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Understanding. Kaileigh Sweeney, SN University of Rhode Island Mentor: Carolyn Hames. Autism Facts:. 1/110 children in the US are diagnosed with an Autism Spectrum Disorder (ASD) More common than childhood cancer, juvenile diabetes, and pediatric AIDs combined

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kaileigh sweeney sn university of rhode island mentor carolyn hames


Kaileigh Sweeney, SN

University of Rhode Island

Mentor: Carolyn Hames


Autism Facts:

  • 1/110 children in the US are diagnosed with an Autism Spectrum Disorder (ASD)
  • More common than childhood cancer, juvenile diabetes, and pediatric AIDs combined
  • Prevalence increasing 10-17% annually
  • More common in boys

What is autism?

  • A general term used to describe a group of developmental disorders called Pervasive Developmental Disorders (PDD).
  • Wide spectrum of disorders
    • Mild to severe impairments
    • Low functioning to high functioning
      • Controversial terminology

What is “low functioning?”

  • Severe end of the spectrum
  • Extensive impairments in all areas of development
  • Little or no language
  • Little awareness
  • “autism symptoms” are visibly apparent

What is “high functioning?”

  • Mild end of the spectrum
  • Intelligence level average or above average
  • Impaired social skills
    • Desire to communicate
    • “don’t know how to go about it”


  • Idiopathic:
    • Multiple theories:
    • Genetics
    • Heredity
    • Inflammation of CNS
    • Exposure
      • Environmental: maternal rubella or cytomegalovirus
      • Chemical: thalidomide or valproate during pregnancy

Diagnosis of an autism spectrum disorder

  • Early Diagnoses promote positive outcome
  • Symptoms noticed typically when child is 24-48 months
  • No medical test
  • Observed behavior
  • Educational testing
  • Psychological testing
  • Modified Checklist of Autism in Toddlers (MCHAT)
    • Other screening tools available for older children
  • *from birth to 36months every child should be screened for developmental milestones

Modified Checklist of Autism in Toddlers: M-CHAT

  • Valid for toddlers 16-30 months
  • List of questions
  • Answers determine need for referral to a developmental specialist
    • Developmental pediatrician
    • Neurologist
    • Psychiatrist
  • Scoring: child requires follow up if
    • Answered “No” to 2 or more critical questions or Answered “No” to 3 questions


Please fill out the following about how your child usually is. Please try to answer every question. If the behavior

is rare (e.g., you\'ve seen it once or twice), please answer as if the child does not do it. (critical questions in red)

1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No

2. Does your child take an interest in other children? Yes No

3. Does your child like climbing on things, such as up stairs? Yes No

4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No

5. Does your child ever pretend, for example, to talk on the phone or take

care of a doll or Yes No

pretend other things?

6. Does your child ever use his/her index finger to point, to ask for something? Yes No

7. Does your child ever use his/her index finger to point, to indicate interest

in something? Yes No

8. Can your child play properly with small toys (e.g. cars or blocks) without just Yes No

mouthing, fiddling, or dropping them?

9. Does your child ever bring objects over to you (parent) to show you something? Yes No

10. Does your child look you in the eye for more than a second or two? Yes No

11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes No

12. Does your child smile in response to your face or your smile? Yes No

13. Does your child imitate you? (e.g., you make a face-will your child imitate it?) Yes No

14. Does your child respond to his/her name when you call? Yes No

15. If you point at a toy across the room, does your child look at it? Yes No

16. Does your child walk? Yes No

17. Does your child look at things you are looking at? Yes No

18. Does your child make unusual finger movements near his/her face? Yes No

19. Does your child try to attract your attention to his/her own activity? Yes No

20. Have you ever wondered if your child is deaf? Yes No

21. Does your child understand what people say? Yes No

22. Does your child sometimes stare at nothing or wander with no purpose? Yes No

23. Does your child look at your face to check your reaction when faced with Yes No

something unfamiliar?


