Objectives The learner will be able to:

● Define Autism Spectrum Disorders

(ASD).
● Identify three areas of impairment
associated with ASD.
● Understand & describe the
characteristics and clinical
manifestations of children with
autism.
● Educate others on how to work &
interact with children with ASD.

Speaker notes: Our learning objectives for today are to be able to define
ASD, identify 3 areas of impairment associated with it, understand and
describe the characteristics and clinical manifestations of children with autism,
and educate others on how to work and interact with children with ASD.
Autism Spectrum Disorder (ASD)
is a neurodevelopmental
DEFINITION
abnormality that begins in early
childhood and is characterized
by impaired communication and
social interaction with restricted
activities, interests, and
behaviors along with repetitive
patterns of behavior.

3 areas of impairment:
● Social
● Communication
● Behavioral
(Ball, Bindler, & Cowen, 2015).

Speaker notes: ASD is a neurodevelopmental abnormality that begins in early

childhood and is characterized by impaired communication and social
interaction including restricted interests and repetitive behaviors. In simpler
terms, ASD causes significant social, communication, and behavioral
challenges. ASD can actually come with other neurodevelopmental, mental, or
behavioral conditions, so manifestations differ remarkably among individuals
(Ball, Bindler, & Cowen, 2015).
 PATHOPHYSIOLOGY ● Exact pathogenesis unclear
● Research/studies: gene
responsible for autism
unknown
● Certain genes may affect:
○ Brain development
○ The way brain cells
communicate
● Some genetic mutations seem
to be inherited; others occur
spontaneously

(Samsan, Ahangari, & Naser, 2014).

Speaker notes: When it comes to the pathophysiology of ASD, it remains

unclear. There are thousands of research and studies that have tried to identify
the gene/genes responsible for autism, but it has yet to be discovered. These
studies suggest that there are certain genes that affect the brain development
of those with ASD including the way brain cells communicate, which lead to
the neurodevelopmental abnormality of impaired communication and
social/behavioral problems (Samsan, Ahangari, & Naser, 2014).
 ETIOLOGY ● 1 in 88 children in the
● Cause unknown U.S. are diagnosed with
● Influences ASD
investigated:
○ Immune ● At-risk groups:
responses ○ Fetal alcohol
○ Certain drugs syndrome (FAS)
while pregnant ○ Fragile X syndrome
○ Environmental ○ Phenylketonuria
exposures ○ Down syndrome
○ Neuroanatomy ○ Tuberous sclerosis

(Ball, Bindler, & Cowen, 2015).

(CDC, 2018).

Speaker notes: So what is the underlying cause of autism? Just like the
pathophysiology of ASD, it is not known. Despite extensive research, the
etiology of ASD remains largely unclear. However, there are a lot of influences
that interact with genetics that are being studied and investigated that suggest
a cause to ASDs. These include immune responses, certain drugs during
pregnancy, environmental exposures, and neuroanatomy. The CDC states that
1 in 88 children in the U.S. have autism (CDC, 2018). At-risk groups include
those with fetal alcohol syndrome (FAS), fragile X syndrome, phenylketonuria,
down syndrome, & tuberous sclerosis. These groups have all been associated
with a higher than normal incidence of autism (Ball, Bindler, & Cowen, 2015).
 CLINICAL MANIFESTATIONS
● Children/adolescents encompass various
intellectual disabilities & language deficits

● ASD correlates between executive function

skills & IQ level

● Exhibit difficulties with tasks measuring

inhibitory control

● Deficits in organization, planning, reasoning,

& problem solving

● Trouble with inhibition & self-monitoring tasks

(Hazlet, Gu, Munsell, & Kim, 2017).
(Weismer, Kaushanskaya, Larson, Mathee, & Bolt, 2018).

