AUTISM SPECTRUM DISORDER

Autism spectrum disorder is the newer term for disorders previously

categorized as different types of a pervasive developmental disorder
(PDD), characterized by pervasive and usually severe impairment of
reciprocal social interaction skills, communication deviance, and restricted
stereotypical behavioral patterns.

Autism spectrum disorder, formerly called autistic disorder, or just autism,

is more prevalent in boys than in girls.

The goals of treatment of children with autism are to

reduce behavioral symptoms (e.g., stereotyped motor behaviors) and to
promote learning and development, particularly the acquisition of language
skills.

Comprehensive and individualized treatment, including special education

and language therapy, as well as cognitive behavioral therapy for anxiety
and agitation, is associated with more favorable outcomes Pharmacologic.

treatment with antipsychotics, such as haloperidol (Haldol) or risperidone

(Risperdal), may be effective for specific target symptoms such as temper
tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped
behaviors. Other medications, such as naltrexone (ReVia), clomipramine
(Anafranil), clonidine (Catapres), and stimulants to diminish self-injury and
hyperactive and obsessive

behaviors, have had varied but unremarkable results.

BEHAVIORS COMMON WITH AUTISM

SPECTRUM DISORDER
• Not responding to own name, by 1 year (e.g., appears not to hear)
• Doesn’t show interest by pointing to objects or people by 14 months of
age
• Doesn’t play pretend games by 18 months of age
• Avoids eye contact
• Prefers to be alone
• Delayed speech and language skills
• Obsessive interests (e.g., gets stuck on an idea)
• Upset by minor changes in routine
• Repeats words or phrases over and over
• Flaps hands, or rocks or spins in a circle; answers are unrelated to
questions
• Unusual reactions to sounds, smells, or other sensory
Experiences
Attention deficit hyperactivity disorder (ADHD)
is characterized by inattentiveness, over activity, and impulsiveness.
ADHD is a common disorder, especially in boys, and probably accounts for
more child mental health referrals than any other single disorder.
The essential feature of ADHD is a persistent pattern of inattention and/or
hyperactivity and impulsivity more common than generally observed in
children of the same age.
ADHD affects an estimated 5.2% of all school-aged children worldwide.
The ratio of boys to girls ranges from 3:1 in nonclinical settings to 9:1 in
clinical settings. To avoid over diagnosis of ADHD, a qualified specialist
such as a pediatric neurologist or a child psychiatrist must conduct the
evaluation for ADHD. Children who are very active or hard to handle
in the classroom can be diagnosed and treated mistakenly for ADHD.
Some of these overly active children may suffer from psychosocial
stressors at home, inadequate parenting, or other psychiatric disorders.
Distinguishing bipolar disorder from ADHD can be difficult but is crucial
in order to prescribe the most effective treatment.

ADULT ADHD
SCREENING QUESTIONS

• How often do you have trouble wrapping up the final details of a project
once the challenging parts have been done?
• How often do you have difficulty getting things in order when you have to
do a task that requires organization?
• How often do you have problems remembering appointments or
obligations?
• When you have a task that requires a lot of thought, how often do you
avoid or delay getting started?
• How often do you fidget or squirm with your hands or feet when you have
to sit down for a long time?
• How often do you feel overly active and compelled to do things, like you
were driven by a motor?

Nursing Interventions for ADHD

Ensuring the child’s safety and that of others Stop unsafe behavior.
Provide close supervision.
• Give clear directions about acceptable and unacceptable
behavior.
• Improved role performance Give positive feedback for meeting
expectations.
Manage the environment (e.g., provide a quiet place free of distractions for
task completion).
• Simplifying instructions/directions Get child’s full attention.
Break complex tasks into small steps.
Allow breaks.
• Structured daily routine Establish a daily schedule.
Minimize changes.
• Client/family education and support Listen to parent’s feelings and
frustrations

Nursing Care Plan : Attention Deficit Hyperactivity Disorder

Nursing Diagnosis
Ineffective Role Performance: Patterns of behavior that do not match the environmental context, norms, and
expectations