Asperger’s Syndrome:

  • Autism Spectrum Disorder (ASD)
  • Often called “high functioning autism”
  • Most diagnoses made between 3-9 years
  • Capable of functioning in everyday life
  • Individuals Diagnosed have:
    • Normal to advanced intelligence level
    • Normal to advanced verbalization skills
    • Severely Impaired Social Skills

Signs/Symptoms of Asperger’s Syndrome:

  • Scripted, robotic, or repetitive speech
  • Inappropriate social interactions
  • Conversations revolving around self
  • Lack of “common sense”
  • Problems with reading, math, or writing skills
  • Obsessions with complex topics
  • Average to below level non-verbal communicative skills
  • Verbal cognitive skills are usually above average
  • Awkward movements
  • Odd behaviors/mannerisms

Treatment of Asperger’s Syndrome:

  • Requires input from “healthcare team”
    • Doctors, teachers, psychologist, therapist, parents
  • Social skills training
  • Alternative therapies
  • Medications

- Antidepressants (social isolation)


Rett Syndrome:

  • Pervasive Developmental Disorder
    • Similar to autism
  • Affects girls almost exclusively
  • Early growth and development
    • Followed by slowed growth and


  • Prevalence: 1/10,000 children in the United States

Signs/Symptoms of Rett Syndrome:

  • Severity Ranges from Mild to Severe
  • Toe walking
  • Lack of eye contact
  • Hypotonia (weakened muscle tone)
  • Difficulty interacting

with others

  • Hand flapping
  • Begins with normal


  • Apraxia (loss of purposeful movements)

Treatment of Rett Syndrome

  • Physical therapy
    • Motor skills
  • Occupational therapy
    • Life skills
  • Speech therapy
  • Splints
  • Sensory therapy
  • Medical interventions
    • Antiepileptic

Childhood Disintegrative Disorder (CDD)

  • Normal development until 3 to 4 years old
    • Then children lose
      • Language skills
      • Motor skills
      • Social skills

Signs/Symptoms of Childhood Disintegrative Disorder (CDD)

  • Delay or lack of spoken language
  • Impairment in non-verbal behaviors
  • Inability to maintain conversation
  • Lack of play
  • Loss of motor, social, & communication skills
  • Loss of bowel/bladder control

Treatment of Childhood Disintegrative Disorder

  • Medication
  • Behavior therapy
    • Social skills
    • Speech therapy
    • Physical therapy


  • Obtain history
    • Family history
    • When did symptoms begin?
    • Motor skills
    • Language skills
    • Personality
    • Behavior
    • Social skills/interactions


  • Decrease stimulation
    • Private room
    • Avoid extraneous auditory and visual distractions
    • Encourage comforting possessions (toys, blanket, etc) which may decrease anxiety
    • Minimize touching child
    • Minimize eye contact

Overall Treatment of ASD:

  • Parent education/training
  • Specialized educational training
  • Language therapy
  • Social skills training
  • Psychotherapy
  • Cognitive/behavioral therapy
  • Medications


  • Varies from case to case based on severity and type of autism.
  • Some children improve with therapy and medication management
  • Learning about autism helps improve quality of living for child diagnosed with autism and family members

Role of the Nurse:

  • Each child requires individualized assessment & treatment
    • Not all children with ASD are the same
    • Teach family members signs and symptoms
    • Help parents understand it is NOT a result of “bad parenting
  • Family Support
  • Behavioral Modification Programs
  • Medications

Behavioral Modification Programs:

  • Promote positive reinforcement
  • Increase social awareness
  • Teach verbal communication


  • Decrease unacceptable behavior
  • *Providing a structured routine for the child to follow is critical in management of ASD*

Medical Management

  • Treat symptoms
    • Hyperactivity
    • Depression
    • Anger
    • Aggression
    • Self-injurious behavior
  • Children with autism may not have a typical response to medication
    • Monitoring Crucial
    • lowest dose possible to be affective


  • Stimulants
    • Ritalin
    • Decrease impulses and hyperactivity
  • Antidepressants
    • Valium, Ativan
  • SSRIs:
    • Zoloft, Prozac, Luvox
    • Treat anxiety, depression, OCD
    • Help decrease repetitive behaviors
    • Improve eye contact


  • Antipsychotics:
    • Haldol, Risperdol, Zyprexa, Geodon
    • Treat behavioral problems
    • Decrease brains use of Dopamine
  • Anticonvulsants:
    • Tegretol, Lamictal, Topamax
    • Monitor drug serum levels