1. ASPERGERS Tammy Marie Baker RN Pediatric Series 2012
2. DSM 299.80 AspergersAn Asperger/HFA screening tool must meet all six areas deﬁned by the DSM-IV description of Asperger Syndrome (A-F below) to qualify for a positive ratingfrom First Signs:A. Qualitative impairment in social interaction, as manifested by at least two of the following:(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate socialinteraction(2) failure to develop peer relationships appropriate to developmental level(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects ofinterest to other people)(4) lack of social or emotional reciprocityB. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus(2) apparently inﬂexible adherence to speciﬁc, nonfunctional routines or rituals(3) stereotyped and repetitive motor mannerisms (e.g., hand or ﬁnger ﬂapping or twisting, or complex whole-body movements)(4) persistent preoccupation with parts of objectsC. The disturbance causes clinically signiﬁcant impairment in social, occupational, or other important areas of functioning.D. There is no clinically signiﬁcant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).E. There is no clinically signiﬁcant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than insocial interaction), and curiosity about the environment in childhood.F. Criteria are not met for another speciﬁc pervasive developmental disorder or schizophrenia.
3. what is Aspergers syndromeAspergers is classiﬁed as one of the Developmental Disorders:Child with Aspergers exhibit unusual preoccupation or limited interest in a particular subject orfascination to the point of selective preoccupation with that activityRegimes are repetitive and ritualisticSpeech and language peculiarities including voice tones and formal inﬂections, literal interpretationof speech communication and language delaysSocial awkwardness with emotionally inappropriate behaviors and inability to interact with peers insuccessful relationships and manor. Socially delayed in relationshipsNon verbal communication is limited, facial expression is limited, peculiar and unfazed byenvironmental factors or interactions. Staring gaze or unresponsive to others.Motor movements are clumsy and uncoordinated
4. What Does Aspergers Look like? A unique individual with a different focal view..... Aspergers looks like a childstruggling to be in the world... A child wrapped up in his own world....
5. symptoms of Aspergers Difﬁculties withDifﬁculties with social functioning: especially outside their own environment such as school settingSensory issues: under or oversensitivity to environmental factors such as bright light, loud sounds andunpleasant smells, touch, seams in clothing, water or external pressure light or deep pressureObsessive interests, with a focus on one subject to the exclusion of all othersSocial isolation and struggles to make friends due to a lack of empathy, and an inability to pick up on orunderstand social graces and cues (such as stopping talking and allowing others to speak)A rigid Insistence on routine (unexpected changes any change can cause an emotional and physiologicalmeltdown)Structural Obsession/ Dependent : needing to know when everything is happening in order not to feelcompletely overwhelmed
6. treatment modalitiesTreatment Modalities are not limited but include Multidimensional and Multidisciplinary Approach Prescribed Medications:individualized Special Education :IEP /Advocasey Behavioral Alterations:social skills/psychologist Group Therapy Occupational Therapy:Sensory Needs/tolerance/input Speech Therapy:Communication needs. PhysicalTherapy:motor/ trunk coordinations/core strengthening
7. Nursing Assessment: incorporates the childs communication, social, sensory, and behavioral skills and successful strategies for successful outcomes.The Aspergers child has special needs that extend beyondhis acute medical diagnosis and problems which need to be incorporated into his POC. NOte the childs social, communication, and behavioral strengths and limitations DIscuss the child’s abilities with the parents and Identify the childs strengths utilize the childs fascination and strengths during assessment to keep him focused use childs favorite activity to refocus and distract child when trying to refocus behaviors rewards and tokens for good behavior ............Assessment Beyond the Stethoscope