Speaker notes: Autistic children and adolescents will express intellectual

disabilities and language deficit (Weismer, Kaushanskaya, Larson, Mathee, &
Bolt, 2018). Executive function skills and IQ levels correlate with ASD. They
will have trouble with focusing on multiple tasks, planning, organizing,
reasoning, and problem solving. It is important for parents to address this with
their Pediatrician in order to prevent progression of ASD (Hazlet, Gu, Munsell,
& Kim, 2017).
CLINICAL MANIFESTATIONS
Signs & symptoms for all age
groups:

● Social communication deficits

● Restricted and repetitive
behaviors
● Cognitive disabilities
● Delayed speech/language
● Developmental regression
● Delayed motor and play
development

(Hazlet, Gu, Munsell, & Kim, 2017).

(Weismer, Kaushanskaya, Larson, Mathee, & Bolt, 2018).

Speaker notes: Clinical manifestations can arise at any age, but ASD is
commonly found during infancy through school-aged groups. Signs and
symptoms vary through every child. Parents can detect developmental delays
in their child if milestones are not met (Weismer, Kaushanskaya, Larson,
Mathee, & Bolt, 2018). Children will not be able to maintain eye-contact and
show signs of deficiency in social communication, limited and repetitive
behaviors, cognitive disabilities, as well as a delay in motor and play
development (Hazlet, Gu, Munsell, & Kim, 2017).
 ● Early screening
○ 12-18 months
● MRI
○ Brain overgrowth
● Autism Observation Scale for
Infants (AOSI)
○ Attentional disengagement
○ Visual tracking
○ Imitation
○ Coordinated eye gaze
○ Early social-communicative

DIAGNOSTICS
behaviors
○ Sensorimotor development
○ Behavioral activity

(Hazlet, Gu, Munsell, & Kim, 2017).

Speaker notes: It is important to do an early screening for children under two

years old, although ASD can appear at a later age. Performing an early
screening around 18-24 months will give the most accurate diagnosis in a child
that has ASD. Many parents usually report developmental delays around this
time frame. It is important to have the parents look out for any behavioral
changes that might detect ASD.

If a child is suspected to have autism, it can be detected through an MRI,

which shows brain overgrowth. This diagnostic will reveal significant postnatal
changes in brain development and volume. Hyperexpansion of the surface
area of the brain linked to social deficits.

Another screening tool used to diagnose ASD is the Autism Observation Scale
for Infants (AOSI). This examines several different categories, such as
attentional disengagement, visual tracking, imitation, coordinated eye gaze,
early social-communicative behaviors, sensorimotor development, and
behavioral activity (Hazlet, Gu, Munsell, & Kim, 2017).
 PHARMACOLOGY
● Selective Serotonin Reuptake
Inhibitors (SSRI)
○ Zoloft

● Amphetamines
○ Adderall

● Antipsychotics
○ Risperidone

(DeFillippis & Wagner, 2016).

Speaker notes: No drugs can improve the core signs of autism spectrum
disorder, but specific medications can help control symptoms such as
depression, anxiety, OCD, ADHD, and Tourette’s. These drugs include
Selective Serotonin Reuptake Inhibitor (SSRI) such as Zoloft, amphetamines
such as Adderall, and antipsychotics specific to autism such as Risperidone
(DeFillippis & Wagner, 2016).
 ● Behavior & communication
therapies
● Educational therapies
● Family therapies
● Other therapies:
○ Speech
○ Occupational
○ Physical

TREATMENT OPTIONS
● Medications

(Deyro, Simon, & Guay, 2016).

Speaker notes: Many programs address the range of social, language, and
behavioral difficulties associated with autism spectrum disorder. Some
programs focus on reducing problem behaviors and teaching new skills. Other
programs focus on teaching children how to act in social situations or
communicate better with others. Children with ASD often respond well to
highly structured educational programs. Successful programs typically include
a team of specialists and a variety of activities to improve social skills,
communication and behavior. Parents and other family members can learn
how to play and interact with their children in ways that promote social
interaction skills, manage problem behaviors, and teach daily living skills and
communication (Deyro, Simon, & Guay, 2016).
 NURSING DIAGNOSIS #1
Impaired social interaction related to disturbance
in thought processes secondary to autism
spectrum disorder (ASD) as evidenced by
excessive distractibility and impulsivity.

