOTA, 2014).

Possible OT Interventions

Social Interaction

Emotional Regulation

Fine Motor Coordination

Gross motor skills (running, climbing)

Client and family education on

disorder

Example of OT Evaluation

Evaluation of client, including standardized and non-standardized assessments:

Test of Playfulness (Bundy 1993)
Assessment is done by watching children play in and outdoors
Looks at elements of external perception of control, extrinsic source of
motivation and not free suspension of reality (can they use things the way they
are suppose to be used)
Preschool Play Scale (Knox, 1974, 1997)
Assessment of four dimensions used to describe play: space management,
material management, imitation, and participation
Physical examination- muscle atrophy, skin/nail status, deformities, wounds, scars,
bruises
Family and client interviews
Based on observation and the results of assessments administered, an intervention plan
will be created to address specific deficits and impairments noted.

Example of OT Goals

Example of intervention goals

Social interaction: Within 4 weeks, client will demonstrate increased social

interaction skills by initiating interaction with two peers during a group
activity for 15 minutes.

Board game with 3+ players

Fine motor coordination: Within 4 weeks, client will demonstrate increased

fine motor control by using dynamic four finger grasp or tripod grasp during
writing activity times.

Theraputty

Task practice

References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American
Journal of Occupational Therapy, 68(Suppl.1), S1 - S48. doi: 10.5014/ajot.2014.682006
Atchison, B. & Dirette, D. (2012). Cerebral Palsy. In Conditions in Occupational Therapy: Effect on Occupational Performance (4th ed., pp. 9-22).
Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Bundy, A. (1993). Assessment of play and leisure: delineation of the problem. American Journal of Occupational Therapy, 47 (3), 217222.
El-Ansary A, Al-Daihan S, Al-Dbass A, Al-Ayadhi L. Measurement of selected ions related to oxidative
stress and energy metabolism in Saudi autistic children. Clin Biochem 2010; 43: 6370
Kellman, Raphael. "The Autism-Thyroid Connection." (n.d.): n. pag. Devdelay. Web. 15 Oct. 2015.
"Medical Testing, Common Issues & Treatment Information." Talk About Curing Autism (TACA). N.p., 7 July 2007. Web. 15 Oct. 2015.