8. Nursing managementSkilled nurse will provide the child a safe environment. Limit external stimuli and be aware of childsensory concerns. Remove noxious stimuli from childs environment if it causes him discomfort.( smells, tastes, texture sensitivities)Give child notice prior to change or event , do not abruptly change routines. Child will not handle abruptchanges well.Administer medications as prescribed ,educate family on meds ,report and adverse reactions ormedication concerns to the PhysicianReward child with praise and use Behavioral incentives per Behavioral intervention plan.Allow child to make choices within safe limitsutilize therapeutic techniques as prescribed to assist childs tolerance of medical procedures.Provide consistent schedule and let the child know if changes will occur so that the child can modulatethe change. These children do not tolerate abrupt changes and behaviors may escalate
9. STRATEGIC THERAPEUTIC TECHNIQUESImitation/role-modeling paired with reinforcement: SN /PCGT demonstrates thedesired action to the child. When the child imitates the action, the parent and/ornurse gives a "reinforcer" such as verbal praise.High-Probability requests/ low-probability requests: Requests that have a highlikelihood of compliance; low probability requests (low-p) are those with lessexpectation of compliance.Rewards :positive reinforcer presented immediately following a behavior, causesthe behavior to increase in frequency and reoccurToken systems. A token is a stimulus . It is paired or associated with anotherreinforcer and is sometimes called a back-up reinforcer. Reinforcers that can beaccumulated and exchanged for a back-up reinforcer is called a token systemShaping: a newer behavioral technique. Shaping involves rewarding a small strideand slowly increasing the expectation before reward is given. ( extending tolerancetime for procedures such a nebulizer or suctioning)
10. therapeutic Strategies continuedDifferential reinforcement: reinforcing desirable behaviors while ignoringunacceptable oneChoices: It is important for children with ASD to express preferences and makechoices to increase personal autonomy. Allow child to make choices.Visuals; Children who have ASD are usually visual learners .Present informationwith a visual as opposed to verbal cues. Visuals create a higher success rate withChildren with ASD when used to foster accomplishing the presented task.Distraction techniques: role-playing and distraction techniques are used tomanage behavior and task goals foster better outcomes and decrease anxiety inAutistic children.
11. treatmentsCommunication and social skills trainingChildren with Aspergers syndrome are taught to learn the unwritten rules of socialization and communication .Techniques are taught in an explicit and rote fashion. Social skills can be like learning a foreign language tothese Children with Aspergers syndrome may also learn how to communicate more effectively speak in amore natural rhythm, as well as how to interpret communication techniques, such as gestures, eye contact,tone of voice, humor and sarcasm.Cognitive behavioral therapy:Techniques aimed at curbing problem behaviors, such as interrupting, obsessions, meltdowns or angryoutbursts, and developing skills such as recognizing feelings and coping with anxiety. Therapy usuallyfocuses on training a child to recognize a troublesome situations; change in environment such as a new placeor an event with more social demands. Strategies are taught and learned to navigate and to cope with thesituation.
12. Medications used to treat Aspergers Medications may improve speciﬁc symptoms such as anxiety, depression or hyperactivity that can occur in many children with Aspergers syndrome.1 Aripiprazole (Abilify). may be effective for treating irritability related to Aspergers syndrome. Side effects may include weight gain and an increase in blood sugar levels.2 Guanfacine (Intuniv). may be helpful for the problems of hyperactivity and inattention in children with Aspergers syndrome. Side effects may include drowsiness, irritability, headache, constipation and bedwetting.3 Selective serotonin reuptake inhibitors (SSRIs). Drugs such as ﬂuvoxamine (Luvox) may be used to treat depression or to help control repetitive behaviors. Possible side effects include restlessness and agitation.4 Risperidone (Risperdal). may be prescribed for agitation and irritability. It may cause trouble sleeping, a runny nose and an increased appetite. This drug has also been associated with an increase in cholesterol and blood sugar levels.5 Olanzapine (Zyprexa). Olanzapine is sometimes prescribed to reduce repetitive behaviors. Possible side effects include increased appetite, drowsiness, weight gain, and increased blood sugar and cholesterol levels.6 Naltrexone (Revia). may help reduce some of the repetitive behaviors associated with Aspergers syndrome. However, the use of low-dose naltrexone — in doses as low as two to four mg a day — has been gaining favor recently. But, theres no good evidence that such low doses have any effect on Aspergers syndrome.