Assessment Data expected outcomes

• Short attention span Immediate
• High level of distractibility The client will
• Labile moods • Successfully complete tasks or assignments
• Low frustration tolerance with assistance within 24 to 36 hours
• Inability to complete tasks • Demonstrate acceptable social skills while
• Inability to sit still or fidgeting interacting with staff or family members, e.g.,
• Excessive talking listening while others talk rather than
• Inability to follow directions interrupting, within 2 to 3 days
Stabilization
The client will
• Participate successfully in the educational
setting
• Demonstrate the ability to complete tasks
with reminders
• Demonstrate successful interactions with
family Members
Community
The client will
• Verbalize positive statements about himself
or herself
• Demonstrate successful interactions with
nonfamily members
• Complete tasks independently
Nursing Interventions (*denotes Rationale
collaborative interventions)
Identify the factors that aggravate and The external stimuli that exacerbate the
alleviate the client’s problems can be identified and
client’s performance. minimized. Likewise, ones that positively
influence the client can be effectively used.
Provide an environment as free from The client’s ability to deal with external
distractions as possible. Institute stimulation is impaired.
interventions on a one-to-one basis.
Gradually increase the amount of
environmental stimuli.
Engage the client’s attention before giving
instructions (i.e., call the client’s name
and establish eye contact).
Give instructions slowly, using simple
language and concrete directions.
Ask the client to repeat instructions
before beginning tasks.
Separate complex tasks into small steps.
Provide positive feedback for completion
of each step.
Allow breaks, during which the client can
move around.
State expectations for task completion
clearly.
Initially, assist the client to complete
tasks.
Progress to prompting or reminding the
client to perform tasks or assignments.
Give the client positive feedback for
performing behaviors that come close to
task achievement.
Gradually decrease reminders.
Assist the client to verbalize by asking
sequencing
questions to keep on the topic (“Then
what happens?”
and “What happens next?”).
*Teach the client’s family or caregivers to
use the same
procedures for the client’s tasks and
interactions at
home.
*Explain and demonstrate “positive
parenting”
techniques
to family or caregivers such as time-in
for good behavior or being vigilant in
identifying
The client must hear instructions as a first
step toward compliance.
The client’s ability to comprehend
instructions (especially if they are complex
or abstract) is impaired.
Repetition demonstrates that the client has
accurately received the information.
The likelihood of success is enhanced with
less complicated components of a task
The client’s opportunity for successful
experiences is increased by treating each
step as an opportunity for success.
. The client’s restless energy can be given
an acceptable outlet, so he or she can
attend to future tasks more effectively.
The client must understand the request
before he or she can attempt task
completion.
If the client is unable to complete a task
independently, having assistance will allow
success and will demonstrate how to
complete the task.
The amount of intervention gradually is
decreased to increase client independence
as the client’s abilities increase.
This approach, called shaping, is a
behavioral procedure in which successive
approximations of a desired behavior are
positively reinforced. It allows rewards to
occur as the client gradually masters the
actual expectation.
Client independence is promoted as staff
participation is decreased.
Sequencing questions provide a structure
for discussions
to increase logical thought and decrease
tangentiality.
Successful interventions can be instituted
by the
client’s family or caregivers by using this
process.
This will promote consistency and enhance
the
client’s
chances for success.
It is important for parents or caregivers to
engage in
techniques that will maintain their loving
relationship
with the child while promoting, or at least
not
and responding positively to the child’s interfering with, therapeutic goals. Children
first bid for need
attention; special time, or guaranteed time to have a sense of being lovable to their
spent significant
daily with the child with no interruptions others that is not crucial to the nurse–client
and no therapeutic
discussion of problem-related topics; relationship.
ignoring minor
transgressions by immediate withdrawal
of eye contact
or physical contact and cessation of
discussion
with the child to avoid secondary gains.

CLIENT FAMILY EDUCATION for ADHD

• Include parents in planning and providing care.

• Refer parents to support groups.
• Focus on child’s strengths as well as problems.
• Teach accurate administration of medication and possible side effects.
• Inform parents that child is eligible for special school services.
• Assist parents to identify behavioral approaches to be used at home.
• Help parents achieve a balance of praising child and correcting child’s
behavior.
• Emphasize the need for structure and consistency in child’s daily routine
and behavioral expectations.