autism

Chcterized by

impairment in socialization

impairment communicatior stereotypical and rigid behaviours restricted interests

Impaire of social tx

Lack of eye contact

Lack of facial expressions

Does not point to objects of interest

Prefers to be alone

Refuses to hug/cuddle

Poorly integrated verbal & nonverbal communication

Abnormal social approah

Impair language development

Does not initiate conversation

Delayed or lack of expressive language

Poor ability to understand words/sentences

Echolalia

Pronoun reversals

Neologisms

STEREOTYPICAL BEHAVIOURS

Repetitive play with the same toy

Preoccupation with or attachment to 1 object (or more)

Walks on tiptoes

Repetitive clapping, hand flapping, finger flicking, body rocking Needs routine and has difficulty with changes

Problems initiating interactions, responding to others, & sustaining interactions

Asd diagnostic ss

Each person with an Autism Spectrurm Disorder (ASD) is unique and will have different abilities.

Symptoms caused by ASD might be very mild in one person and quite severe in another

How to diagnose

parent/caregiver interviews -

patient interviews -

direct observation -

detailed clinical assessment e.g.

family history

Later diagnose

Occurs in the context of co-existing problems such as anxiety, hyperactivity, or mood disorders ----- can exacerbate or mask ASD Other factors include: female sex,

Risk factor genetic

lt is recognized as a genetic disorder e.g.

-twins (identical or non-identical -siblings -

parents with genetic or chromosoma conditions (i.e. Trisomy 21, Fragile X syndrome) -

parents with psyohiatric disorders

-family history of autoimmune diseases

Other risk factor

Environmental factors like matena exposures to infections and toxins.

Others -advanced maternal or paternal age -

maternal exposure to certain meds i.e.

psychotropic or antidepressant drugs -

preterm, LBW, and small-for gestational-age

  Vaccines are not a risk factor for ASD.

ULTIMATE TREATMENT GOAL:

TO INCREASE ADAPTIVE BEHAVIOR AND PROMOTE PHYSICAL AND EMOTIONAL WELL-BEING

HAVIOR ANDPROMOTE PHYSICAL AND EMOTIONAL WELL-BEING

Alleviating family distress lmprovin

lmproving self-care skills Providing

Providing opportunities for socialization lmproving

lmproving communication skills

Teaching Teaching the child how to accomplish purposeful activities

TREATMENTS-INTERVENTIONS THERAPIES

Treatment incl. behaviour modification and education, combined with pharmacotherapy in some cases, to decrease inappropriate behavior and increase self-reliance and independence.

· Early intervention is key!  Each treatment plan is individualized to patient

Multidisciplinary approach = speech, behavioral, and/or_ occupational therapy, psychologists and specialized teachers

Tx option behavior and social intervention

1. Behavioral and educational interventions

Activities are used to improve social skills communication, and behavior.

An example is Applied behavioural Analysis (ABA)

Tx social cognitive skill

2.Social-cognitive skill building develops ability associated with the steps involved in social interaction, including taking turns, paying attention in groups, maintaining eye contact, and using language

Sensory Intergration tx option

3. Sensory integration therapy (e.g., massage, brushing) and sensory-based interventions (e.g., auditory integration training) focus on helping the child manage sensitivity to noises/touch/stimuli

Other tx

Relationship-based interactive interventions

Developmental skill -based programs involve structured classroom experiences involving play.

Medications for behavioural issues (e.g.

aggressivity) or treatment of medical co- morbidities (e.g. seizures

2nd g generation atypical antipsychotics

Risperidone, Olanzapine

Reduces aggression, outbursts.

lrritability, self- injury and stereotypical behaviors.

Stimulant

Ritalin

improve attention and reduce hyperactivity and impulsivity

Alpha-2 adrenergic receptor agonist

clonidine guanfacine

can improve attention, reduce hyperactivity and impulsivity

Selective serotonin reuptake inhibitors S(SSRIs

Prozac /Fluoxetine

improve socia interaction, reduce stereotypical behaviors, anxiety, depression, aggression, self- injury.

Tricyclic antidepressants

amitriptyline nortriptyline, doxepin

can reduce anger, compulsive and ritualized behaviors.

Other rx

Melatonin

2. Hormonal therapies

3. vitamins, herbal remedies and nutritional supplements

can help manage sleep dysfunction.

2. Regulates hormonal imbalances

3. Supplements nutritional deficits

HOSPITALENVIRONMENT CAN CAUSE SENSORY OVERLOAD OR BE A DISTRACTION

Light:Especially bright or flashing

Voice:Any sound level can be distracting, call systems, monitor beeps, ringing phones, or a noisy waiting room.

Touch Unfamili ar sheets band- ages, tongue depress Or.

Smell Alcohol wipes, cleaning solutions, blood

Nursing intervention

COMMUNICATION WITH PARENTS/CAREGIVER e

HAVE PARENTSICAREGIVERS HOLD THE PATIENT

LIMITING DISTRACTTON

DECREASING STIMULATIO

MINIMIZNG PHYSICAL AND EYE CONTACT

ESTABLISH PATIENT TRUST

ADVANCED COMMUNICATION STRATEGIES

Decrease overall sensory stimuli.

Consider liqhts, noises, textures, smells, and vour own non- verbal behavior.

Use visuals as much as possible.

Slow your speech, look at the child, and speak in low tones.

Keep the subject focused on one topic at a time.

Break explanations into chunks of information to allow adequate processing,

Allow the child time to process the information.

Use concrete language; avoid sarcasm; metaphors, slang, and exaggerations.

Check for understanding periodically.

Be alert to breakdowns; the child may not attempt communication repair.

Try to repeat, modify, or recast your message.

Outburst mange,ent

Monitor for signs of impending outbursts such as increasing agitation.

Be prepared to use strategies that have worked in the past (know these from your history).

During the outburst: Do not physicaly intervene unless there is risk for harm to the patient or others.

Stop talking; use only essential words.

Use short sentences

Use a low volume and pitch when speaking Make eye contact.

Slow your movements Be patient