Desired Outcome: Patient will show behavioral improvement

at school with teachers and peers within one month.

Speaker notes: For our first nursing diagnosis, we have impaired social
interaction related to disturbance in thought processes secondary to autism
spectrum disorder (ASD) as evidenced by excessive distractibility and
impulsivity. Our desired outcome is that the patient will show behavioral
improvement at school with teachers and peers within one month.
 Intervention #1: Advise parents to
provide a structured environment at
home with consistency.

INTERVENTIONS Intervention #2: Work closely with

behavioral therapists to improve
NURSING DIAGNOSIS #1 social interactions amongst family and
peers.

(Ackley & Ladwig, 2017).

Speaker Notes: Our first nursing intervention is to advise parents to provide a

structured environment at home with consistency. Rationale for this is that
structure and consistency help the child to focus on behavior improvement.
Our second intervention is to work closely with a behavioral therapist. The
rationale for this is that a behavioral therapist will help improve the child’s
social and behavioral skills while implementing an individualized plan specific
to the child’s needs (Ackley & Ladwig, 2017).
 NURSING DIAGNOSIS #2
Impaired verbal communication related to
alteration in development as evidenced by
cognitive disabilities, delayed speech/language,
and patient not able to maintain eye contact.

Desired Outcome: Patient will demonstrate understanding

even if not able to speak by age 4.

Speaker Notes: Our second nursing diagnosis is impaired verbal

communication related to alteration in development as evidenced by cognitive
disabilities, delayed speech/language, and patient not able to maintain eye
contact. Our desired outcome is that the patient will demonstrate
understanding even if not able to speak by age 4.
 Intervention #1:
Educate family to talk to the child
frequently while also praising the
child’s attempts and achievements

INTERVENTIONS
to communicate.

Intervention #2:

NURSING DIAGNOSIS #2
Teach the patient and family
techniques to increase
communication skills, including
communication devices and tactile
touch.

(Ackley & Ladwig, 2017).

Speaker notes: Our first nursing intervention is to educate family to talk to the
child frequently while also praising the child’s attempts and achievements to
communicate. The rationale for this is that the family involvement decreases
the child’s sense of isolation whereas positive feedback enhances the child’s
effort to overcome communication barriers. Our second intervention is to teach
the patient and family techniques to increase communication skills, including
communication devices and tactile touch. The rationale for this is that working
closely with the patient, family, and communication specialists from the
interprofessional healthcare team will help develop and improve effective
verbal communication skills (Ackley & Ladwig, 2017).
● School = important resource
○ Consistency, safety, &
EDUCATION
learning
● Individualized Education
Program (IEP)
○ Individualized intervention
services
○ Classroom
accommodations
● Utilize an interprofessional team
● Be patient
● Never lose sight of the child

(Ball, Bindler, & Cowen, 2015).

Speaker notes: One of the most important resources in getting the child with
ASD help and support is through school. A young child’s experience at school
can create a place of consistency, safety and learning. Educate the parents
about enrolling their child in IEP. An IEP is an Individualized Education
Program for children 3 years of age and older. An IEP provides your child
individualized intervention services through the public education system. The
IEP will focus on your child’s educational needs and will outline the supports or
services needed, how frequently these services will be provided, and how
progress will be measured. Often children with ASD benefit from special
education services including speech, occupational, and physical therapies, as
well as classroom accommodations such as help with transitions and
modifications to school work.

Educate the parent to work and communicate closely with their

interprofessional team such as the nurse, pediatrician, behavioral therapist,
and speech therapist. This ensures the child is meeting appropriate
milestones, and if the child isn’t, we can easily have an interprofessional team
to figure out what may be needed.

You also want to educate parents to be patient with their child with ASD. The
child will not easily understand concepts or get an activity or task done
correctly on their first try, so it’s vital for parents to not get upset. Instead, they
need to be patient, talk softly and slowly, and understand the level of their
child’s learning disability.

Most importantly, educate parents to keep their eyes on their child at all times.
The tendency of children with ASD to wander off impulsively is a huge safety
issue for parents. There are cases where kids with ASD spontaneously run out
to the streets or wander off when a parent’s back is turned to them, so always
keep them close and nearby (Ball, Bindler, & Cowen, 2015).
 REFERENCES
Ackley, B. J., & Ladwig, G. B. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Maryland Heights,
Missouri: Mosby Elsevier.

Ball, J. W., Bindler, R. C. & Cowen, K. J. (2015). Principles of pediatric nursing: Caring for children. Boston, MA: Pearson.

CDC. (2018). What is autism spectrum disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/facts.html.

DeFillippis, M., & Wagner, K. (2016). Treatment of autism spectrum disorder in children and adolescents. Pyschopharmacol Bulletin, 46(2),
18-41. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044466/.

Deyro, M., Simon, E., & Guay, J. (2016). Parental awareness of empirically established treatments for autism spectrum disorders. Focus on
Autism and Other Developmental Disabilities, 31(3), 184–195. https://doi.org/10.1177/1088357614559210.

Samsam, M., Ahangari, R., & Naser, S. (2014). Pathophysiology of autism spectrum disorders: Revisiting gastrointestinal involvement and
immune imbalance. Word Journal of Gastroenterology, 20(29). https:// doi.org/10.3748/wjg.v20.i29.9942.

Estes, A., Zwaigenbaum, L., Gu, H., John, T., Paterson, S., Elison, J., & Hazlett, H. (2015). Behavioral, cognitive, and adaptive development
in infants with autism spectrum disorder in the first 2 years of life. Journal of Neurodevelopmental Disorders, 7(24). Retrieved from
https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-015-9117-6.
 REFERENCES
Hazlet, H., Gu, H., Munsell, B., & Kim, S. (2017). Early brain development in infants at high risk for autism spectrum disorder. Nature
International Journal of Science 542, 348-351. Retrieved from https://www.nature.com/articles/nature21369.

Weismer, S. E., Kaushanskaya, M., Larson, C., Mathee, J., & Bolt, D. (2018). Executive function skills in school-age children with autism
spectrum disorder: Association with language abilities. Journal of Speech, Language & Hearing Research, 61(11). 2641-2658. Retrieved from
http://web.b.ebscohost.com.nuls.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=0&sid=609caddb-c345-412a-856f-3ef2f5f8fc22%40pdc-v-sessm
gr02.

Zwaigenbaum, L., Bauman, M. L., Fein, D., Pierce, K., Buie, T., Davis, P. A., & Kasari, C. (2015). Early screening of autism spectrum disorder:
Recommendations for practice and research. Pediatrics, 136(Supplement 1), S41-S59. Retrieved from
https://pediatrics.aappublications.org/content/136/Supplement_1/S60.

Zwaigenbaum, L., Bryson, S., Lord, C., Rogers, S., Carter, A., Carver, L., & Yirmiya, N. (2009). Clinical assessment and management of
toddlers with suspected autism spectrum disorder: Insights from studies of high-risk infants. Pediatrics, 123(5), 1383–1391. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833286/.
Thank you!
ANY QUESTIONS?
 Rubric - Teaching Presentation
Topic: Autism
Student Names: Kirsten Pham, Luisa Sawyer, Camelle Sison

Criteria Possible Points Points Achieved

Presentation of the following (ONE power point for each category): 8

Objectives (0.5)
Definition (1),
Pathophysiology (0.5),
Etiology (at-risk groups) (1),
Clinical manifestations by age if applicable (1),
Diagnostic tests / labs / procedures (list abnormal) (1)

Pharmacology and /or other treatment modalities (1)

1 Nursing Diagnosis and 2 nursing interventions (1) Education (1)

Bibliography- Minimum of three (3) resources referenced written within the 2

last 5 years (at least two of the references are to be peer reviewed medical
nursing/legal/psych etc. journal articles). All resources must be specific to
pediatrics. ATI may not be used. (Upload references on Doc Sharing).
APA format utilized.

Total Points 10